Friday, February 25, 2011

A Short Health Care Adventure

I have to renew the prescription for my blood pressure medication soon but hated the thought of going to my old primary care provider. It was time to look elsewhere. The problem was I'm kind of on MediCal and kind of not and more and more doctors are refusing MediCal due to their poor reimbursement rates.

I was thinking of first trying Eureka Family Practice on Harris Street, although I'd heard they don't accept MediCal patients unless they were prior patients of new medical staff. In my case, I thought that might work as I used to see P.A. John Brimlow who'd move there from the old North Coast Family Practice. I also thought I might give them a try since I pretty much pay cash for all my medical expenses so the rather weak link I have to MediCal shouldn't matter.

First thing I did was check their web site. No mention I could find regarding accepting new patients or patient requirements. Rather than call on the phone I sent an e-mail describing my situation to their contact e-mail address. I never received a reply and told myself when I call them on the phone I should recommend they remove the e-mail address from their web site if they don't respond to e-mails.

A few days went by so yesterday I decided I'd better call them and find out if they'd take me as I only had a month or so of my prescription left. I knew it might take weeks to get an appointment, assuming I could get one at all. I gave them a call.

The girl that answered was nice enough, but once I told her I was kind of on MediCal and kinda not she told me they weren't enrolled with MediCal and couldn't accept me. I emphasized that I'd likely be paying cash for all visits as I paid share of cost and planned on only coming in once a year to get my prescription renewed. I also told her, if she checked the MediCal rolls on her computer, I likely wouldn't be found on them as I'm a Share Of Cost member and folks like me aren't usually added unless we go over our share of cost.

She told me it didn't matter but she'd connect me to their billing supervisor and perhaps she could work things out. The supervisor was out of the office so I left a message on her answering machine and hung up. This didn't look good and I assumed the same would happen with my next choice: Redwood Family Practice on Buhne Street. It didn't.

I called them right away, expecting to be immediately turned down, but the girl said they do accept MediCal patients. She immediately started writing down my personal and some medical info. When we got to the MediCal part of it she said, as I expected, that I wasn't on their list of MediCal patients. I explained I likely wouldn't be unless I had to go to the hospital and called the Welfare Office to have the worker fast track my application.

She said they could figure that out later and we set up an appointment for the middle of March which should hopefully be before my prescription runs out. Not bad, and quite a relief, as I wasn't sure where to go next if they turned me down. I guess I could have gone back to the old place I used to go but I really loathed having to go there.

About the only down side was it was going to cost $102.00 for my first visit. After that the standard fee was $72.00 but they have some sliding scale that I may or may not qualify for after they figure out the MediCal thing as it might apply to me. She didn't elaborate further and I didn't pursue it. That's a bit more than the $65.00 flat fee I'd pay at the place I used to go.

Good. A new place to go for medical stuff. I am satisfied and relieved.

The billing supervisor from Eureka Family Practice called and left a message on my answering machine a couple hours later. She confirmed they couldn't accept me and that even if I did pay cash, they'd have problems with referrals to other offices as the MediCal thing was an issue with that, too. Oh well. Luckily, it didn't really matter anymore.


At 3:07 PM, Anonymous Anonymous said...

let me explain. One of the many complicated things about the American health care system is that, if you are covered by MediCaid (Medi-Cal in California), the amount paid to a physician for a basic office visit is based on whether she works in a Rural Health Clinic, Federally Qualified Health Center, or neither of the above. RHCs and FQHCs get paid for their cost of care using some complicated formulas, thresholds and limits. Eureka Family Practice is neither an RHC or FQHC so they get paid on a fee for service basis that does NOT cover the cost of services. EFP would have been paid about $20 for your visit and RFP likely got about $75. We are fortunate to have many RHCs in Humboldt: Redwood Family Practice, Eureka Pediatrics, Humboldt Medical Group, Olkin & Jones, etc. All the Open Door Clinics are FQHCs. People with Medi-Cal and Medicare have many options for care in Humboldt.

At 5:39 PM, Anonymous electronic medical records said...

Oh' glad that you've share this Short Health Care Adventure. I enjoyed reading this post. I also have my own story, but i have no time to blog it. Thanks for sharing.



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