Surgeon For Port Placement

[Stanfordmom]

@meatie
I have lived in the SF Bay Area for 20 years, and have seen many doctors for my parents, my kids and myself. I have never experienced under the table payment or heard of it!! I think it is not the area, it is your surgeon. switch doctors if you can.

Since you are in the San Jose area, if your insurance covers it, I suggest you move your mother's care to the Stanford Cancer Center. I am receiving care there (I am also receiving care from Sloan in the New York City)and it has been good.

Good luck with your mother's upcoming treatment.

Sha

[NWgirl]

As for why we didn't ask the nurse or doctor more questions, sometimes we feel that they don't want to be bothered too much unless there is a monetary incentive. When we try asking questions over the phone, they always suggest scheduling an office visit to talk face-to-face, so they can charge us an office visit fee. At many office visits, the doctor always recommends buying health supplements from them. "Cash-balance-billing" (where the doctor requests off-the-books cash payments in additional to insurance payments) is also common.
The surgeon that did the colon resection for my mother has hinted at a "small" under-the-table cash payment for his services, even though the insurance already paid him. The surgeon originally billed us $7000, but in-network discounting forced him to settle for $2000 from the insurance. Even though technically (legally?) he has been paid in full, he still wants another $1000 cash as reward for doing such a good job (I do admit that my mother has had, so far, very few complications other than frequent bowel moments. So, where I live (sf bay area) the doctors are not always the most approachable unless we are ready open our wallet. That's why I have to search for answers from sources other than our doctors.

"Cash-balance-billing" is NOT common in the US. I seem to recall you were seeing a doctor that is not "in network" with your insurance carrier. This might be a good indication of why they aren't a covered doctor. I would RUN AWAY from any doctor who suggested "cash-balance-billing" or any type of under the table cash payments - that's just scary.

If you have a lot of questions, it's common for the staff to suggest an office visit/consult. And as many questions as you ask here, I can understand why such a visit would be suggested. It's helpful, when you do have an office visit, to write down ALL your questions prior to the visit, so you can be sure to ask them all when you're there (then start a new list for the next visit). While this is a great place to get input from others experiences, you should also be asking all of these questions of your mothers doctors/nursing staff.

[meatie]

Meatie: Are you sure you don't live in SF Bay area, Russia??? One of my dear friends on here is from Russia and she has to pay docs under the table sometimes.

@Val*pal
The ways of the "old world" have always managed to creep into the "new world". I guess it is not too surprising to encounter the "old world" practice of under-the-table payments.

@meatie
I have lived in the SF Bay Area for 20 years, and have seen many doctors for my parents, my kids and myself. I have never experienced under the table payment or heard of it!! I think it is not the area, it is your surgeon. switch doctors if you can.
Since you are in the San Jose area, if your insurance covers it, I suggest you move your mother's care to the Stanford Cancer Center. I am receiving care there (I am also receiving care from Sloan in the New York City)and it has been good.
Good luck with your mother's upcoming treatment.
Sha

@Stanfordmom
Maybe it is bad luck on our part that we keep running into these doctors. One time when I was in still in high school, I fell and got a cut on my forehead. It was a little after 7pm, and all the private practice offices were closed, so my mother and I went to the ER. The doctor that saw us "hinted" that he was an intern and that he didn't get paid that well and that a tip would be nice compensation for the very complicated procedure that I need (stitching up a half-inch gash). My mother had about three 20-bills and several 1-bills. When my mother pulled out her wallet and handed two $20-bills to the intern, he took the money, but then pointed to the remaining $20-bill in the wallet. My mother had no choice but gave that to him too. I guess doctors get training on tricks of the trade in the formative years of med school!

During our search for an oncologist, we checked with Stanford Health Alliance. The lady that took my call bluntly (but honestly) told me that my mother's insurance is not much better than having no insurance.

"Cash-balance-billing" is NOT common in the US. I seem to recall you were seeing a doctor that is not "in network" with your insurance carrier. This might be a good indication of why they aren't a covered doctor. I would RUN AWAY from any doctor who suggested "cash-balance-billing" or any type of under the table cash payments - that's just scary.

If you have a lot of questions, it's common for the staff to suggest an office visit/consult. And as many questions as you ask here, I can understand why such a visit would be suggested. It's helpful, when you do have an office visit, to write down ALL your questions prior to the visit, so you can be sure to ask them all when you're there (then start a new list for the next visit). While this is a great place to get input from others experiences, you should also be asking all of these questions of your mothers doctors/nursing staff.

@NWgirl
"Cash-balance-billing" might not be common in the US in general, but it certainly happens in parts of the US, like the sf bay area. We really cannot run away from our current doctors, as there are very few other doctors that we can run to.

Whenever we tried to squeeze into too many questions into one office visit, the doctor would tell us to calm down and only answer the first two, three questions, and recommend saving the remaining questions for "next time", all the while making sale pitches of his vitamin supplements in between answers.

[Sharon Brent]

Dear Meatie,

You have so much going on in your life right now, I don't live in America so don't know anything about all this Insurance and which doctors you can or can not have.

But its easy to see the Oncology team you are dealing with does not seem at all good, apart from trying to get more money from you, I would not be confident in anything they told you as they only want more money and to sell suppliments that they make more profit on.

There MUST be an alternative for you and your Mum. Please seek help in finding a New place to get treatment as I don't feel you will get good treatment or service from these people you are seeing.

Sending you Love and Kisses from London

[bitchslapped]

Please tell me these are not American (or of American descent) doctors practicing this. In all my years of raising kids, throughout taking care of my DH & DM for many years + myself or ANYONE else that I know, I have NEVER EVER encountered this kind of underhanded cash practice nor have I even heard of it until you. It is illegal as all hell if one is going through insurance. Now, if one is private pay, no insurance involved, then is a different story & cash negotiation comes into play.
Most physicians won't discuss money. That is what their billing department is for. This is unreal.

[justin case]

Please tell me these are not American (or of American descent) doctors practicing this. In all my years of raising kids, throughout taking care of my DH & DM for many years + myself or ANYONE else that I know, I have NEVER EVER encountered this kind of underhanded cash practice nor have I even heard of it until you. It is illegal as all hell if one is going through insurance. Now, if one is private pay, no insurance involved, then is a different story & cash negotiation comes into play.
Most physicians won't discuss money. That is what their billing department is for. This is unreal.

By George, I think we got it!

[mstults]

I think this predicament was caused by insisting on Chinese speaking doctors. I'm not saying this about all but it's very obvious that. You have made an extremely poor choice of doctors. You mentioned getting better insurance. If you can, you need to get better insurance amd get a reputable doctor. Also, perhaps the problem is the insurance. Depending on your mother's income and assets, she may be eligible for Medicaid. If she has worked in the past, she may be eligible for social security disability. Do whatever you must to get a reputable doctor. I don't care where you are, there are reputable doctors available. Blaming it on the area you live in is not a reasonable excuse. It's a cop out. This is serious and affects her treatment, or lack of treatment

[bitchslapped]

Out of network, yes, they can balance bill beyond insurance payments. That is legal. Expecting a tip aside from normal documented billing procedure is not.

Doctors billing codes are based on type of appointment. Initial comprehensive consultation which can be a 1 hr appointment are several hundred bucks depending on what they do. Now I am not speaking to oncologists, but in general, there are allotted time frames for appointments, depending what they are, usually in 15 to 20 minute increments. If you have 45 minutes worth of questions/responses, you cannot expect to pay for a 15 min doctor visit. Furthermore I have an allergist/dermatologist. If I want to talk allergy, they code & bill for that. Dermatology requires another code & another office visit. They will not address both issues at the same appointment due to insurance coding issues for payment. Occasionally, they might allow you to slip in a quick question, & I mean quick. It is not personal, though frustrating, I accept it. They are businessmen/women in the healthcare industry & make no mistake about it, insurance drives the process. They need to get compensated, same as anyone else.

It was within reason for them to ask you to come back & address further questions at the next appointment for another copay. Some of the questions may not need to be addressed by the physician or even the physician assistant. The nurses can answer a lot of those, time permitting of course.

[justin case]

I think this predicament was caused by insisting on Chinese speaking doctors. I'm not saying this about all but it's very obvious that. You have made an extremely poor choice of doctors. You mentioned getting better insurance. If you can, you need to get better insurance amd get a reputable doctor. Also, perhaps the problem is the insurance. Depending on your mother's income and assets, she may be eligible for Medicaid. If she has worked in the past, she may be eligible for social security disability. Do whatever you must to get a reputable doctor. I don't care where you are, there are reputable doctors available. Blaming it on the area you live in is not a reasonable excuse. It's a cop out. This is serious and affects her treatment, or lack of treatment

Perhaps a gratuity in China, reflects on a person's commitment to the community, of which she now resides. Any gratitude(cash) may well be beneficial, in overall survival I don't like it, but it happens.
Michael

[Danieljt]

Andrea. That's funny!