Patient and Healthcare Provider Dialectic

My patient and healthcare provider dialectic, is not a classical dialectic in the sense of the word. Rather, I wrote it with the sole purpose of getting people to think outside the box.

Patient - I have an HMO, and you're my medical group of choice. How much is the co-pay for my visit today?

Healthcare Provider - Your co-pay today is $50.00.

Chorus - Your co-pay is determined by your healthcare organization, not by the receptionist at the front desk. Furthermore, on HMO's, your co-pay should be listed on your insurance card - co-pays vary from provider to provider, example: if you visit your PCP (Primary Care Physician), your co-pay is usually less than if you have to visit an E.R room (Emergency); nonetheless, if you have an HMO, the co-pay amount that you're responsible for, should be listed on your insurance card.

Patient - I heard you're the very best in your field of medicine. And, since I have a POS (Point of Service Plan), I can see anyone I like.

Healthcare Provider - Yes, I believe you're correct in saying that.

Chorus - POS is a combination of an HMO and a PPO in one. If you stay within your chosen medical group - the POS works pretty much like an HMO, with only few variations. However, if you opt out of plan (medical terminology for a person who is going outside their network of providers....), you'll most likely get hit with a deductible; furthermore, some organizations bill separately for professional and facility components/fees, so depending upon how high your deductible is, you could end up owing a great deal of money. Caveat: call your insurance organization and make sure this is all properly explained to you before you decide to see any medical provider outside your network.

Patient - I just turned 65 years old and decided that instead of retiring, I'm going to still work for a living. Is Medicare my primary insurance now?

Healthcare Provider - Yes, because you've turned 65 years of age, Medicare is primary.

Chorus - If you decide you still want to work (or need to work) after you've turned 65 years of age, Medicare becomes your secondary health insurance to the one that you currently have through your employer. Furthermore, make double-triple sure that Medicare knows this, or they may end up denying your claim and requesting COB from you - COB (Coordination of Benefits), is when an insurance carrier doesn't know if they are primary or secondary to another insurance you may have? This could hold up your claim and, if the issue doesn't get resolved, the provider may end up sending your account to an outside collection agency. Rare case scenario - if you don't have insurance through your work when you turn 65 years of age, then Medicare would be your primary. But always - always let Medicare know whether or not you're going to retire when you turn 65.

Note: although the 'Chorus' is right most of the times, what it says is not written in stone. - You, the Patient and Healthcare Provider are really one - you should question yourselves and make sure you get as much information as you can on how health insurance companies function....