Thoughts on charging the same thing for a nurse practitioner as for a doctor...

[gina2000]

I'm with the OP. While I do believe my pediatrician employs an extremely capable, competent staff including a NP, I would rather my son sees the pediatrician. I pay the same amount regardless of whom I see so I think my son should see the person with the most experience and the person whose name is on the shingle out front. I am paying for his expertise and his understanding of my son's physical health. I don't care for the third party relay of information.

 

[beattyfamily]

I'm with the OP. While I do believe my pediatrician employs an extremely capable, competent staff including a NP, I would rather my son sees the pediatrician. I pay the same amount regardless of whom I see so I think my son should see the person with the most experience and the person whose name is on the shingle out front. I am paying for his expertise and his understanding of my son's physical health. I don't care for the third party relay of information.

ITA with you and the OP.

I would much prefer the PCP over the NP but 9 times out of 10 I get a NP. The only time I get the PCP is for our annual physicals.

There have been 2 situations so far where the NP didn't do the right thing and caused major issues with my DD who is sick a lot. I've talked about one of the more serious ones in another NP thread. Not going into this time.

I think the doctor's office should charge the insurance company less for a NP over a doctor.

 

[Lintasare]

I guess I am one of the few who would rather see an NP or PA than an MD.

A few years ago I was having severe abdominal pain and went to a local urgent care affiliated with my insurance. I told the MD I saw that I have a history of ovarian cysts and I thought I had developed one. Instead of doing a pelvic and ultrasound, my concerns were dismissed and he tested for a UTI ONLY and sent me on my way. Well three days later the pain got worse so I went to a different urgent care center and saw a PA there. Told her my history and symptoms and got an immediate ultrasound. Turns out my appendix was inflamed but a course of antibiotics and I was right as rain.

Then a few months later I went back to urgent care because I was getting a sinus infection. Had a cough, sinus congestion and fluid and pain in my ears. Wouldn't ya know I got the same MD. Told him my symptoms and concerns and he dismissed it as a virus. Didn't listen to my chest, didn't look in my ears. Fast forward a few days and I get severe pain in my ear. Go back to urgent care and see the PA. One look in my ear and sure enough the fluid built up so much my eardrum burst and my other ear was infected.

Plus I feel even when I go to my PCP and see the NP I am getting better care because she takes the time to go into detail with my symptoms and if a prescription is necessary to take the time to tell me how it works and any side effects I might have.

 

[Judy from Boise]

I wan't to emphasize that unlike a previous poster stated , in 23 states in this country NP's can have absolute independent practice. They can "hang out their own shingle".

here is the list

NO REQUIREMENT FOR ANY
PHYSICIAN INVOLVEMENT (N = 23)
n Alaska
n Arizona
n Colorado
n District of Columbia
n Hawaii
n Idaho
n Iowa
n Kentucky
n Maine†
n Michigan
n Montana
n New Hampshire
n New Jersey
n New Mexico
n North Dakota
n Oklahoma
n Oregon
n Rhode Island
n Tennessee
n Utah
n Washington
n West Virginia
n Wyoming

in contrast a PA by law has no independent practice.

 

[teacherforhi]

I guess I am one of the few who would rather see an NP or PA than an MD.

A few years ago I was having severe abdominal pain and went to a local urgent care affiliated with my insurance. I told the MD I saw that I have a history of ovarian cysts and I thought I had developed one. Instead of doing a pelvic and ultrasound, my concerns were dismissed and he tested for a UTI ONLY and sent me on my way. Well three days later the pain got worse so I went to a different urgent care center and saw a PA there. Told her my history and symptoms and got an immediate ultrasound. Turns out my appendix was inflamed but a course of antibiotics and I was right as rain.

Then a few months later I went back to urgent care because I was getting a sinus infection. Had a cough, sinus congestion and fluid and pain in my ears. Wouldn't ya know I got the same MD. Told him my symptoms and concerns and he dismissed it as a virus. Didn't listen to my chest, didn't look in my ears. Fast forward a few days and I get severe pain in my ear. Go back to urgent care and see the PA. One look in my ear and sure enough the fluid built up so much my eardrum burst and my other ear was infected.

Plus I feel even when I go to my PCP and see the NP I am getting better care because she takes the time to go into detail with my symptoms and if a prescription is necessary to take the time to tell me how it works and any side effects I might have.

That's just a case of a crappy doctor. If I went to my doctor with a possible sinus infection and he didn't even look in my ears, I'd be raising cain.

Your situation has nothing to do with MD versus NP. The NP took the basic steps that the crappy doctor didn't.

 

[jaminmd]

Well, I'm an RN so I am biased. Many years ago DH had elevated cholesterol & triglycerides, which his MD did nothing about. DH's family has a history of heart disease.

It wasn't until he had to take an appointment with an NP that he was treated. He's been taking meds ever since. She is the one we see for everything. She is very thorough & I trust her judgment.

I have taken DD 12 to an NP since birth for all of her well visits and a few of her sick visits. If the kids are seriously ill, they have to see an MD. Her NP & MD are both fantastic.

When I used a CNM at my gyn's office, she screwed up my pap smear & I had to go in for another one. Fun, fun, fun. I'll never go back to her again. There is an example of an experienced professional that can't do a simple procedure.

See, the thing is, you can have good & bad in both professions. There are top notch MD's & NP's & then there are those I wouldn't allow my DD's stuffed animals to be treated by.

Do what you are comfortable with. I pay the same copay every time, no matter which one I see. I never thought anything of it because it is an office visit.

 

[debf]

I have worked in medical billing for almost 11 years. The fee is the same across the board. It is up to the insurance companies what the patient will be responsible for. Some insurance companies require a physcian to review charts done by a NP,or a PA. Also, a lot of insurance compaines will pay less for a PA or NP,but the copay remains the same.

 

[TiggerStac]

NP visits are billed out under the MD that they are working for that day. They bill out using the same codes that the doctors use and reimbursed the same rate.

If you were to look at the claim...you would think you saw the doctor.

My pedi's office has sever NP's and about 12 MD's. I have no problem seeing the NP's, but don't think it's right that they don't have their own codes for billing, etc.

My dr's office, also, has a NP and I've seen her a couple times, no issues....

 

[Lintasare]

NP visits are billed out under the MD that they are working for that day. They bill out using the same codes that the doctors use and reimbursed the same rate.

If you were to look at the claim...you would think you saw the doctor.

My pedi's office has sever NP's and about 12 MD's. I have no problem seeing the NP's, but don't think it's right that they don't have their own codes for billing, etc.

My dr's office, also, has a NP and I've seen her a couple times, no issues....

I work in insurance claims and NPs do have their own codes. In a way. The code for the visit is the same. However a modifier can be used to indicate that the patient saw an NP or PA instead of an MD. And that modifier affects the pricing of the code. And I am not sure of all companies but I do know that my company and Medicare do have lower reimbursement rates for NPs and PAs.

 

[princessbride6205]

OP - my instinct is to agree with your point. At a general check-up, I could understand paying the same, but for a specialist visit, I'd be irked to pay a special higher copay and not see the doctor.
I have had 2 completely opposite experiences with NPs. The one at my OB-GYN is fabulous! She takes so much time with me and really seems to understand my concerns, provides lots of info, etc. I don't mind paying the regular copay to see her, because I actually choose her over the doctors now that I've been seeing her for 2 years.
The NP at DD's ped office is another story. She doesn't even seem to be up on current baby/toddler info. At DD's 15mos appt, she only looked at the height/weight percentile, then told me DD was overweight and that I shouldn't give her snacks and needed to switch to lowfat milk. DD was chubby but not huge, and besides, kids under age 2 are supposed to have 50% of their calories from fat. She didn't ask me what we fed her, or anything - just assumed we were giving her treats and juice all day! We stick to seeing the ped now, who has always considered DD just "healthy."
Like doctors, NPs are individuals, so there are good and bad ones out there. It does seem that in general, NPs are able to take more time to talk to their patients.

To the insurance question, back 10 years ago, my plan had $0 copay for nurse visits and $15 for dr visits. My current plan has $0 copay if you go to a retail clinic (like Target or CVS, always staffed by NPs) but $25 for seeing a doc or NP in an office setting. So there is some precedent for different payments.

 

[TiggerStac]

I work in insurance claims and NPs do have their own codes. In a way. The code for the visit is the same. However a modifier can be used to indicate that the patient saw an NP or PA instead of an MD. And that modifier affects the pricing of the code. And I am not sure of all companies but I do know that my company and Medicare do have lower reimbursement rates for NPs and PAs.

interesting...I've never seen a modifier come thru on any of the claims for me or my kids. I just peaked at one from my pedi and the price was the same when we saw the NP as a dr's visit.

And when I did billing for MD's/NP's before, there wasn't anything. Is it new?? I check my claims all the time, but I have been doing nursing home billing for the last 6+ years.

 

[kaytieeldr]

I would have questioned the office about that. A few years back I was extremely ill and needed to go to the office every 3 days to check my levels and such. He charged me my co pay on every 5 visit or so.

The insurance being charged differently for the NP and the MD is understandable. But for the co pay, I usually associate that with everything that goes into my having a visit at the office. The paper work, the office time, etc. I wouldn't balk at having to pay the same copay to see the NP.

Agreed. The co-pay isn't for the doctor visit, it's for the office visit. You visit the office, you are seen by a qualified medical professional - you pay the co-pay indicated by your insurance.

I see more PAs and NPs than doctors. My previous physician had just herself, two PAs, and one NP - and was open only certain hours. And the few times I saw the doctor for chronic issues, she was always late. One visit, she had three physicals, a meeting with a sales rep, and a visit to her future office site - all while I waited, with an appointment! And when my employer changed insurance plans, the new one calculated my co-pay at the specialist rate. This was my PCP, but separate from that she also had a specialty.

The practice I see now has two physicians, six NPs, and several medical assistants. They have early, late, and Saturday hours and can almost always fit me in when it's urgent. They can do this because they have sufficient, qualified staff.

If one is self-insured, it might be a good idea to shop around for an insurance company that prorates the co-pay. I'd be surprised if many/any do, but... If, on the other hand, it's employer-paid or other group insurance, well, suggestions need to be made to the person/s responsible for negotiating the contract, Really though, I would expect a plan with the desired payment structure - lower co-pay for lesser degree/training - to be calculated by percentage and result in significantly higher costs.

 

[kaytieeldr]

I'm with the OP. While I do believe my pediatrician employs an extremely capable, competent staff including a NP, I would rather my son sees the pediatrician. I pay the same amount regardless of whom I see so I think my son should see the person with the most experience and the person whose name is on the shingle out front. I am paying for his expertise and his understanding of my son's physical health. I don't care for the third party relay of information.

Understood - but as the OP experience shows, there can be a lonnnnnnnng wait for an appointment with the physician.

 

[kaytieeldr]

I think the doctor's office should charge the insurance company less for a NP over a doctor.

They might. Really. But it wouldn't matter to the patient/policyholder/insured, since most insurance policies have a fixed co-pay for an office visit.

 

[beattyfamily]

They might. Really. But it wouldn't matter to the patient/policyholder/insured, since most insurance policies have a fixed co-pay for an office visit.

Yes, I realize that but my opinion still stands.

What I was really saying was if I walk in and I have to pay because I do not have insurance, I'd expect to pay less for a NP over a PCP. This is my opinion.

 

[luvmy3]

My ds was complaining of ear pain, called the ped and made an appt. I got there and we ended up seeing an NP, turns out ds had an ear infection, got our Rx for Amox. and left. It was no different than it would have been seeing his ped, I didn't have a problem with it or with paying my regular co-pay. Now, had this been something else, more serious like a problem due to his asthma I would not have wanted to see the NP and would have expected to see his Dr.

 

[kaytieeldr]

Well, sure - THAT'S entirely reasonable, beattyfamily!!!

 

[clarabelle]

This is how I understand it
A copay is there is put some responsibility on the patient.
It's function is to keep costs down -the idea is that if patients can get as much health care as they want -without any of the burden being on them -then they would go to the doctor more often and get expensive treatments.

So from the insurance standpoint -they don't care who you are seeing -they just want you to share some of the burden.

Does that make sense?

 

[OceanAnnie]

This is how I understand it
A copay is there is put some responsibility on the patient.
It's function is to keep costs down -the idea is that if patients can get as much health care as they want -without any of the burden being on them -then they would go to the doctor more often and get expensive treatments.

So from the insurance standpoint -they don't care who you are seeing -they just want you to share some of the burden.

Does that make sense?

Yes and no.

I pay $25 co-pay for a GP.
I pay $50 co-pay for a specialist. I paid $50 for the N.P.. There is a tier for the doctors, not the N.P.. It's an observation.

Disclaimer: I understand the argument that it's an office visit. I don't agree, but I understand the argument. I'm paying a different amount for the different doctors I see. That's based on their differences. I understand the argument that it's an insurance issue. Again, it's an observation. It's peculiar to me. I'm not wearing a sign and protesting. It's just peculiar to me. I understand some people equate a N.P. with a doctor with or without some sort of provisions. I don't equate N.P. as doctors. I do agree they provide a service, (optimally for me) for normal visits if I can't see the doctor. That would be my preference. I'm not "belittling" N.P. as a pp mentioned. Not by any means. There is a difference between a doctor and a N.P., and pointing that out is not "belittling".

Anyway, I needed to be seen. It wasn't a "normal" specialist visit. I had a problem. So yes, it was my preference to be seen asap by a N.P. rather than not be seen at all. Again, I like the N.P. I saw. For my problem, I would've liked to have seen the doctor, it wasn't an option. The co-pay made me pause, but I didn't and wouldn't say anything.

 

[arminnie]

I pay $25 co-pay for a GP.
I pay $50 co-pay for a specialist. I paid $50 for the N.P.. There is a tier for the doctors, not the N.P. It's an observation.

I'm a staunch advocate for NPs and PAs, but I think I understand what you are saying here. I most likely would have expected the co-pay to be the same as for the GP.

I recently saw a PA at my orthopedic office. I preferred him over the surgeon as 1) I didn't need surgery and 2) he spent lots more time with me and was extremely knowledgeable. I don't know if his co-pay was the same as for a surgeon or for a GP.

I love NPs for general medicine, but I don't think most of the general NPs that I've seen could have provided the specialized skill set that the orthopedic specialist PA did so I guess a higher co-pay may have been warranted.

Internists make a lot less money than many surgery specialties - even though they may have similar years of training. The internist has to have diagnostic skills on how to treat many, many different medical issues. Some surgeons are so specialized that they just go into the OR and do their thing (pre-diagnosed, etc) and never really spend any time with the patient or in real problem solving. I appreciate the surgeon who took my appendix out in 11 minutes - but I think we often under value those in family practice or internal medicine, and the NPs and PAs.

In some of the states where a NP is not "allowed" to do a solo practice, they only have to have their license "under" a doctor licensed in their state. I know of one NP who runs a Walgreen clinic (and is very good). Her collaborating doctor is hundreds of miles away in another state. He also keeps a license in her state, but really doesn't review anything.

I guess to me the deciding factor is what level of service are they actually providing. I know a man who was a top eye surgeon who now is retired and doing eye exams at an optometrist's office. I don't expect to pay him MORE for a regular eye exams just because he is qualified to do a whole lot more.