Us “poors” can’t get a real doctor anymore and finding a NP isn’t easy either.
- Thread starter teelea68
- Start date
@heretichermes You mean French Quarter Health Clinic?
heretichermes
New member
@teelea68 I'm in NOVA too. Go to www.cigna.com and either register and log-in to look for docs under your network, or use these instruction:
Click on "find a doc" at the top of the page
Enter your criteria (either you have coverage through an employer or you have coverage through healthcare.gov)
The system will then ask you what network you have. If it's through Healthcare.gov there's only one selection. You can then look up docs by type (use "PCP") and location.
It lists if they are accepting new patients or not.
The old fashioned paper copy of in-network physicians is outdated and results in the issue you've been having. Online access is much clearer.
Good luck!
Click on "find a doc" at the top of the page
Enter your criteria (either you have coverage through an employer or you have coverage through healthcare.gov)
The system will then ask you what network you have. If it's through Healthcare.gov there's only one selection. You can then look up docs by type (use "PCP") and location.
It lists if they are accepting new patients or not.
The old fashioned paper copy of in-network physicians is outdated and results in the issue you've been having. Online access is much clearer.
Good luck!foreverthankful
New member
@teelea68 What is the concierge fee? I can't speak to why they are charging them or if it's okay--- but I can't imagine a concierge fee is more than an ER Visit--- an ER Visit is easy $1500 at the least-- and getting any tests/imaging/labs in an ER setting will be the most expensive way to get those done.
Yes- you may have an ER Copay of $250, but that just gets you in the door and evaluated- just like a regular doctor visit-- any test/imaging/bloodwork/etc is extra. I've seen the charge for starting an IV with just Saline be upwards of $50+ in an ER setting.
Yes- you may have an ER Copay of $250, but that just gets you in the door and evaluated- just like a regular doctor visit-- any test/imaging/bloodwork/etc is extra. I've seen the charge for starting an IV with just Saline be upwards of $50+ in an ER setting.
@foreverthankful It’s $180 per month subscription to join the practice. In addition to what I already pay out of my paycheck. $180x12 months = $2160. My deductible is $1500.
winston_32
New member
tabitha007
New member
@tabitha007 Pretty sure I heard “per month “ but can certainly confirm. If that’s how they operate that’s their prerogative, but why is Cigna listing them as available practices?
tabitha007
New member
@teelea68 Concierge fees are per month, and it’s like a monthly subscription fee because they do not take insurance, but your fee allows you generally to be seen and call/text/virtual as many times per month as you need. You pay separately for labs but they usually have low contracted rates. They do this to allow a lower patient load (and allow longer appts with patients) and to avoid dealing with insurance BS. I have no idea why Cigna is listing doctors that you can go to who aren’t accepting insurance patients. Unless they’ve all recently switched to concierge medicine?
@mikiee I'm guessing it's a hybrid model. I worked for a doctor about 10 years ago who did this while working in an otherwise normal group practice. He had a normal patient panel and accepted all the insurance plans that the rest of the practice was contracted with, but he also had an option for patients to pay an extra concierge fee for 24/7 cell phone access, longer appointments, guaranteed same-day slots, extra testing that's not covered by insurance, etc. I believe all of his concierge patients had traditional insurance, and the doctor still billed insurance for all their eligible visits. The concierge fee was just extra money for him and these patients were all wealthy enough to pay it voluntarily. He had a limited number of concierge slots so that he could give them sufficient extra attention.
Perhaps the providers OP called have a similar model but require all new patients to join the concierge program? I can understand the sentiment on the provider side because insurance reimbursement is crap, but the doctor I worked for was a greedy slimeball so my opinion of it is...not particularly favorable.
Perhaps the providers OP called have a similar model but require all new patients to join the concierge program? I can understand the sentiment on the provider side because insurance reimbursement is crap, but the doctor I worked for was a greedy slimeball so my opinion of it is...not particularly favorable.
cyclone_105
New member
@teelea68 Contact Cigna and request a Member Advocate, Health Advocate, etc. If it's an available benefit, they can call on your behalf to find an INN provider.
Otherwise, call Cigna and ask for the details of their network adequacy requirement is for your plan type.
They have to have a certain number of providers available in your area who can see you within a reasonable amount of time at your INN cost-share amounts. If they do not have sufficient providers for a covered service within their mandated radius that are accepting patients, request a network adequacy exception and see any provider that is willing to take you - your insurer will work out the details.
You may have to call around, but they can't control when providers are and are not updating their status in a timely manner unless it's reported. Honestly, fax may also be an option. For large healthcare provider groups, you may be able to check on a myChart or equivalent en masse.
You may be able to jump this by filing a General Complaint for incorrect directory information with Cigna, you may have to do this by writing. Compliance folks tend to be linked in with resolution teams and network management and this is a compliance issue. Your plan documents will advise you of how to handle it.
You can still get care, you've just gotta work within the system.
Otherwise, call Cigna and ask for the details of their network adequacy requirement is for your plan type.
They have to have a certain number of providers available in your area who can see you within a reasonable amount of time at your INN cost-share amounts. If they do not have sufficient providers for a covered service within their mandated radius that are accepting patients, request a network adequacy exception and see any provider that is willing to take you - your insurer will work out the details.
You may have to call around, but they can't control when providers are and are not updating their status in a timely manner unless it's reported. Honestly, fax may also be an option. For large healthcare provider groups, you may be able to check on a myChart or equivalent en masse.
You may be able to jump this by filing a General Complaint for incorrect directory information with Cigna, you may have to do this by writing. Compliance folks tend to be linked in with resolution teams and network management and this is a compliance issue. Your plan documents will advise you of how to handle it.
You can still get care, you've just gotta work within the system.
@cyclone_105 Thanks, I appreciate the feedback. I feel I just don’t have the mental capacity to jump through all the hoops. I already had a panic attack dealing with this yesterday. I’m 52 and wanted to find a practice I could have a relationship with. Get checked for all the things a 50yo should get checked for. And now I just don’t care. I will try contacting Cigna again to see if they provide a better listing or offer extra help.
@teelea68 I saw your more recent comment that you were able to find a provider, and I'm so glad! I just wanted to validate this comment and tell you that you're not alone. I've been working in healthcare administration/medical billing for almost 15 years, and I cried in a pharmacy a couple months ago because of a similarly convoluted mess of back-ordered medication and secretly out-of-network pharmacies. If I can't navigate this crap as a literal industry professional, I don't know how anyone else is supposed to figure it out.
@jahypnus7 Appreciate the validation! My HR lady was also very helpful and supportive. She had never heard of the concierge thing and is following up with Cigna for more info.