Superior Medical Care or Medical Mutual of Ohio

by Loraine Ritchey thatwb@yahoo.com

What is a patient to do?
(image Bro. Kirk)

Here we go again…. The “public” will once again be bearing the cost of the posturing , the who is right – who is wrong? Now all have their valid points the doctors and insurance companies- But who is really the one suffering here?

The price of healthcare is rising- the cost of coverage is rising- the cost to the physician for insurance is rising-the cost to the insurance companies is rising and in the end the patient and the public pays. Doctors are paying out more and more for training, equipment, malpractice insurance – everyone has their problems -So here is my latest dilemna

No. 1. Our family Dr. retired – mainly due to the high costs involved of being a one man practice. I loved my Dr. both he and the family Dr. we had before him ( passed away) had treated the “whole family” from pregnancy, childhood through middle and old age. We had faith, trust , friendship and “ownership” which worked both ways- we were NEVER a number.

No 2. A group of four Drs. took over his practice locally – and we all went to a different Dr. in the practice, (due to their days in office) and to see which one we all liked best ( truth be known) . We still could go to the old office and with the same staff.

NO. 3. -No2 lasted about 3 months or so and then the offices closed and we were sent to what I called the “Chicken Coop” - I absolutely hated sitting in the large waiting room surrounded by the coughs, colds and goodness knows what else and the large Plasma TV tuned to CNN. I felt more like a number than a patient. The nurses would poke their heads out of the little window cubicles like so many battery chickens. The four Drs. have turned into a group of over 30 .

Thankfully my mother’s Dr. left the group and I left with him, however the rest of my family was scattered among the remaining Drs.

The have each received a letter written November 6th-2008 stating that this particular group Superior Medical Care (SMC) will not be accepting Medical Mutual of Ohio(MMO) as of January 20th-2009
Click on all letter images to enlarge

Where does that leave us – the patients – the last sentence in the one letter (emphasis mine ) ” Superior Medical Care “MAY” continue to see you in our offices… “YOU” will be responsible for payment at your time of visit…..

I called the number listed in Superior Medical Care’s letter and basically YOU the patient will be “coughing up”.

I remember seeing little notices on the chicken coop windows that there were other insurances they also weren’t accepting
We do not accept Caresource, Summa Healthcare and Humana….

Then on November 16th a HUGE FULL PAGE ad in the Chronicle Telegram ( only part of which would fit into my scanner) states

At the very bottom of the ad for the FAST TRACK CLINIC it states in big letters “This is NOT a free clinic” so I wonder who pays????

Then the next day – November 17th- yet another letter

with a copy of a letter from Medical Mutual of Ohio -

This time Superior Medical Care states the MMO initiated the need for SMC to terminate the contract with them …so who is accepting whom and who and how? According to SMC all they requested from MMO was to pay at a similar level to what other insurance companies are currently paying…… and so it goes and the patient well he/she is on the table!

HMMMMM looks like we, the patient, have got ourselves in the middle of a price war and guess who is going to end up paying ?
SOURCE

Now it is difficult enough with all these forms and intricacy involved when you are ill to figure out the caps, the costs, the will they? – won’t they? and NOW we are also expect to also figure out ” MMO depending on your plan may reimburse you for what you paid as out of network”.
Speaking to a representative of MMO basically they confirmed what I had already thought:

If the Dr. charges for example $300 for a service and MMO had contracted to pay $150 -the Dr. agreed to accept that under the contract. Now you will be responsible for the $300 and possibly be required to pay that up front depending upon the Dr. This could get very expensive – for example recently we were charged $2,000 for a procedure from a Dr. in this group – he agreed to accept $800 through MMO however, now this could mean “out of pocket” to the patient for the other $1,200 (if the Dr. is not under a contract to accept that $800)-that adds up.

Some medications, we have dealt with recently cost $10,000 per injection in that instance MMO agreed to $2,500. If a patient had to have one of those injections a month (as is what happened to us) for 7 months guess which line you will be standing in?

Well , sorry Superior Medical Care , whilst I see your problem- 5 of my family who are under MMO are going elsewhere, you see we already have too much hassle and I am tired of being caught between a rock and a hard place and quite frankly “I don’t like chicken coops!”

Now I guess I will have to pay for the records to be transferred ( yet again) and start the whole process over…….

Time for equality and equity and a health care system that is healthy! I for one am tired of being plucked , sliced and diced – and being told ‘How Lucky We Are”
Out of Network and out of patients = Out of pocket and out of patience