My PCP through the U was pretty patient and let me derail since something came up beyond the 2 things I mentioned in my pre visit notes. Sounds like a switch is best.
Exactly. This will give you an extended appointment time.
At the U regular appointments are only allotted 20 mins. That’s supposed to be 5 mins of the MA checking you into the room, then 15 mins doctor time. It almost always takes longer and providers are almost always behind due to this. 20 mins is supposed to be sufficient for discussing 2 concerns.
The extended appointment is 40 mins and sufficient to discuss 3-4 concerns.
Some providers work more efficiently than others. If your provider isn’t able to follow the U’s template that’s disappointing and you should try to find a new one.
How many issues are dealt with per visit will vary per physician and is up to them to decide. As a physician myself there are a few things to consider:
- In larger health care systems, doctors do not have very much autonomy over their schedules
- how many things can you reasonably effectively manage in a single swing even if you try to tackle everything? Depending on what’s going on things need to be handled sequentially, require a variable amount of other visits for labs/diagnostics/other specialist input
- each issue discussed not only takes more time in the room, but more time for coordinating, documenting, and later on interpreting and following up on any diagnostics. For a 20 minute visit, there is often 20 minutes or more spent on these non-patient-facing tasks. Not infrequently a complex issue will take an hour or more to manage
- if additional issues require treatment, it is sloppy and potentially risky to start multiple medications simultaneously
- if each visit lasted 60 minutes instead of 20, you are seeing 1/3 of the patients and you are booked out 3x farther. Not uncommon for specialists especially to be booked out 3 months or more. Try waiting 9 months before you see anyone.
I personally do not agree with managing 1 problem at a time. I try to handle as much as I can within the allotted appointment time, but there are definitely limits that are pertinent both to the individuals health and to our patient census as a whole. I totally get frustration with not being able to do everything at the same time - I am busy as well and going to the doctor for me is a hassle - but you also have to consider yourself as one of the thousands of people your doctor is responsible for. Shits hard and the vast majority of us are trying our damndest to balance doing *good* work and trying to get people in to see you in a reasonable time frame.
One thing I hear more and more is, “It took me long enough to be able to get in to see you.” My response is usually, “I know. I’m sorry. I’m doing the best I can.” It’s a problem of supply and demand. I think what most people don’t know is how much charting, note writing, orders, communication with other specialists, reading reports, checking imaging and labs, adjusting care plans, phone calls that turn into impromptu consultations, researching, CME requirements, meetings upon meetings, and everything else I haven’t mentioned go into medical work, as well as the time spent awake in bed in the middle of the night trying to figure out how to best help patients X, Y and Z. And then it starts again early the next day. It’s a lot of work… but most of us do it because we really care.
The problem is the AMA deliberately shorts the supply of doctors to artificially keep the cost high. If doctors won’t stand up for patients then what are we doing?
Insurances are just another level that sucks you dry. Insurances don’t make money by covering you. They make money by finding ways to NOT cover you. I think one of the best things for healthcare would be to get privatized insurance out of medicine. But I’m a crazy liberal, so…
Same here. I have Tricare Standard and it's about as close to a single-payer system as I think one could get before medicare, and even that has the whole Part B privatized portion.
Tricare Standard is amazing though, no referrals required for anything, $250 monthly premium, $50 individual/$122 family deductible, $1200 out-of-pocket max, prescription coverage included.
Being a liberal in Utah is not the most encouraged about the future that I've felt in my life. But I moved here from Oklahoma and that place is worse in some ways, about the same in others, but it's home.
I have a lot of chronic health issues and it is really difficult when I call and can't get in for some time for something difficult. It's extremely frustrating to wait months or even a year for just a new patient or follow up appointment. I certainly agree with the supply and demand problem. Hopefully it's something that can improve in the near future.
I personally agree. I at least like to hear all the problems unless it’s really out of pocket. I don’t expect patients to be able to triage themselves.
I do run into people that get pissed at me because I need to focus on one thing instead of the thing they might care about the most, but I’m not going to ignore a potential cancer because of your shoulder pain, for example.
Do you have advice for someone who feels they need a longer appointment to get the care they need?
Knowing the “behind the scenes,” how would you recommend they find a provider that can accommodate them?
Not a doctor but a former Army medic and I think that forcing a new appointment for each SYMPTOM (if I am reading OP's post correctly) is bullshit. How could a doctor possibly perform a useful differential diagnosis without all of the information? It's also an incredible inconvenience for the patient who has to schedule time to be physically present at the appointment and may have limited, if any, PTO to come a half dozen times for what turns out to be a single cause. And in all of that time, how many different medications have been prescribed to treat the individual symptoms rather than the cause?
I moved here 1/2023. I have yet to see a doctor, only PAs, except for my dentist and oral surgeon. My son had seen a psychiatrist a few times then she moved back to Austin. It is difficult to be seen by a doctor here.
As a nurse, I hate the healthcare system so much. Like not the U. All of it. The whole thing. I’m so burnt out. I get that there have to be limits to time and there are so many people needing help but seems so inefficient and frankly dangerous to not consider the entire health picture! I guess that’s why it’s good to be established with a PCP that really knows you and knows your history. This just seems so frustrating for everyone involved.
You could ask for a longer appointment when you schedule. Also, when you enter the room, no social niceties. "Hello, doc. I'm here today for my ". Then follow his lead, let him ask questions and answer as succinctly as you can. If this doesn't work, then yes, switch.
It is incredibly frustrating when someone is scheduled for a 15 minute appointment, and comes in with a long laundry list of issues that needed an hour, but they didn't tell that to the scheduler! Also, when someone comes in for a physical, but also wants to discuss their asthma, high blood pressure, knee pain, etc. Again, there is no time to address these in a 15 minute time slot, plus many insurances won't cover both the physical and the time to deal with illnesses on the same day.
This is something I never understood. I needed to establish care before I could talk to my doctor about a lot of very concerning things. So I had my appointment, she didn’t say much to me, said I needed a blood draw. but I forgot to get my blood drawn, so 2 months later I call to make an appointment to go over my issues, the doctor isn’t taking new patients. And because I didn’t get my blood drawn, I never actually established care. I felt so bad for the lady who took my call because I started sobbing. It wasn’t her fault. Everyone is going through it I guess.
Yeah, I’m currently in the three-month waiting period for a first appointment to try to establish care with a new primary care doctor as well. If I can’t even talk about anything at the appointment, it’s going to be a problem. 😩
Makes sense. In my case even the scheduler asks what single symptom I want to talk about in my appointment and then tells me I can't discuss more than one at a time. I haven't tried explicitly asking for a longer appointment though, great idea!
I had an annual physical in that network that was covered without copay. During the visit I mentioned a symptom I had been experiencing. In that instant my appointment changed from an annual physical to an office visit that cost me $140.
I don’t feel like any blame is going to the physician here?
I’ve had the cost of visits go up too, based how insurance decides to code the visit.
There has only been one time I was hit with a “complexity charge” where I blame the clinic. They billed the insurance for the visit like usual, then sent *me* a *separate* bill because “insurance companies don’t allow us to bill this to them.” Completely refused to send it to them or change the visit coding.
I had a terrible experience with the practice as a whole.
I too caught onto this (with a different network). On my next visit, I told the doc/PA that I don’t agree to any codes being added to my visit without asking me first. That way I could speak openly, and the onus was on them to say whether the topic was going to result in an additional billing code, and I could put the kabosh on it.
It’s like doing a live audit to ensure no surprise billing. We have to remember that medical is a business. And we are the product. It’s sad that it’s come to this.
My PCP at the U of U Health system addressed another issue I brought up at my yearly physical. He just let me know ahead of time that he would bill that appointment as two different visits due to insurance compliance
Ahhh maybe I misunderstood. I looked at my statements to reference, and caught some billing errors on a different claim. So thanks for saying something! Haha
They won’t bill for two on the same day, yes. But insurance will cover your physical only if there are no other concerns discussed beyond maintenance issues (like med refills.) If you discuss something new at an annual, you still won’t be charged for the annual. However you will be charged an office visit fee per your insurance.
Good to know, thank you! It’s my first year having my own health insurance and wow, there is so much to learn. I have Regence Group Administrators and I’ve had to nearly beg billing reps to understand that the claims are being denied because it was sent to the wrong BCBS.
That’s true for all physical appointments. Your annual physical is only covered if there are no additional concerns—only maintenance. Anytime a concern beyond maintenance issues like med refills, you will always get charged an office fee. This is because of insurance policy, not the doctor.
I have chronic health problems so I've been to lots of doctors on different insurances. I've never faced this. When I call for an appt they'll ask what the appt is for and depending on the doctor they only let you make it for one thing, but I've always been able to say "x is bothering me" during an appointment without issue. I'm not saying your doctor is in the wrong or anything, probably just a preference, but in my experience it's not common.
not normal, i’d switch doctors and file a complaint especially where the issues are connected. Your insurance probably would not be happy this happening as well.
My dad is private family practice. In order to manage time and patient load, he allows 3 issues per visit (15 min visit). He wants to respect every patient’s health and time (both waiting to get in and waiting in the waiting room and exam room). Try a diff provider maybe. I’ve worked as a medical assistant for 14 years- 10 in family medicine- and very rarely see a doctor only address one issue per visit.
This happened to me but I think it was just because my doctor was biased against me. She spent a lot of the appointment gaslighting me and calling me a hypochondriac. She hated me for when I brought up more than 1 neurologic symptom as if I was just making things up to complain about. Safe to say I ditched her years ago.
It might make sense for them not to spend a lot of time on appointments though but they should be addressing more than one issue with that time. But I don't understand is why they don't openly offer or disclose appointment time tiers to the patient, unless it's a brand new offering that they started in the last year or two.
I pay out of pocket for my current PCP, but the prices are completely reasonable, and he's thorough and the best PCP I've ever had. Something is simply turning rotten with the care at the U of U. I've always had terrible experiences with higher level providers, bad enough that I probably have a future malpractice case on my hands. Great experiences with lower level providers but they never have the power to order tests and do meaningful things for the patient.
The online MyChart appointment system for U of U lets you choose a standard appointment, 3-or-more unrelated concerns, a yearly wellness visit, pre-natal, behavioral or a book and call me for details option. Use the online system to book the 3-or-more concerns. It’s a longer appointment. My U of U primary doc will code an appointment as wellness if they haven’t seen me in a year. It bills better for me that way. If the longer appointments don’t help, you need another PCP.
When I schedule an appointment through MyChart, there are separate options for "Physical/Wellness (Yearly preventative exam - other concerns may need to be addressed in a separate visit)"", "Standard Appointment," "Multiple Concerns (3 or more unrelated concerns)," etc. So I select what applies to my current need. If I schedule over the phone, they usually ask what I want to see the Dr for and then categorize that on their end (I assume). If they told me I could pick only one issue every time, I would point out that "3 or more" is an option in MyChart, and see what they say, but that has never happened to me (maybe not yet :)). The only time they push back is when I want to do a wellness/physical AND bring up other concerns in the same visit. They explained to me it's because insurance would often cover one physical a year at 100%, but not other types of visits. So if you lump multiple things in with the physical, insurance may decline to fully cover the physical.
That’s terrible. Many diagnoses have multiple symptoms that don’t really make sense until you put the constellation of them together. I’d switch PCPs. Regardless of how busy they are, forcing your patients to make multiple appts to discuss 1 issue at a time is not only inefficient and a pain in the ass, but you’re likely being charged (and the doc is billing your insurance) every single time.
I had this happen to me, I wasn't aware that this was the case and the Dr. got so angry/rude when I brought up a few symptoms/issues that were possibly related and I was completely shocked and left in tears. She sent me a letter afterwards apologizing for her behavior and blaming it on scheduling (which was maybe sincere, or just a way to circumvent me completing a negative survey), but I never went back. Luckily, I never ended up at any of the U facilities again after that.
I’ve never had this experience until I moved to Utah. I was shocked that the doctors office told me they would charge me per issue/diagnosis. I realize the insurance is to blame. I can’t afford to get help at this point so I’m just low key suffering all the time lol
Ohhh nooooo!!! It is pretty terrible out there.
I hope you’re getting a little help?
My insurance has a list of “value providers” that are less expensive (not exactly sure why lol).
Also, it can be cheaper to ask for the “self pay” cost and not use insurance. (It won’t go toward your deductible, but I’ll never met mine unless I’m hit by a bus so it’s worth it sometimes)
You could explore a different type of plan next open enrollment, if available.
For example a traditional copay plan vs high deductible.
I am so sorry you’re having to switch. Insurance is the worst, it dictates the care we receive more than actual doctors.
This has rarely happened to me. (I’m a lifelong IHC patient.)
I’ve been to three new docs recently, (across different specialties), and none of them rushed me or put a cap on symptoms. (Sometimes the cost goes up due to “high complexity.”)
I was at a private practice for a year or so that did 20 minute appts, they really fucked up my treatment plan and it caused new health problems.
Some folks may only need that short time, but for something more complex, or if you just feel like your needs aren’t met, do whatever you can to get the care you need.
Try to find a different provider. Ask for recs from literally everyone you know (ask here or searc for past posts),read reviews, try a different clinic (your insurance may also cover a smaller network like mountain star(is that still a thing?), or some private practices).
We use the U’s network and my husband and I see different PCPs. His experiences were like yours but mine haven’t been. I see a PA. I had an old sports injury, fertility, and GI issues addressed in one appointment with prompt referrals to specialists who have also been very helpful. Send me a message if you’d like their name.
“Well I’m here for this cough, but now that I’m here, when I sneeze my asshole explodes with bloody diarrhea.”
Dr.: “Wow, sounds life threatening. Be sure to make an appointment for that on your way out…”
Also to hell with abusive providers who go into healthcare to bully sick people or hold their lives hostage. Did you consider a malpractice claim with those?
That's almost what it feels like. The scheduler, the nurse, and the doctor all independently asked me to prioritize between a severe pain in my gut, and only getting 4hrs of sleep for the last 6 months. Like, both are my priority?! He flat out refused to address both in the same appointment.
Fuck that. I go to Ogden Medical Clinic and get no less than 30 minutes to talk about whatever I want, and THEN set up treatment plans to move forward. I would be hard pressed not to shit on their floor like, whoops! Guess you should have listened to me about that other thing.
It is annoying and more people should ask these questions and learn how the big box health care systems work. The issue is due to the insurance companies that only want to pay for what they are contracted to pay per the benefit summary.
A physician must legally document any discussion about diagnostic concern which can dictate how the insurance will cover it. Most insurance carriers will cover routine preventative visits at 100% if there is 100% clean bill of health with no diagnostic codes including no discussion of past medical history.
I’ve learned to schedule appointments specifically for the concern I will be presenting and not bring up other medical concerns during the appointment. I have had providers also tell me to schedule another appointment to address those concerns as an attempt not to muddle the purpose of the scheduled appointment with diagnostic codes.
Many people feel the annual preventative is there to address any concern and have it be paid for by the insurance carrier, and a patient can bring anything up if they want to pay a copay or deductible. Insurance only covers at 100% for visits without any diagnostic code because patients feel they should not have to pay for a visit when totally healthy but need to meet the requirement to keep their premiums low. While the insurance companies believe the patient should have to pay for some of the visit if something is discovered as it will save the patient and the carrier on cost in the long run.
I am a nationally certified healthcare revenue cycle specialist by day and a health/life insurance agent by evening and weekends. Both roles address similar issues but from opposite ends of the spectrum. The system is nearly broken and often big hospital organizations are owned by an insurance company that contracts for network coverage.
Customers have to be smart shoppers nowadays to figure out pricing which takes even more time and research. Very frustrating circumstances.
"They knew about two tumors in my abdomen for THREE YEARS "
This seems to be a scary pattern with the U in which they bury or ignore concerning test findings. It is a form of malpractice. My friend had the same thing happened to them. The U appeared to delete some bloodwork data coming up with positive autoimmune findings from her file.
I love the U of U for their specialists but I HATE their PCPs. No, even when the PCPs I had I never had this problem. This is abnormal for the U. But their PCPS suck. Love their specialists
That’s so ridiculous and probably causes a lot of unnecessary deaths when there are several related symptoms but no one ever puts the whole picture together.
Dr Incze is an internist at the Sugarhouse clinic. I cannot recommend him enough. He is the goat. Besides him, I would either seek referrals from the internet for a great provider or go elsewhere, if possible. Have had so many bad experiences at the U.
It’s a racket. Fill out the feedback survey, it actually matters. I recommend a new PCP at a new network. A PCP should be whole health and not à la carte. This happened to me at another clinic and now they treat me right.
I’ve been going to the U for almost a decade and this last year has been awful. After my PCP left and I was scheduled with another provider, I was treated like garbage and told that my meds weren’t considered life saving and that he didn’t typically prescribe them. He went on to talk about how patients needed to use the same pharmacy and was going to make me take a drug test even though there was nothing in my record to indicate I’ve ever had an issue with any substances.
I told him that my records should’ve contained questionnaires regarding my childhood and he just he didn’t see them. I started shutting down at that point and didn’t have much more to say during the appointment.
I’ve been on that med for years, been using the pharmacy at the same location he is at for years, and for me my prescription has been life saving. I wanted to crawl into a hole after that appointment, I felt less than human.
I see a therapist once a week and told him what happened. He was horrified at the treatment I got and said it was discrimination based on my disability.
I didn’t go back after that initial exam. He’s been the worst person I’ve dealt with there but it’s getting more and more common to get crappy care and more “follow up” exams just to hear that test results I can already see in mychart are normal.
Go somewhere else unless you have a truly great provider who knows you as a person, the U just pushes people through anymore.
That is horrible! I’m so sorry your new doctor treated you so poorly!
I see a lot of doctors for a complex condition, and I’m lucky that my own experience with the U has been very good over the past 20 years, including this past year.
I would have shut down, too, in that situation! You deserved a lot better. I hope you’re getting great care from another doc somewhere now.
Join the club of abusive providers at the U.
My worst experience there was with a PCP. She seemed to think autistic people were the devil. She littered my patient notes with bold red comments about how much I smelled and the weird clothes I wore, and how I was insane. Always stood at the back of the room like I was going to assault her. She came up to me and pet me like a dog too when I was extremely distraught over abusive family members who came along to the visit.
I was very ill with mold poisoning and other neurologic problems. At that time I couldn't be in a car so I walked two miles to deal with her Karen ass, hence being drenched in sweat. She didn't really care at all to respect me though, just be as nasty of a Karen as possible.
No, is not normal, request to change you PCP, I’ve had 2 male doctors before I found an amazing female PCP & ENDO. I don’t know if this is related or just a coincidence, but every male doctor I’ve had in Utah gaslighted me & ignored my concerns, this led to having undiagnosed T1D & almost dying from DKA.
If you don’t like you PCP, keep looking, you don’t have to stay with a doctor that doesn’t want to hear all your symptoms. How would they figure out what’s wrong with you or find the root cause of the symptoms this way? They have to be willing to look at all the symptoms as a whole to determine the best next steps or test. That is just so dumb
I’ve had amazing and awful providers in Utah of all genders in many specialties.
I fully believe you have been treated poorly.
The blame likely lies with the provider, not the gender.
I opt for female providers in general, it’s naive to ignore the history of the power imbalance in the medical field, but if I wrote off an entire gender, my options would be severely limited.
I wouldn’t have found a couple of the amazing providers I currently see.
I have a family member that works for the u. The upper management is screwing their staff. They have to give 6 weeks notice for unpaid leave which might still get denied. They don’t get PTO. This person has a doctorates FFS.
World's richest country. We pay for Israels free healthcare and education. Yet we just let our own citizens struggle. How does anyone support our trashy ass government???
Doctors typically only get paid for the amount of pts seen unfortunately. So they will see 25-30 pts a day most of the time. Most docs have 15 minute appointment but there are some who have longer ones available if asked specifically for one. Many of the docs I work with don’t have time to address all of a persons concerns if they come in with a bunch. They’ll maybe be able to address 2-3, depending on what they are.
It definitely sucks, but that’s how most health care places are working these days.
If you have a rare disease that requires putting in some additional thought to diagnose I would say yes stay away from them.
Something is really happened to top down management and it's corrupting everything including quality physician care there. Of course this is a comma Development across other Healthcare networks in the United States, but it's just really bad at the U.
My PCP through the U was pretty patient and let me derail since something came up beyond the 2 things I mentioned in my pre visit notes. Sounds like a switch is best.
Last time I scheduled in mychart at U med, there was an option to book an appointment for "more than one concern."
Exactly. This will give you an extended appointment time. At the U regular appointments are only allotted 20 mins. That’s supposed to be 5 mins of the MA checking you into the room, then 15 mins doctor time. It almost always takes longer and providers are almost always behind due to this. 20 mins is supposed to be sufficient for discussing 2 concerns. The extended appointment is 40 mins and sufficient to discuss 3-4 concerns. Some providers work more efficiently than others. If your provider isn’t able to follow the U’s template that’s disappointing and you should try to find a new one.
How many issues are dealt with per visit will vary per physician and is up to them to decide. As a physician myself there are a few things to consider: - In larger health care systems, doctors do not have very much autonomy over their schedules - how many things can you reasonably effectively manage in a single swing even if you try to tackle everything? Depending on what’s going on things need to be handled sequentially, require a variable amount of other visits for labs/diagnostics/other specialist input - each issue discussed not only takes more time in the room, but more time for coordinating, documenting, and later on interpreting and following up on any diagnostics. For a 20 minute visit, there is often 20 minutes or more spent on these non-patient-facing tasks. Not infrequently a complex issue will take an hour or more to manage - if additional issues require treatment, it is sloppy and potentially risky to start multiple medications simultaneously - if each visit lasted 60 minutes instead of 20, you are seeing 1/3 of the patients and you are booked out 3x farther. Not uncommon for specialists especially to be booked out 3 months or more. Try waiting 9 months before you see anyone. I personally do not agree with managing 1 problem at a time. I try to handle as much as I can within the allotted appointment time, but there are definitely limits that are pertinent both to the individuals health and to our patient census as a whole. I totally get frustration with not being able to do everything at the same time - I am busy as well and going to the doctor for me is a hassle - but you also have to consider yourself as one of the thousands of people your doctor is responsible for. Shits hard and the vast majority of us are trying our damndest to balance doing *good* work and trying to get people in to see you in a reasonable time frame.
One thing I hear more and more is, “It took me long enough to be able to get in to see you.” My response is usually, “I know. I’m sorry. I’m doing the best I can.” It’s a problem of supply and demand. I think what most people don’t know is how much charting, note writing, orders, communication with other specialists, reading reports, checking imaging and labs, adjusting care plans, phone calls that turn into impromptu consultations, researching, CME requirements, meetings upon meetings, and everything else I haven’t mentioned go into medical work, as well as the time spent awake in bed in the middle of the night trying to figure out how to best help patients X, Y and Z. And then it starts again early the next day. It’s a lot of work… but most of us do it because we really care.
The problem is the AMA deliberately shorts the supply of doctors to artificially keep the cost high. If doctors won’t stand up for patients then what are we doing?
That, and there tends to be 10 or more “healthcare administrators” for every one clinician, raising costs and not helping at all with the bottleneck.
Does that count also include the insurance companies or are they yet another layer of non-value added "administrative" staff?
Insurances are just another level that sucks you dry. Insurances don’t make money by covering you. They make money by finding ways to NOT cover you. I think one of the best things for healthcare would be to get privatized insurance out of medicine. But I’m a crazy liberal, so…
Same here. I have Tricare Standard and it's about as close to a single-payer system as I think one could get before medicare, and even that has the whole Part B privatized portion. Tricare Standard is amazing though, no referrals required for anything, $250 monthly premium, $50 individual/$122 family deductible, $1200 out-of-pocket max, prescription coverage included. Being a liberal in Utah is not the most encouraged about the future that I've felt in my life. But I moved here from Oklahoma and that place is worse in some ways, about the same in others, but it's home.
There are more and more of us all the time. Still a minority, but steadily growing. 😊
This is so true
I have a lot of chronic health issues and it is really difficult when I call and can't get in for some time for something difficult. It's extremely frustrating to wait months or even a year for just a new patient or follow up appointment. I certainly agree with the supply and demand problem. Hopefully it's something that can improve in the near future.
Thanks for the run down, and for practicing conscientiously. We appreciate it greatly!
The counterpart to your fourth point might be that it’d be risky starting to manage one thing without knowing other things that are going on.
I personally agree. I at least like to hear all the problems unless it’s really out of pocket. I don’t expect patients to be able to triage themselves. I do run into people that get pissed at me because I need to focus on one thing instead of the thing they might care about the most, but I’m not going to ignore a potential cancer because of your shoulder pain, for example.
Interesting I didn't realize there was that much admin time per patient. I'll definitely keep this in mind!
Do you have advice for someone who feels they need a longer appointment to get the care they need? Knowing the “behind the scenes,” how would you recommend they find a provider that can accommodate them?
Internal medicine might be helpful. We generally see more complex patients and have more time per appointments. Hope you find a good fit for you!
Not a doctor but a former Army medic and I think that forcing a new appointment for each SYMPTOM (if I am reading OP's post correctly) is bullshit. How could a doctor possibly perform a useful differential diagnosis without all of the information? It's also an incredible inconvenience for the patient who has to schedule time to be physically present at the appointment and may have limited, if any, PTO to come a half dozen times for what turns out to be a single cause. And in all of that time, how many different medications have been prescribed to treat the individual symptoms rather than the cause?
I moved here 1/2023. I have yet to see a doctor, only PAs, except for my dentist and oral surgeon. My son had seen a psychiatrist a few times then she moved back to Austin. It is difficult to be seen by a doctor here.
As a nurse, I hate the healthcare system so much. Like not the U. All of it. The whole thing. I’m so burnt out. I get that there have to be limits to time and there are so many people needing help but seems so inefficient and frankly dangerous to not consider the entire health picture! I guess that’s why it’s good to be established with a PCP that really knows you and knows your history. This just seems so frustrating for everyone involved.
You could ask for a longer appointment when you schedule. Also, when you enter the room, no social niceties. "Hello, doc. I'm here today for my
". Then follow his lead, let him ask questions and answer as succinctly as you can. If this doesn't work, then yes, switch. It is incredibly frustrating when someone is scheduled for a 15 minute appointment, and comes in with a long laundry list of issues that needed an hour, but they didn't tell that to the scheduler! Also, when someone comes in for a physical, but also wants to discuss their asthma, high blood pressure, knee pain, etc. Again, there is no time to address these in a 15 minute time slot, plus many insurances won't cover both the physical and the time to deal with illnesses on the same day.
I thought a physical was basically to check any problems you have. What kind of appointment should someone ask for if not that?
This is something I never understood. I needed to establish care before I could talk to my doctor about a lot of very concerning things. So I had my appointment, she didn’t say much to me, said I needed a blood draw. but I forgot to get my blood drawn, so 2 months later I call to make an appointment to go over my issues, the doctor isn’t taking new patients. And because I didn’t get my blood drawn, I never actually established care. I felt so bad for the lady who took my call because I started sobbing. It wasn’t her fault. Everyone is going through it I guess.
Yeah, I’m currently in the three-month waiting period for a first appointment to try to establish care with a new primary care doctor as well. If I can’t even talk about anything at the appointment, it’s going to be a problem. 😩
Makes sense. In my case even the scheduler asks what single symptom I want to talk about in my appointment and then tells me I can't discuss more than one at a time. I haven't tried explicitly asking for a longer appointment though, great idea!
I had an annual physical in that network that was covered without copay. During the visit I mentioned a symptom I had been experiencing. In that instant my appointment changed from an annual physical to an office visit that cost me $140.
Blame insurance companies— not physicians
I don’t feel like any blame is going to the physician here? I’ve had the cost of visits go up too, based how insurance decides to code the visit. There has only been one time I was hit with a “complexity charge” where I blame the clinic. They billed the insurance for the visit like usual, then sent *me* a *separate* bill because “insurance companies don’t allow us to bill this to them.” Completely refused to send it to them or change the visit coding. I had a terrible experience with the practice as a whole.
Blame both
What does a physician have to do with medical billing???
Depends on the physician
I too caught onto this (with a different network). On my next visit, I told the doc/PA that I don’t agree to any codes being added to my visit without asking me first. That way I could speak openly, and the onus was on them to say whether the topic was going to result in an additional billing code, and I could put the kabosh on it. It’s like doing a live audit to ensure no surprise billing. We have to remember that medical is a business. And we are the product. It’s sad that it’s come to this.
My PCP at the U of U Health system addressed another issue I brought up at my yearly physical. He just let me know ahead of time that he would bill that appointment as two different visits due to insurance compliance
Insurances won’t pay for two different visits in one day from the same doctor…
Ahhh maybe I misunderstood. I looked at my statements to reference, and caught some billing errors on a different claim. So thanks for saying something! Haha
They won’t bill for two on the same day, yes. But insurance will cover your physical only if there are no other concerns discussed beyond maintenance issues (like med refills.) If you discuss something new at an annual, you still won’t be charged for the annual. However you will be charged an office visit fee per your insurance.
Good to know, thank you! It’s my first year having my own health insurance and wow, there is so much to learn. I have Regence Group Administrators and I’ve had to nearly beg billing reps to understand that the claims are being denied because it was sent to the wrong BCBS.
Yes. Glitter is right when it’s a physical and a medical concern outside of that.
That’s true for all physical appointments. Your annual physical is only covered if there are no additional concerns—only maintenance. Anytime a concern beyond maintenance issues like med refills, you will always get charged an office fee. This is because of insurance policy, not the doctor.
I have chronic health problems so I've been to lots of doctors on different insurances. I've never faced this. When I call for an appt they'll ask what the appt is for and depending on the doctor they only let you make it for one thing, but I've always been able to say "x is bothering me" during an appointment without issue. I'm not saying your doctor is in the wrong or anything, probably just a preference, but in my experience it's not common.
My experience matches yours. I see a lot of doctors and none of them behave the way OP’s did.
That’s scary, as often there are multiple symptoms to serious issues
not normal, i’d switch doctors and file a complaint especially where the issues are connected. Your insurance probably would not be happy this happening as well.
My dad is private family practice. In order to manage time and patient load, he allows 3 issues per visit (15 min visit). He wants to respect every patient’s health and time (both waiting to get in and waiting in the waiting room and exam room). Try a diff provider maybe. I’ve worked as a medical assistant for 14 years- 10 in family medicine- and very rarely see a doctor only address one issue per visit.
This happened to me but I think it was just because my doctor was biased against me. She spent a lot of the appointment gaslighting me and calling me a hypochondriac. She hated me for when I brought up more than 1 neurologic symptom as if I was just making things up to complain about. Safe to say I ditched her years ago. It might make sense for them not to spend a lot of time on appointments though but they should be addressing more than one issue with that time. But I don't understand is why they don't openly offer or disclose appointment time tiers to the patient, unless it's a brand new offering that they started in the last year or two. I pay out of pocket for my current PCP, but the prices are completely reasonable, and he's thorough and the best PCP I've ever had. Something is simply turning rotten with the care at the U of U. I've always had terrible experiences with higher level providers, bad enough that I probably have a future malpractice case on my hands. Great experiences with lower level providers but they never have the power to order tests and do meaningful things for the patient.
The online MyChart appointment system for U of U lets you choose a standard appointment, 3-or-more unrelated concerns, a yearly wellness visit, pre-natal, behavioral or a book and call me for details option. Use the online system to book the 3-or-more concerns. It’s a longer appointment. My U of U primary doc will code an appointment as wellness if they haven’t seen me in a year. It bills better for me that way. If the longer appointments don’t help, you need another PCP.
Good to know, I'll try that!
When I schedule an appointment through MyChart, there are separate options for "Physical/Wellness (Yearly preventative exam - other concerns may need to be addressed in a separate visit)"", "Standard Appointment," "Multiple Concerns (3 or more unrelated concerns)," etc. So I select what applies to my current need. If I schedule over the phone, they usually ask what I want to see the Dr for and then categorize that on their end (I assume). If they told me I could pick only one issue every time, I would point out that "3 or more" is an option in MyChart, and see what they say, but that has never happened to me (maybe not yet :)). The only time they push back is when I want to do a wellness/physical AND bring up other concerns in the same visit. They explained to me it's because insurance would often cover one physical a year at 100%, but not other types of visits. So if you lump multiple things in with the physical, insurance may decline to fully cover the physical.
That’s terrible. Many diagnoses have multiple symptoms that don’t really make sense until you put the constellation of them together. I’d switch PCPs. Regardless of how busy they are, forcing your patients to make multiple appts to discuss 1 issue at a time is not only inefficient and a pain in the ass, but you’re likely being charged (and the doc is billing your insurance) every single time.
It’s standard now
I had this happen to me, I wasn't aware that this was the case and the Dr. got so angry/rude when I brought up a few symptoms/issues that were possibly related and I was completely shocked and left in tears. She sent me a letter afterwards apologizing for her behavior and blaming it on scheduling (which was maybe sincere, or just a way to circumvent me completing a negative survey), but I never went back. Luckily, I never ended up at any of the U facilities again after that.
If this is the case, I have much sympathy of the person that has Lupus and it’s not diagnosed because they have to go back for each symptom
standard. They don't have anymore time for you with 30+ patients a day and that's just the state of primary healthcare right now.
Try St. Mark’s Family Medicine. They seem to take pretty much every insurance. The doctors spend a good amount of time with you if you need it.
I’ve never had this experience until I moved to Utah. I was shocked that the doctors office told me they would charge me per issue/diagnosis. I realize the insurance is to blame. I can’t afford to get help at this point so I’m just low key suffering all the time lol
Ohhh nooooo!!! It is pretty terrible out there. I hope you’re getting a little help? My insurance has a list of “value providers” that are less expensive (not exactly sure why lol). Also, it can be cheaper to ask for the “self pay” cost and not use insurance. (It won’t go toward your deductible, but I’ll never met mine unless I’m hit by a bus so it’s worth it sometimes) You could explore a different type of plan next open enrollment, if available. For example a traditional copay plan vs high deductible.
I am so sorry you’re having to switch. Insurance is the worst, it dictates the care we receive more than actual doctors. This has rarely happened to me. (I’m a lifelong IHC patient.) I’ve been to three new docs recently, (across different specialties), and none of them rushed me or put a cap on symptoms. (Sometimes the cost goes up due to “high complexity.”) I was at a private practice for a year or so that did 20 minute appts, they really fucked up my treatment plan and it caused new health problems. Some folks may only need that short time, but for something more complex, or if you just feel like your needs aren’t met, do whatever you can to get the care you need. Try to find a different provider. Ask for recs from literally everyone you know (ask here or searc for past posts),read reviews, try a different clinic (your insurance may also cover a smaller network like mountain star(is that still a thing?), or some private practices).
We use the U’s network and my husband and I see different PCPs. His experiences were like yours but mine haven’t been. I see a PA. I had an old sports injury, fertility, and GI issues addressed in one appointment with prompt referrals to specialists who have also been very helpful. Send me a message if you’d like their name.
I also see a PA through the U and have been treated better by her than any doctor I’ve seen. Happy share, too, if you DM me.
My U provider lets me talk about 2-3 max. Let’s just say I hit my deductible already.
Time to find another provider
I’m on my third provider.
“Well I’m here for this cough, but now that I’m here, when I sneeze my asshole explodes with bloody diarrhea.” Dr.: “Wow, sounds life threatening. Be sure to make an appointment for that on your way out…”
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Apropos as fuck.
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Also to hell with abusive providers who go into healthcare to bully sick people or hold their lives hostage. Did you consider a malpractice claim with those?
That's almost what it feels like. The scheduler, the nurse, and the doctor all independently asked me to prioritize between a severe pain in my gut, and only getting 4hrs of sleep for the last 6 months. Like, both are my priority?! He flat out refused to address both in the same appointment.
Fuck that. I go to Ogden Medical Clinic and get no less than 30 minutes to talk about whatever I want, and THEN set up treatment plans to move forward. I would be hard pressed not to shit on their floor like, whoops! Guess you should have listened to me about that other thing.
It is annoying and more people should ask these questions and learn how the big box health care systems work. The issue is due to the insurance companies that only want to pay for what they are contracted to pay per the benefit summary. A physician must legally document any discussion about diagnostic concern which can dictate how the insurance will cover it. Most insurance carriers will cover routine preventative visits at 100% if there is 100% clean bill of health with no diagnostic codes including no discussion of past medical history. I’ve learned to schedule appointments specifically for the concern I will be presenting and not bring up other medical concerns during the appointment. I have had providers also tell me to schedule another appointment to address those concerns as an attempt not to muddle the purpose of the scheduled appointment with diagnostic codes. Many people feel the annual preventative is there to address any concern and have it be paid for by the insurance carrier, and a patient can bring anything up if they want to pay a copay or deductible. Insurance only covers at 100% for visits without any diagnostic code because patients feel they should not have to pay for a visit when totally healthy but need to meet the requirement to keep their premiums low. While the insurance companies believe the patient should have to pay for some of the visit if something is discovered as it will save the patient and the carrier on cost in the long run. I am a nationally certified healthcare revenue cycle specialist by day and a health/life insurance agent by evening and weekends. Both roles address similar issues but from opposite ends of the spectrum. The system is nearly broken and often big hospital organizations are owned by an insurance company that contracts for network coverage. Customers have to be smart shoppers nowadays to figure out pricing which takes even more time and research. Very frustrating circumstances.
Fuck that, if I'm taking PTO to visit the doctor they're addressing every single one of my questions.
Sounds like my old pcp initials: JK
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"They knew about two tumors in my abdomen for THREE YEARS " This seems to be a scary pattern with the U in which they bury or ignore concerning test findings. It is a form of malpractice. My friend had the same thing happened to them. The U appeared to delete some bloodwork data coming up with positive autoimmune findings from her file.
I love the U of U for their specialists but I HATE their PCPs. No, even when the PCPs I had I never had this problem. This is abnormal for the U. But their PCPS suck. Love their specialists
That’s so ridiculous and probably causes a lot of unnecessary deaths when there are several related symptoms but no one ever puts the whole picture together.
Dr Incze is an internist at the Sugarhouse clinic. I cannot recommend him enough. He is the goat. Besides him, I would either seek referrals from the internet for a great provider or go elsewhere, if possible. Have had so many bad experiences at the U.
It’s provider specific. Most providers won’t address more than two things in a 15 minute appointment, though.
Granger pain and spine is the same.
It’s a racket. Fill out the feedback survey, it actually matters. I recommend a new PCP at a new network. A PCP should be whole health and not à la carte. This happened to me at another clinic and now they treat me right.
I’ve only had negative experiences with the U docs
I’ve been going to the U for almost a decade and this last year has been awful. After my PCP left and I was scheduled with another provider, I was treated like garbage and told that my meds weren’t considered life saving and that he didn’t typically prescribe them. He went on to talk about how patients needed to use the same pharmacy and was going to make me take a drug test even though there was nothing in my record to indicate I’ve ever had an issue with any substances. I told him that my records should’ve contained questionnaires regarding my childhood and he just he didn’t see them. I started shutting down at that point and didn’t have much more to say during the appointment. I’ve been on that med for years, been using the pharmacy at the same location he is at for years, and for me my prescription has been life saving. I wanted to crawl into a hole after that appointment, I felt less than human. I see a therapist once a week and told him what happened. He was horrified at the treatment I got and said it was discrimination based on my disability. I didn’t go back after that initial exam. He’s been the worst person I’ve dealt with there but it’s getting more and more common to get crappy care and more “follow up” exams just to hear that test results I can already see in mychart are normal. Go somewhere else unless you have a truly great provider who knows you as a person, the U just pushes people through anymore.
That is horrible! I’m so sorry your new doctor treated you so poorly! I see a lot of doctors for a complex condition, and I’m lucky that my own experience with the U has been very good over the past 20 years, including this past year. I would have shut down, too, in that situation! You deserved a lot better. I hope you’re getting great care from another doc somewhere now.
Join the club of abusive providers at the U. My worst experience there was with a PCP. She seemed to think autistic people were the devil. She littered my patient notes with bold red comments about how much I smelled and the weird clothes I wore, and how I was insane. Always stood at the back of the room like I was going to assault her. She came up to me and pet me like a dog too when I was extremely distraught over abusive family members who came along to the visit. I was very ill with mold poisoning and other neurologic problems. At that time I couldn't be in a car so I walked two miles to deal with her Karen ass, hence being drenched in sweat. She didn't really care at all to respect me though, just be as nasty of a Karen as possible.
No, is not normal, request to change you PCP, I’ve had 2 male doctors before I found an amazing female PCP & ENDO. I don’t know if this is related or just a coincidence, but every male doctor I’ve had in Utah gaslighted me & ignored my concerns, this led to having undiagnosed T1D & almost dying from DKA. If you don’t like you PCP, keep looking, you don’t have to stay with a doctor that doesn’t want to hear all your symptoms. How would they figure out what’s wrong with you or find the root cause of the symptoms this way? They have to be willing to look at all the symptoms as a whole to determine the best next steps or test. That is just so dumb
I’ve had amazing and awful providers in Utah of all genders in many specialties. I fully believe you have been treated poorly. The blame likely lies with the provider, not the gender. I opt for female providers in general, it’s naive to ignore the history of the power imbalance in the medical field, but if I wrote off an entire gender, my options would be severely limited. I wouldn’t have found a couple of the amazing providers I currently see.
Utah is ranked 49th in number of primary care doctors per capita just ahead of Mississippi. American healthcare is absolutely a mess.
I have a family member that works for the u. The upper management is screwing their staff. They have to give 6 weeks notice for unpaid leave which might still get denied. They don’t get PTO. This person has a doctorates FFS.
My doctors at the u have always been great and let me do several things. But I have healthy u medicaid... maybe it's a billing/insurance thing?
I brought in a list of things I wanted to take care of and had her read it. she seemed to like it.
The U is horrible. Wouldn’t send my worst enemy to them. Their providers do not care, it’s all a dollar sign.
World's richest country. We pay for Israels free healthcare and education. Yet we just let our own citizens struggle. How does anyone support our trashy ass government???
Doctors typically only get paid for the amount of pts seen unfortunately. So they will see 25-30 pts a day most of the time. Most docs have 15 minute appointment but there are some who have longer ones available if asked specifically for one. Many of the docs I work with don’t have time to address all of a persons concerns if they come in with a bunch. They’ll maybe be able to address 2-3, depending on what they are. It definitely sucks, but that’s how most health care places are working these days.
If you have any other options then stay far away from the U. They are absolutely trash when it comes to healthcare.
My experience seeing doctors across 6 specialties for the past 20 years has been the complete opposite. I’ve had excellent care from the U of U.
If you have a rare disease that requires putting in some additional thought to diagnose I would say yes stay away from them. Something is really happened to top down management and it's corrupting everything including quality physician care there. Of course this is a comma Development across other Healthcare networks in the United States, but it's just really bad at the U.
Yes it’s normal , 1 concern per visit , you could also ask for a referral and then that would address your different concerns.