Author Topic: Medical Appointments  (Read 787 times)

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Offline Mediman14

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Medical Appointments
« on: May 09, 2019, 09:42:34 »
Recently I attended my specialist appointment and we was discussing waiting times. The specialist informed me that DND pays the same price as Medicare does for Dr’s Appointments. What I didn’t realize till now was that the Dr’s was being paid a lot more than normal to see Military Members. This explains why military personnel are able to receive Appointments quicker than the average civilian. With DND paying the same now as Medicare, this places military members on the same level as everyone when it comes to getting specialist appointments. End point is that Members now face the same wait time as others. Maybe this was case all along but I know in my neck of the woods, that wasn’t the case.

Offline Blackadder1916

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Re: Medical Appointments
« Reply #1 on: May 09, 2019, 12:39:08 »
Recently I attended my specialist appointment and we was discussing waiting times. The specialist informed me that DND pays the same price as Medicare does for Dr’s Appointments. What I didn’t realize till now was that the Dr’s was being paid a lot more than normal to see Military Members. This explains why military personnel are able to receive Appointments quicker than the average civilian. With DND paying the same now as Medicare, this places military members on the same level as everyone when it comes to getting specialist appointments. End point is that Members now face the same wait time as others. Maybe this was case all along but I know in my neck of the woods, that wasn’t the case.

I suppose that I could call "urban myth", but with all the factors at play and thirteen different jurisdictions with sometimes different rules applying to medical billing, it could be said that the CAF paid more for referred medical services and that was why some said military members got to the front of the line quicker.  The same comment was also made for those who sought medical services for Workers Compensation Board (WCB) covered medical conditions.  However, based on my past experience (though now quite dated) as both a CF health administrator (the guy who paid the bills) and formerly the manager of a multi-location, multi-practitioner civilian medical group (the guy who submitted the bills), I would say that is a very simplistic description of the situation and most likely incorrect.

Where to begin?  That's how I started a two hour presentation to the clinic managers and senior medical clerks about this very topic.  Actually it was about setting fees for "uninsured services" (IOW, everything not paid by provincial health insurance) and making the most of collecting the best rate for those services.  Yes, it is easy to set a premium for "uninsured services" but it was not a free for all.  Besides the limitations that may be placed by guidelines published by a practitioner's college (his licensing body) or by a provincial medical association (often his bargaining agent with the provincial gov't re fees) there may be restrictions placed on billing practices by provincial Medical Acts (the legislation giving authority to practice the profession).  Additionally, depending on the "third party payer", limitations on payment may be set by the third party either by regulation (in the case of some government agencies) or by an entity (usually an insurer) who can mandate (or negotiate) rates due to the volume of their client base.

In my experience, the CAF was never able to mandate fees because our referred volume of service was never so great in any one location that there was competition from the limited pool of service providers that they would accept anything less than the maximum they could claim.  That being said, while there may have been medical service providers who had no compunction about trying to gouge the CAF, I never noticed it.  And on the few occasions when I submitted bills for services to CAF patients the amounts were within the various guidelines which were usually above (but not much above) the provincial schedule of benefits (and believe you me, I had no compunction about setting the highest fee possible regardless of who was the payer).

Having a quick look at some of the Medavie Blue Cross guidelines online, there does not seem to be any specific limitations on fees for professional medical services to CAF members.  So how does one account for a perception that military members got preferred service if specialists weren't getting rich by seeing a handful of soldiers each year?  My opinion - personal relationships.  Some on the part of the referring doctor with the consultant.  Some just the personal preference of the consultant with regards to seeing a particular type of patient.  And probably a lot of the time the personal relationship of the referring doctor's referral clerk (or whatever the title/occupation of the person who does this) to the person who does the bookings for the consultant.
« Last Edit: May 09, 2019, 12:57:44 by Blackadder1916 »
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Offline Mediman14

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Re: Medical Appointments
« Reply #2 on: May 09, 2019, 18:35:50 »
Blackladder,
    Interesting reply! Thanks for the insight. Working with several Physicians, who also "moonlight"/ work in the ER of several civilian hospitals, they often tell us that regular civilian Physicians love seeing military members in the ER (after regular work hours of the military clinic) because they get more money than seeing the average civilian. However, given that it is an ER, triage level take priority!
      Having an agreement with certain specialty's, such as Cardiologist, Ortho's would explain why military members get in sooner than most.

Offline Lumber

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Re: Medical Appointments
« Reply #3 on: May 10, 2019, 09:59:46 »
I had to have an MRI done on my knee.

The PA said they had two hospitals they normally contracted the service out to: one in Hamilton, Ontario (where I was posted), and one in Mississauga (about 30 mins away).

They recommended, and I agreed, to go with Mississauga, and hte reason was this: for whatever reason, the Mississauga hospital was able to charge DND double the amount as the hospital on Hamilton, and because of that, they were willing to "squeeze" DND members into their schedule, whereas the hospital in Hamilton expected DND memebrs to stand in line with the rest of hte plebes. (I jest).

The net result was that I received an MRI in just short of 2 weeks after prescription, vice 6-8 weeks had we gone with the "closer" hospital.
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