January 2012 Insurance

The Doctor Is In

Gail Hacker MD
Gail Hacker, MD

January 2012

But I have insurance. Why can't I come to the Health Clinic?

health clinic graphic icon of stethoscopeWell, you can. BUT, there are some sticky points. We are not contracted with any insurance plans, and we do not have the ability to bill any insurance plans. Some insurance plans require you to see your own primary care physician or nurse practitioner for routine health care needs, before seeing a specialist, or before going to the emergency room.  Some insurance plans won't allow us to order any diagnostic tests because we aren't contracted with them.

Why don't we bill? We are not a free standing health clinic. Luckily LCC recognizes the value of providing health care on site, (we are the only community college in the state that offers such services), and has provided the space, people, and supplies we need to practice medicine, but we are not a separate financial entity.  The clinic operates under the college business plan and any fees charged during your visit are billed to your student account or "L" account if they are not paid at the time of service. Those fees are generally quite a bit lower than they would be at a private health clinic, and not all visits generate any additional fees. We are happy to generate a statement for you that you can submit to your insurance company to see if you can be reimbursed for any charges you paid to LCC.  The list of services provided as part of your health care fee you pay is listed elsewhere on this site and I would encourage you to visit it.

Why do some insurance plans require you to have a primary care provider (PCP)? As a board certified family physician I am proud to be trained to offer care to all people, of all ages, with a variety of health issues. But I am no longer considered a PCP by health insurance plans. Why? A PCP must be able to see you or talk to you at any time, night or day, weekend or holiday. The clinic is not staffed at a level that allows this.  A PCP is there to take care of your health care needs to the extent of his/her ability, and then to coordinate your care with other specialists as needed. While we can do some of this, we do not know which specialists your insurance plan contracts with and cannot make these referrals for you. It is in your best interest to have a PCP that gets to know you over time, understands your needs and personality, and helps you to navigate your way through our rather complex health care system. Many of you are students and will only be here for a limited time. We will do our very best to meet your needs while you are here at Lane, but we are not able to provide all that a PCP can provide.

Why is OHP so different? It actually isn't different. If you have been lucky enough to get on the Oregon Health Plan, sometimes referred to as LIPA, you have an excellent opportunity to get your health care needs met. The OHP is what is called a managed care plan. This means that you have a PCP, either assigned by OHP or chosen by you, and you can get health care that more than 50% of your fellow students cannot get. But you have an agreement with LIPA, who administers OHP in Lane County, to utilize your PCP for all but urgent or emergent health issues. Your PCP is receiving money every month from LIPA to help you organize your health care. Your PCP is the only one, other than emergency room physician, that can prescribe medication, order tests, or refer you to other doctors. This is why we ask if you have OHP when you call to schedule an appointment. If you are one of the fortunate people on campus to have qualified for OHP we will encourage you to see your PCP for routine health care appointments and for ongoing management of chronic medical problems.  We are always available to see you for more urgent issues, but remember we cannot order certain tests, in particular x-rays or MRIs, so you will need to contact your PCP if you think you may need diagnostic testing.

woman in sunshineIn conclusion, while we are very proud to offer medical services that are above and beyond what many college health clinics are able to offer, we cannot be everything to everybody. If you are asked to contact your PCP when you call to schedule an appointment, there is a reason for this. We are available to all students and staff that pay the health care fee for urgent problems, but we cannot replace your PCP if you are lucky enough to have one. We all love what we do, are committed to providing the very best health care, and will be there for you when you need us.

Supporting you in good health,
Gail Hacker, MD