[wighty]

> The nurses have left and you can't legally 'bill' or code the appointment without the nurses.

What? I've never heard this requirement and I cannot think of why it would be the case (I'm a PCP). The rest of your comment is pretty much the issue as PCP though. I have at least 30 minutes a day of "out of visit" requests (reviewing documents from outside hospital/consults, labs, imaging, other results, extra nurse patient triages) in addition to anywhere from 30 minutes to 2 hours of completing my notes each night.

The payment methods for primary care do not work.

[maxerickson]

I think it's pretty stupid that basic appointments are billed on complexity and not time. Well, and lots of other things too. Getting a radiologist to do a definitive diagnosis using imaging doesn't actually make the ER doctors job harder (rather, it de-risks the interaction for them).

It's also ridiculous that I have to promise to pay any bills that my insurance won't cover. If some care can't be justified as medically necessary, there should be a specific contract for that when it comes up, not a blanket rider prior to accessing treatment.

Forcing the two sophisticated entities to have a workable agreement where they can't dump costs off on the individual patient would at least improve perceptions of care.

[nradov]

The No Surprises Act included some protections against balance billing. It's still a problem but somewhat less than before.

https://www.cms.gov/newsroom/fact-sheets/no-surprises-unders...