That's why when you first come into a doctors' office you sign papers saying that YOU are responsible for costs even if your insurance doesn't cover it. It is you job as the policy holder and the ones paying the premiums to know what you plan covers and doesn't cover. If it's found later your insurance doesn't cover it, then you are responible for it.
Often times doctors tell patients, for something that might not be covered (i.e. skin tags or seborrheic keratoses) to check with their insurance to see if it's covered or not. Insurance plans change so often, and even from year to year (covered one year, but not covered the next year) there is no way a doctor can tell u if something is covered or not.
What's your point? If you prescribe Xarelto instead of warfarin and find out later it's not covered. You as the physician get the phone call from Pharmacy.
How do YOU know it's not a significant burden? You think doctors memorize every single freakin' network they are a part of when it changes so often? So what happens if the assistant surgeon is not a part of the network? The surgery and all the pre-op work stops?
Well in the original article the providers were in-network, at least until the patient was under anesthesia. Then the out-of-network providers suddenly showed up, like a pack of hyenas. It seems a little unfair to put that burden on an unconscious patient.
Yes, I'm sure they showed up like a pack of hyenas in The Lion King. I'm sure they came in completely unannounced.
You realize that different insurance companies have different plans right? Not all of them have the same benefits. Doctors may know which insurance companies they take, but they won't know each and every plan under 1 insurance company (which has been negotiated btw the insurance company and the pt's employer) and it's unreasonable for you to expect them to do so. Patients are buying medical services although they're paying thru a third party. Any costs are their responsibility. This is no different than a dentist's office.
And again, each insurance company (Humana, Cigna, BCBS, etc.) have TONS of separate plans. I don't think you realize how many plans an insurance company has, of which you may not be in-network for every single one of them. There's a reason each time you sign up for a plan as a patient you get an entire booklet listing the benefits that you get. Even out-of-networks are covered differently in different plans.
When you call into a doctor's office they immediately ask for the name of your insurance co., the member number, group number, etc. to check and see that you are in-network. You can still see the doctor if you are out-of-network, but you'll pay much more out of pocket. There are even some people who (before Obamacare) paid all their medical costs out of pocket. Try to understand how health insurance actually works before pontificating on it and putting nearly all the onus on the doctor.
that doesn't matter at all. insurance is a service and if they want to take advantage of that service, they are responsible for understanding it. that doesn't mean they actually have to understand. you don't actually read every privacy policy you submit to. im sick of this crap where medicine is some holy ground where it's our job to watch over patients and do stuff for them. it's not. their insurance, their responsibility. I doubt they'd be thrilled if I told them that they need to understand my future malpractice insurance for me.
Misconception. Hospitals just add more complexity. Example : An academic office I trained at was in a hospital, so the hospital tacked on a $400 "facility fee" to all the CLINIC visits. They did this because many plans would pay. But those whose plan didn't pay couldn't afford to come see the subspecialist more than a couple times.
If the govt. was really concerned about costs, they wouldn't allow places to charge facility fees for the SAME SERVICE that an outpatient facility can offer.
Exactly.
I should cut back on removing cancers to spend all day calling other physicians and hospitals and see what plans they're on as well.
Physicians can not memorize every single dinky insurance company with their reams of subplans and remember if they are in-network or not. Many times it changes year to year as to whether you're even in their network which varies by plan. Not all Humana plans are equal. Just go to ZocDoc and there are TONS of plans that each company offers.
No, I'm not expecting premeds, or medstudents to understand those intricacies. The reason I know more about subplans, recently is bc of Obamacare (bc the office would take the private insurance company's plan but not the Obamacare exchange version from the SAME insurance company)
It's pretty black and white: the existing billing system sucks.
I agree on this specific issue. It is very intricate and convoluted. That's what happens when you have a third party involved to pay your medical bills and as a patient you're relatively insulated from the real price of things. I was more referring to the person above who obviously doesn't know what the term out-of-network means and its ramifications.
You are a dyed in the wool SDNer. A leopard (cougar) can't hide its spots.
Here from day 1!
Must be nice for her to lecture and pontificate from the lectern when you have the ability to leave it all and become a full-time writer like she can and live in Beijing.
Yeah, I didn't understand him either about joining the AMA. The AMA is the one that gave their blessing to pass this thing without which it would NOT have passed. Why did they do it? Bc they get 72 million dollars in govt. royalties for their CPT codes, which is much more than membership dues. Not at all surprised they don't represent actual physicians. Then when they complain like this: http://www.kevinmd.com/blog/2012/09/ama-member-complain.html, about people leaving - it shows they are just plain out of touch.
I recently got some AMA form about why I'm not "engaged with the AMA" as a resident.
Not at all shocked that he believes something should be forced (AMA makes you pay dues, by the way) all under the banner of "professionalism". It's why the word doesn't have any power for medical students bc stupid **** gets labeled as unprofessional when it isn't.
That I'm not sure as the story doesn't say. I'm just amazed that people who actually read the article felt sorry for the patient and thought that the patient came up with the 110k when the article even says that the insurance company gave the patient the check and the patient WILLINGLY withheld it until he had no choice.
