Exactly how bad are doctors getting shafted by insurance companies?

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dantt

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Today, my doctor's billing person showed me how much the insurance company would have reimbursed them for a diagnostic test. It was less than their cash price. I suspect the cash price is near breaking even. I say would have because the deductible first must have been met. At those breakeven prices, there's no way in hell I'd ever be able to clear my deductible unless something pretty bad happened to me.
 

JohnMadden

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While insurance companies are often given a bad rap, please remember that the US government is the largest health insurer in the country.

Most private health insurance companies follow a standard set by Medicare. That is, they pay rates that are anywhere from 80% to 130% of what Medicare pays for a particular test, procedure, ect.

Medicare is expected to cut physician professional fee reimbursement by 10% this year, unless Congress steps in at the last minute, as they have done in the past.
 
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W

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Also keep in mind that the physician's reimbursement will probably vary from private carrier to private carrier even though the fee schedule is supposedly constant. In other words, let's say his best reimbursement is from Aetna at $90/level I visit. Also assume that you have something like Cigna which agreed to $75. The doc will bill at $90 because that's the fee, only Cigna will send you a notice that says they were overbilled and you aren't responsible for the difference.

Screwed? Perhaps, but it's still up to the doc to accept the insurance plan. There's nothing stopping you for asking for cash only as a doctor. You can turn the patient away at the receptionist's desk if he/she is broke. There's a fine balance between maintaining your clientele and balancing revenue. A Beverly Hills plastic surgeon who is highly valued can take credit cards or cash only and do quite well without having to hassle with insurance.

The biggest thing now is that healthcare is becoming more privatized--HCA, Quest Diagnostics, drug companies, etc. aren't in it to help people anymore. They're out to make a profit off of people becoming ill. Then you have to invite the lawyers to the table to fend off lawsuits from the other greedy dogs who want their piece of the pie too.
 

baylormed

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Wait, so am I . . .

My Porsche is going to have a bumper sticker that says, "Your skateboard bought my car."

Hell, I'm going to market it. Think about it, it could work for critical care, ortho, or neurosurg!

Emergency Medicine!!

You can always count on people doing stupid things. As long as they don't get any smarter, we'll have our jobs.
 
W

Wizard of Oz

Wait, so am I . . .

My Porsche is going to have a bumper sticker that says, "Your skateboard bought my car."

:thumbup:

I realize that your post was in jest, but I should have made my point differently. Docs invest in their education so that they can bill for services rendered yes, but I draw the line at investing in private companies in an effort to transiently snowball cash from a passive standpoint at the expense of another person's health. There's no place in healthcare for public ownings IMO, but I suppose that if the old way worked better than they wouldn't be selling out to companies in the first place. I do have an issue, though, when they put the name of a school or religious group on the side of the hospital for marketing even though no such affiliation exists.

I brought up Quest and HCA because I've worked for both (and still work for HCA), and I have indeed witnessed sacrifices in patient care in exchange for increased profit for stockholders (though I guess HCA wasn't a great investment since it's off the market now). I've seen sweatshop labor employed by inadequately trained/paid employees and extensive shortcuts taken to minimize labor and maximize bottom lines. And don't get me started on Six Sigma...
 

braluk

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Emergency Medicine!!

You can always count on people doing stupid things. As long as they don't get any smarter, we'll have our jobs.
Lol just finished watching Jackass 1 on TV...
 

BellyDancingDoc

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Wait, so am I . . .

My Porsche is going to have a bumper sticker that says, "Your skateboard bought my car."

Hell, I'm going to market it. Think about it, it could work for critical care, ortho, or neurosurg!

If you will market this bumper sticker, I will buy it from you. I promise. :thumbup: :smuggrin:
 

maestro1625

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Wait, so am I . . .

My Porsche is going to have a bumper sticker that says, "Your skateboard bought my car."

Hell, I'm going to market it. Think about it, it could work for critical care, ortho, or neurosurg!

well your paintball gun paid for my college education... yay for opthalmology in the family. :D
 

dantt

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The cash price is substantially higher than the actual cost. This is one issue in the whole "Health Disparities" field: Poor people with no insurance become responsible for bills that are substantially higher than their insurance would have paid, if they had insurance.

Are insurance companies screwing doctors? Depends how you look at it, I guess. They pay less than the doctors want them to pay, but you don't see a lot of practices filing for bankruptcy.

That is one aspect of it. The purpose of this cash price however, is for patients with poor insurance coverage who would rather pay a lower, essentially under the table price than have to cover their deductible. We were just so surprised the contract price was still less than the cash price.
 
W

Wizard of Oz

Compare this to dentistry practice, where the contract price is often higher than the cash price.

Actually this can be true for doctors too. When I used to have to go to a derm, my cash price was lower than what my insurance had been billed after I lost my insurance. Aetna? $86 Visa? $56 It saves them a lot of hassle messing with insurance companies, so it can be worth it to take cash. A bird in the hand is worth two in the bush.
 

Law2Doc

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They pay less than the doctors want them to pay, but you don't see a lot of practices filing for bankruptcy.

Unless you hang out at the bankruptcy courts, you wouldn't "see" this, even when it occurs. Actually it depends on what you consider "a lot". But from a legal perspective I have seen more than a few physicians/practices seek bankruptcy protection. Not due purely to reimbursements, more frequently due to a variety of bad business management choices, but yes, it in fact happens more than you would think.
 

laurenem

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Totally depends on which insurance companies. Private companies tend to be ok when it comes to reimbursing. The trick is, if you are primary care and own a private practice (and I mean really private... not owned by the local hospital or clinic...), you cannot afford to take medicare/medicaid or self pay. In the town I work (small city), the majority of the primary care physicians are owned by the hospital/clinics. Then, there is the practice I work for and another doc who was privately owned. That other doc, took EVERYONE on as patients. He did not screen for what type of insurance people had... and he went out of business a short time after opening. We are the only primary care private practice remaining. And the reason we're around is that we don't take any medicare/medicaid/self pay patients. When you hear about horrible reimbursements, people are typically thinking of government run medicaid/medicare... not the private companies. And now Bush wants to cut funding for medicare... (what are these people thinking??)
 

smq123

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Wait, so am I . . .

My Porsche is going to have a bumper sticker that says, "Your skateboard bought my car."

Hell, I'm going to market it. Think about it, it could work for critical care, ortho, or neurosurg!

That's sick, but still pretty funny.

My sister did an organ transplant fellowship. She's started calling motorcycles "donor-cycles." Sad, but true.
 
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