~premed~

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How much do internist get paid for one visit?
and also for blood test and urine test?
 

strawberryfield

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It depends on the complexity of the visit (i.e. focused, limited problem vs. complete physical, also if the patient is established or new to the physician, also depends on the amt of time physician spends w/ patient), also depends on if the physicians accept insurance or not and what insurance company will be paying, which often depends on the state....

at the IM office where I work, in AZ, office visit charges range from $55-$250 (lowest complexity est. patient-highest complexity new patient) but the actual amount the insurance companies pay for those services probably ranges from $25-$175,

not sure which "blood test" you're referring to, as there are hundreds of different tests that can be ordered... the charge for CBC (complete blood count) w/ diff is $13...insurance probably pays between $5-$10 for that, for CMP--comprehensive metabolic panel (includes glucose, lytes, liver and kidney function tests) our charge is $50, insurance probably pays between $15-$40 for it, and a charge for UA (urine) w/ microscopy is $10, insurance probably pays between $3-$7 for it. As said above, it really depends on the state and if the doc accepts insurance or not...also we have a full lab at the office, many physicians use outside labs in which case you'll be billed by an outside lab rather than the physicians office, although many will run simple urine dips and strep screens in the office...
 
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~premed~

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strawberryfield said:
It depends on the complexity of the visit (i.e. focused, limited problem vs. complete physical, also if the patient is established or new to the physician, also depends on the amt of time physician spends w/ patient), also depends on if the physicians accept insurance or not and what insurance company will be paying, which often depends on the state....

at the IM office where I work, in AZ, office visit charges range from $55-$250 (lowest complexity est. patient-highest complexity new patient) but the actual amount the insurance companies pay for those services probably ranges from $25-$175,

not sure which "blood test" you're referring to, as there are hundreds of different tests that can be ordered... the charge for CBC (complete blood count) w/ diff is $13...insurance probably pays between $5-$10 for that, for CMP--comprehensive metabolic panel (includes glucose, lytes, liver and kidney function tests) our charge is $50, insurance probably pays between $15-$40 for it, and a charge for UA (urine) w/ microscopy is $10, insurance probably pays between $3-$7 for it. As said above, it really depends on the state and if the doc accepts insurance or not...also we have a full lab at the office, many physicians use outside labs in which case you'll be billed by an outside lab rather than the physicians office, although many will run simple urine dips and strep screens in the office...


What do you mean by 'doctor charges 50, but insurance pays 15-40'?
Does it mean that the doctor gets paid only what the insurances pays or does the difference (between charge and what insurance pays) get paid by the patient?
 

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~premed~ said:
What do you mean by 'doctor charges 50, but insurance pays 15-40'?
Does it mean that the doctor gets paid only what the insurances pays or does the difference (between charge and what insurance pays) get paid by the patient?
Physicians contract to accept whatever an insurance plan will pay for covered services. They are not permitted to balance-bill patients for the difference. That's why physicians should always analyze an insurer's fee schedule before signing on to the plan.

If a service is non-covered (e.g., a cosmetic procedure), the physician collects their usual fee directly from the patient.
 

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~premed~ said:
What do you mean by 'doctor charges 50, but insurance pays 15-40'?
Does it mean that the doctor gets paid only what the insurances pays or does the difference (between charge and what insurance pays) get paid by the patient?
Agree with Kent above. A doctor can claim he charges whatever he wants, but that is irrelevant -- he won't get paid that. In most cases all the doctor will ever get paid is the amount the insurance companies are willing to reimburse, and will have a negligible number of noninsurance covered patients. So throughput is the name of the game.
There are a few "conceirge services" out there, where the doctors accept no insurance cases and only offer services to cash-paying customers, but these are few and far between and not realistic in the longterm, given the increase of folks covered by various plans.
 

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Maybe I'm reading too much into the question, but the physician pockets only a percentage of the amount charged to the patient. You gotta pay the rent, the nurses, the phone bill, etc., out of that money, too.

Don't forget production incentives from the clinics and pay-for-performance incentives from the insurance companies that will ultimately play into the physicians bottom line.
 

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ed2brute said:
Maybe I'm reading too much into the question, but the physician pockets only a percentage of the amount charged to the patient. You gotta pay the rent, the nurses, the phone bill, etc., out of that money, too.
Definitely -- overhead, insurance etc will be a fairly substantial chunk coming out of the amounts reimbursed by the insurance company.
 

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deuist said:
My preceptor charges $50; I don't know if every insurance company and Medicare pay that amount. I don't know about testing.
my internist charges in the neighborhood of $180 for an office visit...that's in chicago...not sure what region the OP is looking for
 

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jbrice1639not sure what region the OP is looking for[/QUOTE said:
Seems like he is trying to calculate an internist's income based on hourly fee and lab charges. Not sure it's of any value without knowing reimbursement amounts and expenses though...
Either that or he thinks he paid too much.
 

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My gf works for a doc in NYC, who charges around $450 for an office visit; that's just to walk in the door. He charges $1100 or so for a yearly physical, so combine that with the office fee and you're looking at $1550 for a physical! :eek: Oh yeah, and he doesn't accept insurance. This guy has patients lining up to see him; let's just say he's quite wealthy... Who says IM docs can't make money?
 

MossPoh

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I think I'll stick with my free physicals and buy fun stuff with the saved money before seeing new york guy.
 

strawberryfield

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~premed~ said:
What do you mean by 'doctor charges 50, but insurance pays 15-40'?
Does it mean that the doctor gets paid only what the insurances pays or does the difference (between charge and what insurance pays) get paid by the patient?
If the doc is contracted w/ the insurance co and the charges are covered, the doc agrees to accept whatever the insurance allows as "payment in full" so the different between what is charged and what insurance "allows" is usually referred to as a "write off."

A patient may or may not have to pay for something, depending on their insurance benefits...say an insurance co allows $30 for a $50 test, but applies $30 to the patient's deductible...the patient has to pay that $30, but not the additional $20 that is the "contractual write off" w/ the insurance co...if a physician participates w/ insurance then it is against the contract to bill a patient for any difference between what the doc charges and the insurance allows as w/ the contract a physician is agreeing to accept lesser payment as payment in full for services rendered that are covered by an insurance co... if services are not covered, then the physician can bill the patient for the full amount charged.
 

strawberryfield

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KentW said:
Physicians contract to accept whatever an insurance plan will pay for covered services. They are not permitted to balance-bill patients for the difference. That's why physicians should always analyze an insurer's fee schedule before signing on to the plan.

If a service is non-covered (e.g., a cosmetic procedure), the physician collects their usual fee directly from the patient.
exactly :thumbup:
 

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strawberryfield said:
if services are not covered, then the physician can bill the patient for the full amount charged.
This is a very important point. The same thing occurs with hospitals billing the uninsured for services rendered. The hospital will accept less (sometimes much less) from an insurance company, but if you don't have insurance, you're on the hook for the full amount.
 

Law2Doc

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joe6102 said:
This is a very important point. The same thing occurs with hospitals billing the uninsured for services rendered. The hospital will accept less (sometimes much less) from an insurance company, but if you don't have insurance, you're on the hook for the full amount.
Then again, 9 out of 10 uninsured people who visit the typical hospital are collection proof and pay nothing. ever.
Same thing can happen to doctors, which is why most are happy to take insured patients who, although they can't be billed as much, are guaranteed to generate some reimbursement amount.
 
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