When you go see a doc and give a copay, how much do they actually get paid?

[yalla22]

So if i go and see my internist for example just for a checkup, i know I give like a 20 dollar copay..but how much does the internist actually get for seeing me? I know it probably varies, but what is a range?

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[lilnoelle]

the copay is a small amount of what gets paid in the end because your insurance company pays them as well. I think its pretty normal for the physician to get about a third of what they would charge a cash paying customer from the insurance company.

 

[BeatrixKiddo]

So if i go and see my internist for example just for a checkup, i know I give like a 20 dollar copay..but how much does the internist actually get for seeing me? I know it probably varies, but what is a range?

probably like 30-50 bucks

 

[ms2007plz]

A doctor that I work with told me that primary care doctors get $8/visit for Medicaid patients when we were discussing what is wrong with our healthcare system...I don't know how much they get for insured patients.

 

[riceman04]

A doctor that I work with told me that primary care doctors get $8/visit for Medicaid patients when we were discussing what is wrong with our healthcare system...I don't know how much they get for insured patients.

Yeah...my pops (he's a private prac interninst in an underserved community where the majority of his patients are either on medicare or medical...the Cali form of medicaid) intentionally wanted me to open up one of his medicare checks with the hope that it would dissuade me from pursuing medicine. The check was like $3.75...this was for a regular visit for which he billed.

 

[djquickfingers]

Yeah...my pops (he's a private prac interninst in an underserved community where the majority of his patients are either on medicare or medical...the Cali form of medicaid) intentionally wanted me to open up one of his medicare checks with the hope that it would dissuade me from pursuing medicine. The check was like $3.75...this was for a regular visit for which he billed.

ouch!!! But isnt that the point of the medicaid system? To provide healthcare for people who wouldnt otherwise beable to have access to it for the sheer lack of money? I mean, if you wanna make the big bucks, then have cash customers and some insured, but if you really want to help people, then the underserved is the way to go.

 

[yalla22]

Thats so crazy..i just dont understand, every doctor I know is doing well financially..how is that possible make 3.75 to see a patient-is that because he's in an underserved area and docs not in that position would make more?
Also, how would this differ from being a dermatologist for example and doing regular checkups?

 

[lilnoelle]

Yeah...my pops (he's a private prac interninst in an underserved community where the majority of his patients are either on medicare or medical...the Cali form of medicaid) intentionally wanted me to open up one of his medicare checks with the hope that it would dissuade me from pursuing medicine. The check was like $3.75...this was for a regular visit for which he billed.

This is why many physicians don't take medicaid or medicare. The physicians where my husband works don't accept medicaid or medicare but then work in an eye clinic once or twice a week, which is essentially volunteer work.

 

[BeatrixKiddo]

This is why many physicians don't take medicaid or medicare. The physicians where my husband works don't accent medicaid or medicare but then work in an eye clinic once or twice a week, which is essentially volunteer work.

I've opened a few Medicaid bills as well. The trick is to see so many patients that the 3 dollars adds up and you get a check of like $200 so you feel all rich and stuff.

 

[LizzyM]

As one of my friends says, "When you lose money on every patient, you can't make it up in volume." This is a huge problem in geriatrics where virtually every patient is on Medicaid and/or Medicare. Ditto any of the specialties that have a case mix that is predominately disabled adults (as they are covered by Medicaid).

When insurance agrees to pay up to a maximum amount for a given servicethe amount varies by insurance company, by location, and isn't a fixed percentage of every bill. (Docs often enter into agreements to accept insurance without even knowing what the maximum is for a given procedure). When I took one of my kids for a routine visit with immunizations, the amount billed was $435, insurance paid $283 and I was responsible for $45 which included the $25 copay a $20 eye exam which insurance claimed was not covered. mad: don't get me started on that last point).

 

[Cirrus83]

So if i go and see my internist for example just for a checkup, i know I give like a 20 dollar copay..but how much does the internist actually get for seeing me? I know it probably varies, but what is a range?

It's not that hard to find out...your insurance company actually should be able to tell you how much they paid. They actually mail me statements summarizing what they approved, etc.

It varies of course, but I see my physician file for anything from like $70ish to $100ish. And my old pediatrician would file for various things. I think one time I just went and talked to her and she referred me to a new doctor and she filed for that but they rejected it because they thought I had switched doctors before seeing her (stupid insurance company), but either way their negotiated rate was like $12 or something nonsensical, so they sent me a notice that I would be responsible for the $12. Apparently my pediatrician had already closed it out since it was silly anyway, but I had already filed for a petition to get it fixed since she actually was still my PCP when I had seen her. My pediatrician's office workers told me to just cancel the thing with the insurance company but I didn't since it was already filed lol. Anyways, long story short, they got another $12.