Why can't physicians bill patients directly?

[GalenAgas]

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Something like this:

Mr. Doe sees Dr. John. Dr. John bills Mr Doe directly though he does accept as part of payment whatever medicare will cover. The remaining bill goes to Mr. Doe.

So if Dr. John bills for $100 and Medcare's fee schedule covers $50 the remaining 50 will go to Mr. Doe

 

[rog411]

Physicians can bill patients directly if they do not use or don't have insurance. Insurance companies usually prevent physicians from billing directly because it would ruin their business model.

 

[badasshairday]

Medicare does not allow for balance billing as you suggested.

 

[GalenAgas]

So all we have to do is, as a whole, force the insurance companies to allow balance billing.

Sounds like a plan!

 

[calvnandhobbs68]

Another reason to become a dentist..

 

[rog411]

So all we have to do is, as a whole, force the insurance companies to allow balance billing.

Sounds like a plan!

Yup. They can't stop us!

 

[GUH]

Nothing stops you from billing patients for 100% of the bill directly.
You are not required to accept medicare or medicaid.

 

[Winged Scapula]

I am not aware of any private payor insurances that allow for bulk billing either.

 

[GalenAgas]

What if we shifted some of our overhead to the patients directly.

For example, the nurses/techs/vampires can be part of a company that directly bills for services (starting IV's drawing blood etc). The billing company can also bill the patient for setting up the billing. Machines/scanners/infusion/dialysis/etc could be rented from XYZ Medical Rental Company such that anyone who is a patient at ABC Medical Office gets a bill from this entity separate of what the physician would bill for. That way the physicians are not technically balance billing. The corporation ABC Medical office or XYZ Medical Rental Company is simply billing for its own separate cost and perhaps this entity does not accept medicare.

note: I am assuming that the physician reimbursement subsidizes part of the overhead and covering overhead would dramatically improve the capacity to make a practice profitable.

 

[GalenAgas]

deleted

 

[Winged Scapula]

What if we shifted some of our overhead to the patients directly.

For example, the nurses/techs/vampires can be part of a company that directly bills for services (starting IV's drawing blood etc). The billing company can also bill the patient for setting up the billing. Machines/scanners/infusion/dialysis/etc could be rented from XYZ Medical Rental Company such that anyone who is a patient at ABC Medical Office gets a bill from this entity separate of what the physician would bill for. That way the physicians are not technically balance billing. The corporation ABC Medical office or XYZ Medical Rental Company is simply billing for its own separate cost and perhaps this entity does not accept medicare.

note: I am assuming that the physician reimbursement subsidizes part of the overhead and covering overhead would dramatically improve the capacity to make a practice profitable.

Stark Violation.

 

[deleted393595]

Something like this:

Mr. Doe sees Dr. John. Dr. John bills Mr Doe directly though he does accept as part of payment whatever medicare will cover. The remaining bill goes to Mr. Doe.

So if Dr. John bills for $100 and Medcare's fee schedule covers $50 the remaining 50 will go to Mr. Doe

OP, check this video out. Ignore the misleading title though.

[YOUTUBE]0uPdkhMVdMQ[/YOUTUBE]

 

[sazerac]

Can the doctor not accept insurance, and bill the patient in full, and then if the patient has insurance the patient seeks reimbursement from their insurance company directly? This would seem to solve a lot of problems. If an insurance company is really difficult to deal with or provides extremely low reimbursements, it will become very unpopular with their (patient) customers.

 

[werd]

Can the doctor not accept insurance, and bill the patient in full, and then if the patient has insurance the patient seeks reimbursement from their insurance company directly? This would seem to solve a lot of problems. If an insurance company is really difficult to deal with or provides extremely low reimbursements, it will become very unpopular with their (patient) customers.

can the doctor not accept insurance? yes.
and bill the patient in full? yes.
and then... the patient seeks reimbursement from their insurance? no.

insurances are set up to reimburse providers at a negotiated rate (ie $110 charged, insurance negotiated rate of $60... insurance pays $48, patient gets a bill for the remaining $12), but to my knowledge don't reimburse patients directly.

you either accept an insurance or you don't.

 

[JGimpel]

As long as there are hungry physicians a couple years out of residency, there will be companies, including Medicare, to take advantage of them. Your goal, as is the goal for many physicians that are still trying to make a good living, is to get to where Medicare is only 25% of your practice. Then you focus on keeping only the top 3-5 insurers that pay well and have the least problems with reimbursement overall. After that, you open up the "concierge medicine" part of your practice where patients pay a certain amount per year to get better access and faster response times from you. This is why you'll see one physician selling his practice for $2 million when he retires when the guy down the street in the same field can barely get $500k.

Opt out of Medicare and your quality of life will improve substantially. If we all opt out of Medicare, our government will get the message. By the way, we're looking at almost a 30% pay cut this year if this whole "cliff" thing they pull every year doesn't get postponed...again.

 

[NickNaylor]

Can the doctor not accept insurance, and bill the patient in full, and then if the patient has insurance the patient seeks reimbursement from their insurance company directly? This would seem to solve a lot of problems. If an insurance company is really difficult to deal with or provides extremely low reimbursements, it will become very unpopular with their (patient) customers.

Unless you're going to change that overnight, though, it won't work. Why would a patient willingly choose to see a physician that creates more work for the patient when he/she can simply go down the road to a different physician and not deal with that nonsense?

(sent from my phone)

 

[michaelrack]

can the doctor not accept insurance? yes.
and bill the patient in full? yes.
and then... the patient seeks reimbursement from their insurance? no.

insurances are set up to reimburse providers at a negotiated rate (ie $110 charged, insurance negotiated rate of $60... insurance pays $48, patient gets a bill for the remaining $12), but to my knowledge don't reimburse patients directly.

you either accept an insurance or you don't.

Some insurances will reimburse patients directly for out of network services; it is a lot of paperwork for the patient however and usually the reimbursement is only a fraction of what the patient paid the doc. This is only a practical option in certain limited situations (well-motivated, intelligent patient getting frequent, regular services from a doc). Some psychiatrists will do this (the ones treating the less severely ill).

I agree that you either accept an insurance or you don't. This method puts the responsibilty entirely upon the patient and most will not accept this model, and even those who do will have a lot of difficulty actually collecting the $ from their insurance co.

 

[michaelrack]

Unless you're going to change that overnight, though, it won't work. Why would a patient willingly choose to see a physician that creates more work for the patient when he/she can simply go down the road to a different physician and not deal with that nonsense?

(sent from my phone)

Some psych patients will do this if they find a psychiatrist who gives them what the need/want (skilled treatment in some cases, xanax/ritalin in other cases). Some pain docs can also go this route.

To do this, you either need to give excellent treatment that is highly valued by the patient; or hand out narcs like they are candy.


Obviously, I do NOT recommend the liberal prescription of controlled substances.

 

[GalenAgas]

As long as there are hungry physicians a couple years out of residency, there will be companies, including Medicare, to take advantage of them. Your goal, as is the goal for many physicians that are still trying to make a good living, is to get to where Medicare is only 25% of your practice. Then you focus on keeping only the top 3-5 insurers that pay well and have the least problems with reimbursement overall. After that, you open up the "concierge medicine" part of your practice where patients pay a certain amount per year to get better access and faster response times from you. This is why you'll see one physician selling his practice for $2 million when he retires when the guy down the street in the same field can barely get $500k.

Opt out of Medicare and your quality of life will improve substantially. If we all opt out of Medicare, our government will get the message. By the way, we're looking at almost a 30% pay cut this year if this whole "cliff" thing they pull every year doesn't get postponed...again.

Yes the 26 percent cut is why I made this post.

 

[sazerac]

Why would a patient willingly choose to see a physician that creates more work for the patient when he/she can simply go down the road to a different physician and not deal with that nonsense?

Why would a physician willingly choose to see a patient that creates more work for the physician when he/she can simply send the patient down the road and see a different patient and not deal with all that nonsense?

(Obviously I'm not talking about emergencies or major hospitalizations, but rather the day to day primary care visits.)

 

[achamess]

OP, check this video out. Ignore the misleading title though.

[YOUTUBE]0uPdkhMVdMQ[/YOUTUBE]

+1

This guy is the man. He's reclaiming the doctor-physician relationship. What a novel concept - to know the price of medical care BEFORE a service is rendered. Revolutionary 😉

I hope what he's doing is still allowed in the coming years.

 

[NickNaylor]

Why would a physician willingly choose to see a patient that creates more work for the physician when he/she can simply send the patient down the road and see a different patient and not deal with all that nonsense?

(Obviously I'm not talking about emergencies or major hospitalizations, but rather the day to day primary care visits.)

Because your options are either 1) operate a cash only practice which many people will not be able to afford or 2) accept insurance and deal with the nonsense. Physicians have very little bargaining power in this situation it would seem.

 

[rog411]

Unless you're going to change that overnight, though, it won't work. Why would a patient willingly choose to see a physician that creates more work for the patient when he/she can simply go down the road to a different physician and not deal with that nonsense?

(sent from my phone)

I would put up with more work as a patient if the physician was good enough. Not all physicians are the same quality-wise.

 

[investing101]

It is a dog leash on doctors. Government would love to do something similar to those people that earn cash on the side or on the job.