Feb 27, 2010
66
2
0
Status
Attending Physician
Often much of the debate on healthcare reform boils down to an opinion over whether a person trusts government or not. Personally, I do not trust government. As an example let me relate my story about attempting to get payment for my services as an anesthesiologist.

After noticing that my Medicare payments had appeared to not be coming in, I contacted my billing company. My billing company contacted Medicare. My billing company had numerous telephone contacts, faxes, application forms sent back to Medicare. After months of this, Medicare then claimed none of this communication actually occured, (despite my billing company producing faxes documenting the communication).

Finally, my billing company asked if I could conference call with Medicare to try to get information. Finally we were able to conference with a Medicare representative (this was no small feat to speak to an actual person). After identifying myself as the physician and explaining the problem (No payments received for months), the representative explained that she could give me NO information. She could not explain why she could not even give information to the physician for whom billing was being done. After we persisted in explaining the insanity of the situation (whose privacy are they trying to protect), the Medicare rep then finally relented somewhat to tell us that someone had filled out a Medicare form using an extra space somewhere in the form so that they could not process the form. When we asked if we could simply resubmit another corrected form, we were told no. That we needed to know who actually filled out the form. Once again, I pointed out that the billing was being done for me, but she refused to allow us to correct the form without knowing the name of the billing company person who actually filled out the form (What difference does this make?). The billing company person then went through a guessing game, until after several tries she named the correct person.

At this point, she told us what form needed to be resubmitted. I thought things were almost done-boy was I wrong. So after getting the form, filling it out, we waited, and waited, and waited. Months go by. My billing company has been calling Medicare, but were told that it is being reviewed. Medicare would not give out the name, telephone or contact info of the analyst reviewing the form. Finally, we are lucky and get the email address of the analyst reviewing the form. About a month later, the analyst informs us that the form we submitted has expired, and that another form must be filled out and submitted.

After filling out another form and submitting it we are told that another piece of information on the form does not match their records, and must be resubmitted. Bottom line after over six months, countless telephone calls, faxes, emails, certified mails, they finally say that there records are correct.

If I had any choice in accepting Medicare, do you think I would still take it? Medicare knows that Anesthesiologists are a hospital-based practice, and are obligated to accept medicare payments by their contracts with hospitals. Therefore, IMHO, since Medicare knows they can screw anesthesiologists they do.
 

carlosc1dbz

10+ Year Member
Jan 29, 2007
306
21
251
Southern California
Status
Attending Physician
That must be terribly annoying. It is scary to think that the goverment will control reimbursements? What is to keep them from saying they don't want to pay you, or that they want to cut reimbursements by 40% then 30% the year after that. If they become the only one paying out, no one can really do anything, except decided to stri....I mean take a vacation, since doctors cannot unionize.
 

daveyjwin

Senior Member
10+ Year Member
Jun 9, 2005
301
7
251
FL ,USA
Status
Attending Physician
Yes yes, because the government is out to get us, and soon all Doctors will get paid the same as teachers. I mean, yes, getting reimbursed can be a pain in the ass, but that's true for Medicare and Insurance companies. Frankly, I'd rather have someone incompetent who's not trying to make a profit paying me (the government) , instead of someone who's highly competent and trying to eek every penny out of the system to pad their bottom line.
 

Instatewaiter

But... there's a troponin
10+ Year Member
Apr 28, 2006
6,022
2,031
281
Washington
Status
Attending Physician
Yes yes, because the government is out to get us, and soon all Doctors will get paid the same as teachers. I mean, yes, getting reimbursed can be a pain in the ass, but that's true for Medicare and Insurance companies. Frankly, I'd rather have someone incompetent who's not trying to make a profit paying me (the government) , instead of someone who's highly competent and trying to eek every penny out of the system to pad their bottom line.
I think his point was not that gov't is out to get us (although our system of gov't was set up because gov't was out to get the people), but rather the sheer bureaucracy involved when dealing with the gov't is frustrating. At least insurance companies have an interest in keeping you happy, otherwise you will drop them and accept their competition. Quite frankly, while frustrating, insurance companies are nowhere near as bad as the gov't.

To me, what Orangele sounds like something out of The Trial.
 

MOHS_01

audemus jura nostra defendere
10+ Year Member
Oct 2, 2005
11,855
7,476
281
the old rickhouse
Status
Attending Physician
Yes yes, because the government is out to get us, and soon all Doctors will get paid the same as teachers. I mean, yes, getting reimbursed can be a pain in the ass, but that's true for Medicare and Insurance companies. Frankly, I'd rather have someone incompetent who's not trying to make a profit paying me (the government) , instead of someone who's highly competent and trying to eek every penny out of the system to pad their bottom line.
Tell me, oh wise one, what entity you currently purchase from is not out to get as much money as it can out of your sorry ass? Now tell me what stage of your career you are in.

Only the incompetent prefer the incompetent; to the rest of us incompetence is just plain ****ing annoying.
 

RabbMD

ASA Member
10+ Year Member
May 13, 2008
216
0
241
Status
Attending Physician
No one has ever answered why doctors should trust the government to fairly pay doctors if they ever obtain monopoly power, ie a single payer. The only evidence we have is how Medicare reimburses in situations where they have essentially monopoly pricing power. Like stated above hospital based specialties are doctors that have to in effect accept Medicare. Look at the rates Medicare pays when they have this monopoly power. They pay 33% ie 66% lower than what private payers pay. Why would they do any differently to other specialties once they have monopoly reimbursement power. Doctors are "rich" and thus subject to the fairness Obama wealthv redistribution doctrine for the betterment of the country.
 

MOHS_01

audemus jura nostra defendere
10+ Year Member
Oct 2, 2005
11,855
7,476
281
the old rickhouse
Status
Attending Physician
Rabb,

They have not, and will not, because they cannot.
 

coffeeslug

7+ Year Member
Oct 1, 2009
9
0
1
Status
Couple of questions from the peanut gallery

1) Why don't docs get payment from patients and then empower patients to get reimbursed from their insurance company?

2) Is is possible for docs to push towards a cash-based practice with the incentive being cheaper prices and longer appointments? (IF no how are dentists able to do something similar)
 

coffeeslug

7+ Year Member
Oct 1, 2009
9
0
1
Status
Often much of the debate on healthcare reform boils down to an opinion over whether a person trusts government or not. Personally, I do not trust government.
The way this bill was "pitched" to the American people is a great example of just how dishonest and incompetent the muppets in Washington truly are.

Here is a great letter from the Chamber of Commerce Board of Directors that I saw earlier on the WSJ and it outlines several key important facts that demonstrate just how terrible the current legislation is. Our liberal media tends to forget these facts and focus on puppies and unicorns.


http://online.wsj.com/public/resources/documents/chamber0330.pdf
 

MOHS_01

audemus jura nostra defendere
10+ Year Member
Oct 2, 2005
11,855
7,476
281
the old rickhouse
Status
Attending Physician
1978.


[YOUTUBE]http://www.youtube.com/watch?v=VPADFNKDhGM[/YOUTUBE]
 

Dr McSteamy

sh*tting in your backyard
10+ Year Member
Oct 22, 2006
3,024
1
0
Status
Couple of questions from the peanut gallery

1) Why don't docs get payment from patients and then empower patients to get reimbursed from their insurance company?
won't work because it places a huge burden on the pt.

and many pts don't have the means, or want, to pay the whole cost up front.

if your visit cost $200, and the insurance-dr negotiated rate and denied charges result in a final bill much less than $200, then the insurance reimburses you a small sum, and you have to go back to the dr to get a refund on the rest. Too many parties involved. too much hassle.
 

tncekm

MS-1
10+ Year Member
Jul 18, 2006
3,616
4
0
Status
Medical Student
Tell me, oh wise one, what entity you currently purchase from is not out to get as much money as it can out of your sorry ass? Now tell me what stage of your career you are in.

Only the incompetent prefer the incompetent; to the rest of us incompetence is just plain ****ing annoying.
And, just to make the point, the government DOES attempt to get as much money as possible out of people. E.g. You can get a $20 cell phone ticket in CA that turns into $150 after all the fees. Some cities are now charging $300 per 911 call. LA uses it's water and power supply company (LADWP) to funnel massive amounts of cash into the general fund--they allow raises in the electricity rates, although a surplus already exists, and the LADWP then forward cash to the general fund. I can go on, and on, and on for ages.

The government is not only just as greedy, but far more crooked and has become highly authoritarian.
 

Blue Dog

Fides et ratio.
Gold Donor
10+ Year Member
Jan 21, 2006
12,084
4,785
281
Status
Attending Physician
Why don't docs get payment from patients and then empower patients to get reimbursed from their insurance company?
Some do, although due to the cost of procedure-based specialty or surgical care, most cash-only practices are in fields like primary care and psychiatry.

Is is possible for docs to push towards a cash-based practice with the incentive being cheaper prices and longer appointments? (IF no how are dentists able to do something similar)
The percentage of patients who have dental insurance is much lower than those with medical insurance. Dental care isn't cheap, either. The average dental visit costs in excess of $200. Because of this, many patients forgo dental care until its too late. It would be a mistake to wish this upon the medical profession.

if your visit cost $200, and the insurance-dr negotiated rate and denied charges result in a final bill much less than $200, then the insurance reimburses you a small sum, and you have to go back to the dr to get a refund on the rest.
A refund is unlikely. In a cash-based practice, all insured patients are out-of-network. There is no contract between the doctor and the insurer. Fees are set by the practice, and payment is typically made in full at the time of service. The doctor's office will not file any insurance claims, although they can provide patients with documentation to enable the patient to file a claim themselves. If a patient's insurance company doesn't reimburse the full amount of the bill, it's the patient's problem, not the doctor's...as it should be.
 

Dr McSteamy

sh*tting in your backyard
10+ Year Member
Oct 22, 2006
3,024
1
0
Status
A refund is unlikely. In a cash-based practice, all insured patients are out-of-network. There is no contract between the doctor and the insurer. Fees are set by the practice, and payment is typically made in full at the time of service. The doctor's office will not file any insurance claims, although they can provide patients with documentation to enable the patient to file a claim themselves. If a patient's insurance company doesn't reimburse the full amount of the bill, it's the patient's problem, not the doctor's...as it should be.
true for out of network.

but i was assuming the other poster's hypothetical in-network model with negotiated rates........ where the sequence of events is shuffled so that the dr sees money sooner, and the burden of paperwork is on the pt:
pt sees in-network dr,
pt pays up front,
pt asks ins co for reimbursement........
which will not work because certain things get denied, which means pt overpaid.
 

Sol Rosenberg

Long Live the New Flesh!
10+ Year Member
Feb 12, 2006
3,534
7
251
Living in America
Status
Attending Physician
true for out of network.

but i was assuming the other poster's hypothetical in-network model with negotiated rates........ where the sequence of events is shuffled so that the dr sees money sooner, and the burden of paperwork is on the pt:
pt sees in-network dr,
pt pays up front,
pt asks ins co for reimbursement........
which will not work because certain things get denied, which means pt overpaid.
What do you mean "won't work?" This is the way things worked up to and through most of the 1980s. Having a 3rd party directly pay the doctor is a relatively recent phenomenon.
 

Blue Dog

Fides et ratio.
Gold Donor
10+ Year Member
Jan 21, 2006
12,084
4,785
281
Status
Attending Physician
true for out of network.

but i was assuming the other poster's hypothetical in-network model with negotiated rates........ where the sequence of events is shuffled so that the dr sees money sooner, and the burden of paperwork is on the pt:
pt sees in-network dr,
pt pays up front,
pt asks ins co for reimbursement........
which will not work because certain things get denied, which means pt overpaid.
If the doctor is participating with an insurance provider, they have agreed to submit claims on behalf of the patient and to accept as payment in full the insurance company's negotiated fee schedule for covered services. You can't make the patient submit their own claims, and you can't balance-bill the patient. If you do, you will likely be kicked out of the plan and forced to repay any overpayments. If you do this with Medicare, you can face fines or jail time.
 

docB

Chronically painful
Moderator Emeritus
Lifetime Donor
10+ Year Member
15+ Year Member
Nov 27, 2002
7,742
213
281
Las Vegas, NV
Status
Attending Physician
true for out of network.

but i was assuming the other poster's hypothetical in-network model with negotiated rates........ where the sequence of events is shuffled so that the dr sees money sooner, and the burden of paperwork is on the pt:
pt sees in-network dr,
pt pays up front,
pt asks ins co for reimbursement........
which will not work because certain things get denied, which means pt overpaid.
If the doctor is participating with an insurance provider, they have agreed to submit claims on behalf of the patient and to accept as payment in full the insurance company's negotiated fee schedule for covered services. You can't make the patient submit their own claims, and you can't balance-bill the patient. If you do, you will likely be kicked out of the plan and forced to repay any overpayments. If you do this with Medicare, you can face fines or jail time.
If a patient pays for something and then the insurer denies the claim does it really mean the patient overpaid? Under the current system where the doc does the procedure and then tries to get reimbursed and it gets denied the doc just provided the service for free. We all know that insurers deny claims for some really stupid reasons. Why should the doc bear all the risk for the denials? I suppose we are expected to understand insurance policies better than the patients but do we? I know I don't.
 

Blue Dog

Fides et ratio.
Gold Donor
10+ Year Member
Jan 21, 2006
12,084
4,785
281
Status
Attending Physician
Under the current system where the doc does the procedure and then tries to get reimbursed and it gets denied the doc just provided the service for free.
Not necessarily. If it's a non-covered service, you bill the patient (if you knew it was a non-covered service, you should've gotten payment up front).

If it's a covered service, but is denied based on some stupid technicality (e.g., i-not-dotted or t-not-crossed), simply fix it and re-submit.

If they deny it again, you bill the patient.

If the patient doesn't like it, tell them to call their insurer. Meanwhile, they need to pay you.

This works great in private practice, where you have the option to dismiss people who don't pay their bills. In the E.D., it's another story.
 

docB

Chronically painful
Moderator Emeritus
Lifetime Donor
10+ Year Member
15+ Year Member
Nov 27, 2002
7,742
213
281
Las Vegas, NV
Status
Attending Physician
Not necessarily. If it's a non-covered service, you bill the patient (if you knew it was a non-covered service, you should've gotten payment up front).

If it's a covered service, but is denied based on some stupid technicality (e.g., i-not-dotted or t-not-crossed), simply fix it and re-submit.

If they deny it again, you bill the patient.

If the patient doesn't like it, tell them to call their insurer. Meanwhile, they need to pay you.

This works great in private practice, where you have the option to dismiss people who don't pay their bills. In the E.D., it's another story.
Yeah, I obviously see everything through an EM filter.

So I understand what you're saying but that would seem to force the doc to be very well versed in all of their patient's different insurances and all of their varying policies. How does any doc keep up with that? Do you just have to call and verify insurance before you do anything?

I think I already know the answer based on the large numbers of patients I see every day sent to the ED for testing that should have been done outpatient.
 

Blue Dog

Fides et ratio.
Gold Donor
10+ Year Member
Jan 21, 2006
12,084
4,785
281
Status
Attending Physician
So I understand what you're saying but that would seem to force the doc to be very well versed in all of their patient's different insurances and all of their varying policies. How does any doc keep up with that? Do you just have to call and verify insurance before you do anything?
We don't accept every type of insurance, so we understand those we do accept. We also verify insurance coverage at every visit (e.g., look at the patient's insurance card). We have software that takes care of some of the verifications prior to the visit, but it doesn't work for all insurers (including Anthem, the 800-lb. gorilla in our market).
 

Impromptu

ASA Member
10+ Year Member
Feb 19, 2009
556
139
281
Status
Attending Physician
One 'regulation' that would probably save the biggest chunk of the health care dollars would be to make all insurers have the same set of rules for billing, 2nd opinions, pre-authorizations, and so forth. Those hundreds of different rules for hundreds of different companies for thousands of different billable events are the reason the administrative costs are so high in private insurance as compared to government/single payer.

It is in the insurance companies' interest to keep it confusing, that way they can deny as much as possible.
 

docB

Chronically painful
Moderator Emeritus
Lifetime Donor
10+ Year Member
15+ Year Member
Nov 27, 2002
7,742
213
281
Las Vegas, NV
Status
Attending Physician
One 'regulation' that would probably save the biggest chunk of the health care dollars would be to make all insurers have the same set of rules for billing, 2nd opinions, pre-authorizations, and so forth. Those hundreds of different rules for hundreds of different companies for thousands of different billable events are the reason the administrative costs are so high in private insurance as compared to government/single payer.

It is in the insurance companies' interest to keep it confusing, that way they can deny as much as possible.
The insurers often have those differences on purpose just to make their insureds pay for better service. Often the bargain basement insurance requires a referral for every specialty visit and the more expensive PPO coverage allows self referrals for example.