My poor doctor
December 18, 2008 5:57 PM Subscribe
My doctor says my insurance only pays him twenty-one cents per visit. Help me understand this.
So I was at my podiatrist's office the other day, and he told me that he's not taking my insurance plan anymore (Oxford Freedom). He said it was because Oxford only paid twenty-one cents per visit. How can this be? I thought that the insurance payed the total of the bill minus my co-pay. So, for instance, if the charge was $50, I would pay $10, and the insurance would pay $40 directly to the doctor. I'm realizing now that I have no idea how this stuff works. How could a doctor make a living wage at only a few cents per patient? Could someone please explain? Thanks all.
So I was at my podiatrist's office the other day, and he told me that he's not taking my insurance plan anymore (Oxford Freedom). He said it was because Oxford only paid twenty-one cents per visit. How can this be? I thought that the insurance payed the total of the bill minus my co-pay. So, for instance, if the charge was $50, I would pay $10, and the insurance would pay $40 directly to the doctor. I'm realizing now that I have no idea how this stuff works. How could a doctor make a living wage at only a few cents per patient? Could someone please explain? Thanks all.
Check your previous insurance statements from visits to the doctor in question. They will show exactly how much was paid. You can also ask for a summarized billing statement from the doctor's office, which will show what your insurance company paid. Alternatively, you can call your insurance company directly and ask. Those are the only ways to know for sure.
Various insurance companies contract with doctors and set an agreed upon amount which they will pay for different services. Even if your copay is only $10, it doesn't mean that the insurance company pays the exact difference between your $10 and what the doctor actually charges (although I seriously doubt they're only paying him 21 cents).
posted by amyms at 6:13 PM on December 18, 2008
Various insurance companies contract with doctors and set an agreed upon amount which they will pay for different services. Even if your copay is only $10, it doesn't mean that the insurance company pays the exact difference between your $10 and what the doctor actually charges (although I seriously doubt they're only paying him 21 cents).
posted by amyms at 6:13 PM on December 18, 2008
I don't really understand how this works either, but apparently your insurance doesn't always pay what the doctor bills. I discovered this when I was hospitalized last year - my bill came to $18k, of which my insurance paid less than half and nobody covered the rest. I don't understand this either but apparently that's how the system works.
posted by pombe at 6:13 PM on December 18, 2008
posted by pombe at 6:13 PM on December 18, 2008
With my insurance plan and, I assume, other plans there is a maximum billable amount for every visit, procedure, etc. By agreeing to take your insurance, the doctor also agrees to your insurance companies reimbursement rates, i.e. the maximum billable amount. So say your doctor charges $100 for a visit. Your insurance company might have a maximum allowed of $70, and so if you have a $10 co-pay, insurance will give your doctor $60, which he must accept as full payment. I would be really suprised if Oxford is paying him cents per visit though. Definitely get an itemized bill, or look at your insurance explanation of benefits.
posted by robinpME at 6:18 PM on December 18, 2008
posted by robinpME at 6:18 PM on December 18, 2008
Perhaps he meant 'pennies on the dollar,' or only 21% of what he considers your checkup to be worth?
posted by datacenter refugee at 6:20 PM on December 18, 2008 [1 favorite]
posted by datacenter refugee at 6:20 PM on December 18, 2008 [1 favorite]
I suspect your Dr. lied to you... or is really, really confused.
Check your bill
posted by HuronBob at 6:29 PM on December 18, 2008
Check your bill
posted by HuronBob at 6:29 PM on December 18, 2008
I bet datacenter refugee is right - pennies on the dollar makes sense.
posted by robinpME at 6:33 PM on December 18, 2008
posted by robinpME at 6:33 PM on December 18, 2008
Maybe he meant 21 cents per minute?
What's probably more likely is that he is paid $X per year to accept Oxford Insurance patients. And dividing that out per patient per visit, that might amount to 21 cents for your last visit of the year. However, he was probably paid much more for your first few visits, and he still gets your copay.
posted by gjc at 6:54 PM on December 18, 2008
What's probably more likely is that he is paid $X per year to accept Oxford Insurance patients. And dividing that out per patient per visit, that might amount to 21 cents for your last visit of the year. However, he was probably paid much more for your first few visits, and he still gets your copay.
posted by gjc at 6:54 PM on December 18, 2008
Nthing datacenter's theory that your doc may only be receiving 20% of what he bills Oxford.
Oxford has a reputation amongst healthcare providers as being a stingy reimburser. In some cases, it pays 40% less than Medicare. Since its merger with UnitedHealth Group, physicians have sued over this issue and dropped out of its plans.
"[D]efinitely the cellar of our reimbursement amounts," said one physician. Oxford's reimbursement rate for a minor surgical procedure was less "than what one would get paid to change the brake pad on your Ford," said another.
posted by terranova at 7:24 PM on December 18, 2008
Oxford has a reputation amongst healthcare providers as being a stingy reimburser. In some cases, it pays 40% less than Medicare. Since its merger with UnitedHealth Group, physicians have sued over this issue and dropped out of its plans.
"[D]efinitely the cellar of our reimbursement amounts," said one physician. Oxford's reimbursement rate for a minor surgical procedure was less "than what one would get paid to change the brake pad on your Ford," said another.
posted by terranova at 7:24 PM on December 18, 2008
My insurance does the same thing— pays somewhere between 30% and 50% of what the doctor would charge me if I didn't have insurance. You usually can't change insurance providers easily, but it's very easy to switch doctors, so the insurance company is negotiating from a position of power here.
posted by hattifattener at 7:24 PM on December 18, 2008
posted by hattifattener at 7:24 PM on December 18, 2008
Health insurance companies never pay what doctors actually bill. The way they do this is that they essentially tell physicians that the plan won't cover any patients unless the physician agrees to take whatever the plan decides to pay. So if the doctor bills $10,000, the insurance company will probably pay something between $3000 and $5000, the patient will pay about $1000, and the rest just gets written off. Physicians agree to this mistreatment lest they find that no insurance company will include them in coverage plans.
There are places where physicians have banded together to fight this. When a single entity grows to control a significant percentage of the hospital beds in a particular metropolitan area, they can usually tell the insurance companies to get stuffed, i.e. "We won't take any of your patients unless you pay us x." If the group saying that controls 40% of the hospitals in a city, the insurance companies will pay up. But unless that happens, physicians typically collect between 20% and 40% of what they actually bill.
This goes a long way towards explaining why the "cost" of health care has gone up as much as it has. Physicians aren't stupid. They know they're never going to get paid what they bill. So they bill two or three times what they actually need, so that when the insurance company pays their normal fraction, that fraction covers the physicians' costs.
posted by valkyryn at 7:47 PM on December 18, 2008
There are places where physicians have banded together to fight this. When a single entity grows to control a significant percentage of the hospital beds in a particular metropolitan area, they can usually tell the insurance companies to get stuffed, i.e. "We won't take any of your patients unless you pay us x." If the group saying that controls 40% of the hospitals in a city, the insurance companies will pay up. But unless that happens, physicians typically collect between 20% and 40% of what they actually bill.
This goes a long way towards explaining why the "cost" of health care has gone up as much as it has. Physicians aren't stupid. They know they're never going to get paid what they bill. So they bill two or three times what they actually need, so that when the insurance company pays their normal fraction, that fraction covers the physicians' costs.
posted by valkyryn at 7:47 PM on December 18, 2008
Insurance companies contract with providers (doctors) for their services. Part of that contract is that the provider agrees to be paid a certain dollar amount for each service that they provide. This dollar amount is almost always lower than what the provider initially bills you for, sometimes significantly lower. So for instance, it is very common for a provider to initially bill $100 for a service, but under the contract they agreed to with Oxford, Oxford only has to pay $50 for that service. So if you are paying a $10 copay + Oxford is paying $50, that equals a total of $60 of the original $100 on the bill. The provider is essentially writing off the other $40 from the original billed amount. So why do they agree to these contracts if they are going to be making so much less money? Two reasons - one is that they get steady stream of patients referred to them by the insurance company, and two is that insurance companies almost always pay on time, and that's easier to deal with administratively than chasing down patients for the payment.
Now, let's talk about these 21 cents. The prices that insurance companies set for provider services are typically based on what Medicare pays, plus or minus a percentage. 110% or 120% of the Medicare rate is pretty common. The Medicare rate for a basic office visit (CPT code 99211) is somewhere between $17 and $27, depending on where you live (San Francisco is more expensive than Memphis, for example). So my guess is that in this particular instance, your doctor meant to say $21, not $0.21, which would fall within the standard Medicare range. Or he was talking about a charge other than your office visit charge (like a charge for medical supplies or therapy or something). Or he likes to exaggerate.
posted by platinum at 8:05 PM on December 18, 2008
Now, let's talk about these 21 cents. The prices that insurance companies set for provider services are typically based on what Medicare pays, plus or minus a percentage. 110% or 120% of the Medicare rate is pretty common. The Medicare rate for a basic office visit (CPT code 99211) is somewhere between $17 and $27, depending on where you live (San Francisco is more expensive than Memphis, for example). So my guess is that in this particular instance, your doctor meant to say $21, not $0.21, which would fall within the standard Medicare range. Or he was talking about a charge other than your office visit charge (like a charge for medical supplies or therapy or something). Or he likes to exaggerate.
posted by platinum at 8:05 PM on December 18, 2008
Health insurance companies never pay what doctors actually bill.
That's not actually true. This year I've seen 3 or 4 patients whose coverage actually paid my full fee. This is called 'fee for service' and it is, in fact, a vanishing model. (When GM goes under it will be pretty well gone; it could be argued that their fee-for-service health coverage of former employees was what bankrupted them.)
Medicare, or more precisely HCFA (the Health Care Financing Administration) essentially fixes prices by determining Medicare reimbursement rates for all services and procedures performed by healthcare personnel. Health plans then negotiate with providers (individually or as groups) to reimburse provided services at a given rate. Like any negotiation, a lot of things are taken into account.
I'm a neurologist; rural Medicare rates pay about 60% of my full fee. (I am considered a rural doctor because I live and work in a part of California that is classified rural, even though housing costs and practice expenses are in the 95th percentile compared to the rest of the nation.) Insurance companies I contract with pay anything from 140% of Medicare rates (which is about the urban Medicare rate), to 100% of Medicare rates (typical), to 40% of Medicare rates (crappy HMOs, and Medi-Cal, which is California's state Medicaid.)
I take on a few Medi-Cal patients, and a few patients with crappy HMO healthcare, usually as a favor to other doctors. But when I came to town I was sent a stack of 800 Medi-Cal charts and was asked to book them "as soon as possible." I quickly calculated that I could fill my entire practice with Medi-Cal patients, and after paying rent, practice expenses, and my employees salaries and benefits, I would be paying approximately $200,000 a year out of pocket for the privilege of caring for these patients (assuming they all showed up; I find my Medi-Cal patients have a no-show rate of about 40%, much worse than my private insurance patients whose no show rate is about 5%. Taking the no-shows into account, I would be losing closer to $300,000 a year.) Needless to say, that was not attractive to me.
That's the math your podiatrist is doing. It sucks, but I look at it this way: I'm a good doc. If I can't make enough money to keep the lights on in my office, no patients will be able to benefit from my services at all.
posted by ikkyu2 at 8:16 PM on December 18, 2008 [11 favorites]
That's not actually true. This year I've seen 3 or 4 patients whose coverage actually paid my full fee. This is called 'fee for service' and it is, in fact, a vanishing model. (When GM goes under it will be pretty well gone; it could be argued that their fee-for-service health coverage of former employees was what bankrupted them.)
Medicare, or more precisely HCFA (the Health Care Financing Administration) essentially fixes prices by determining Medicare reimbursement rates for all services and procedures performed by healthcare personnel. Health plans then negotiate with providers (individually or as groups) to reimburse provided services at a given rate. Like any negotiation, a lot of things are taken into account.
I'm a neurologist; rural Medicare rates pay about 60% of my full fee. (I am considered a rural doctor because I live and work in a part of California that is classified rural, even though housing costs and practice expenses are in the 95th percentile compared to the rest of the nation.) Insurance companies I contract with pay anything from 140% of Medicare rates (which is about the urban Medicare rate), to 100% of Medicare rates (typical), to 40% of Medicare rates (crappy HMOs, and Medi-Cal, which is California's state Medicaid.)
I take on a few Medi-Cal patients, and a few patients with crappy HMO healthcare, usually as a favor to other doctors. But when I came to town I was sent a stack of 800 Medi-Cal charts and was asked to book them "as soon as possible." I quickly calculated that I could fill my entire practice with Medi-Cal patients, and after paying rent, practice expenses, and my employees salaries and benefits, I would be paying approximately $200,000 a year out of pocket for the privilege of caring for these patients (assuming they all showed up; I find my Medi-Cal patients have a no-show rate of about 40%, much worse than my private insurance patients whose no show rate is about 5%. Taking the no-shows into account, I would be losing closer to $300,000 a year.) Needless to say, that was not attractive to me.
That's the math your podiatrist is doing. It sucks, but I look at it this way: I'm a good doc. If I can't make enough money to keep the lights on in my office, no patients will be able to benefit from my services at all.
posted by ikkyu2 at 8:16 PM on December 18, 2008 [11 favorites]
So why do they agree to these contracts if they are going to be making so much less money? Two reasons - one is that they get a steady stream of patients referred to them by the insurance company
Well, not really. The patients walk in and they have whatever coverage they have. Very few patients can afford my fees out of pocket, much less the costs of the tests I have to order to help figure out what's wrong with them.
The way docs get around this, more and more these days, is to go 'non-participating'. They bill your insurance for whatever the insurance will pay, and then bill the patient for the difference between that and their full fee. If the patient won't or can't pay up, they're dumped and have to go find another doctor. That's called 'balance billing.'
and two is that insurance companies almost always pay on time, and that's easier to deal with administratively than chasing down patients for the payment.
Pardon me, but are you fucking smoking crack cocaine to type something like this? The insurance companies almost always hold the payment for months, generating interest income on their 'float,' employing legions of people to create new and inventive reasons for denial of payment, which then have to be appealed, and then the grounds for appeals have to be documented with sending of medical records, taking yet more employee time and effort. The insurance companies' goal is that it should cost the doctor more in employee time to actually collect the bill than the bill is worth, so they will drop efforts at collection.
My own billing service takes 7% off the top of my gross. They don't code, they don't deal with my office, they just send out the bills and keep track of the collections and the denials. In exchange for that 7%, they fight the insurance companies tooth and nail to make sure the amount they're getting 7% of is as large as possible.
7% of my gross is a huge waste of my money and time. One way to look at it is that I am working 1 month of every year free, just in exchange for the privilege of being able to collect payment for the work I do. Does that make sense? Would you work December for free, just to be allowed to cash your paychecks from January through November? Does that seem fair?
You're paying for that when you buy health insurance, by the way. This is how your insurance company does what it boasts about: "keeping health care costs down."
posted by ikkyu2 at 10:19 PM on December 18, 2008 [7 favorites]
Well, not really. The patients walk in and they have whatever coverage they have. Very few patients can afford my fees out of pocket, much less the costs of the tests I have to order to help figure out what's wrong with them.
The way docs get around this, more and more these days, is to go 'non-participating'. They bill your insurance for whatever the insurance will pay, and then bill the patient for the difference between that and their full fee. If the patient won't or can't pay up, they're dumped and have to go find another doctor. That's called 'balance billing.'
and two is that insurance companies almost always pay on time, and that's easier to deal with administratively than chasing down patients for the payment.
Pardon me, but are you fucking smoking crack cocaine to type something like this? The insurance companies almost always hold the payment for months, generating interest income on their 'float,' employing legions of people to create new and inventive reasons for denial of payment, which then have to be appealed, and then the grounds for appeals have to be documented with sending of medical records, taking yet more employee time and effort. The insurance companies' goal is that it should cost the doctor more in employee time to actually collect the bill than the bill is worth, so they will drop efforts at collection.
My own billing service takes 7% off the top of my gross. They don't code, they don't deal with my office, they just send out the bills and keep track of the collections and the denials. In exchange for that 7%, they fight the insurance companies tooth and nail to make sure the amount they're getting 7% of is as large as possible.
7% of my gross is a huge waste of my money and time. One way to look at it is that I am working 1 month of every year free, just in exchange for the privilege of being able to collect payment for the work I do. Does that make sense? Would you work December for free, just to be allowed to cash your paychecks from January through November? Does that seem fair?
You're paying for that when you buy health insurance, by the way. This is how your insurance company does what it boasts about: "keeping health care costs down."
posted by ikkyu2 at 10:19 PM on December 18, 2008 [7 favorites]
Medicare, or more precisely HCFA (the Health Care Financing Administration)
Actually they are called CMS (Centers for Medicare and Medicaid Services) now.
posted by Pax at 6:20 AM on December 19, 2008
Actually they are called CMS (Centers for Medicare and Medicaid Services) now.
posted by Pax at 6:20 AM on December 19, 2008
look at your bill next time you're at the hospital
no exaggeration follows
when i was in for stomach flu, i paid $80 for two OTC tylenol
when my mom was in for carpel tunnel surgery, she paid $67 for the sharpie ink on her arm
when my grandmother was in for being old, she paid $23 for "green gelatin sustance" aka lime jello
health care in america is a joke.
posted by phritosan at 7:33 AM on December 19, 2008
no exaggeration follows
when i was in for stomach flu, i paid $80 for two OTC tylenol
when my mom was in for carpel tunnel surgery, she paid $67 for the sharpie ink on her arm
when my grandmother was in for being old, she paid $23 for "green gelatin sustance" aka lime jello
health care in america is a joke.
posted by phritosan at 7:33 AM on December 19, 2008
@ikkyu2: In light of the insanity you have described in your posts in this thread, do you support single-payer healthcare? Is there any other practicable way to address this insanity? Or is losing 7% to a billing service actually a reasonable price to pay for sustaining a system that, while convoluted, at least allows you to bill at rates (I presume, with little evidence) greatly in excess of docs in your specialty in other wealthy nations?
I had a general sense of how perverse the health insurance situation was in the U.S., but (as a Canadian) the more details I hear from the 'business' side of things the more amazed I am that this system has yet to fall apart entirely. I guess there's still enough profit to make it worthwhile for everyone who can afford to participate.
posted by onshi at 7:52 AM on December 19, 2008
I had a general sense of how perverse the health insurance situation was in the U.S., but (as a Canadian) the more details I hear from the 'business' side of things the more amazed I am that this system has yet to fall apart entirely. I guess there's still enough profit to make it worthwhile for everyone who can afford to participate.
posted by onshi at 7:52 AM on December 19, 2008
Another possible interpretation: medicaid pays my hospital 21% of "cost" as the bean counters determine it. Private insurers pay something like 120-200% of cost depending on how big they are. This is probably the same calculation that ikkyu2 is talking about. It's also why said bean counters hope the ER burns down, and why there is mixed happiness and terror at the possibility of single payer.
posted by a robot made out of meat at 8:28 AM on December 19, 2008
posted by a robot made out of meat at 8:28 AM on December 19, 2008
@ikkyu2: In light of the insanity you have described in your posts in this thread, do you support single-payer healthcare?
You know what, the devil is in the details. I would support, for instance, a single payer system that actually paid me what I think I'm worth, and did away with waste and fraud.
Medicare is essentially a single-payer for qualifying Americans over 65, and 68% of my receivables are from Medicare beneficiaries, so in a sense, I am already 68% into the single-payer system.
Medicare is also 13 months behind in payments to me, will pay no interest to me for those arrears, pays only a fraction of what I'm worth, takes my cost-of-living into account according to tables and multipliers developed in the 1960's, and there are huge incentives to 'game' the payment system. Medicare also has engaged in the disastrous "Medicare Managed Care" experiment, which further cuts my reimbursement for performing the same services on the same patients, while increasing the total overall cost of care to the taxpayer (all of the increase, and then some, going towards "administrative costs," which means into the pockets of health insurers.)
So no, I do not support "single-payer healthcare" as a blanket concept or a cure-all for the current problems. It's unfortunately more complicated than that. I would support "good single-payer healthcare" if it was done right.
posted by ikkyu2 at 11:03 AM on December 19, 2008
You know what, the devil is in the details. I would support, for instance, a single payer system that actually paid me what I think I'm worth, and did away with waste and fraud.
Medicare is essentially a single-payer for qualifying Americans over 65, and 68% of my receivables are from Medicare beneficiaries, so in a sense, I am already 68% into the single-payer system.
Medicare is also 13 months behind in payments to me, will pay no interest to me for those arrears, pays only a fraction of what I'm worth, takes my cost-of-living into account according to tables and multipliers developed in the 1960's, and there are huge incentives to 'game' the payment system. Medicare also has engaged in the disastrous "Medicare Managed Care" experiment, which further cuts my reimbursement for performing the same services on the same patients, while increasing the total overall cost of care to the taxpayer (all of the increase, and then some, going towards "administrative costs," which means into the pockets of health insurers.)
So no, I do not support "single-payer healthcare" as a blanket concept or a cure-all for the current problems. It's unfortunately more complicated than that. I would support "good single-payer healthcare" if it was done right.
posted by ikkyu2 at 11:03 AM on December 19, 2008
Response by poster: Thanks guys, this is really enlightening. I'm betting my doctor meant 21%. He's a great guy and we sat and talked a long time. I can think of no reason why he would lie to me about this stuff. My insurance is a PPO, so I will still go to him. I've had at least 2 doctors drop Oxford in the past few years. My company offers the option of switching to Oxford's EPO, but I'd rather not take the chance of losing any more of my favorite doctors.
It never occurred to me to look at my EBO to see how much the insurance was contributing as opposed to how much my doctor charged. I've just looked at how much I've paid and the insurance has paid, assuming the doctor was completely covered.
This is quite an eye-opener. To make matters worse, my monthly contribution more than doubles starting in January.
posted by Evangeline at 11:59 AM on December 19, 2008
It never occurred to me to look at my EBO to see how much the insurance was contributing as opposed to how much my doctor charged. I've just looked at how much I've paid and the insurance has paid, assuming the doctor was completely covered.
This is quite an eye-opener. To make matters worse, my monthly contribution more than doubles starting in January.
posted by Evangeline at 11:59 AM on December 19, 2008
Yeah, I'd support a system that pays me what I think I'm worth too.
posted by gjc at 5:55 PM on December 19, 2008
posted by gjc at 5:55 PM on December 19, 2008
at least allows you to bill at rates (I presume, with little evidence) greatly in excess of docs in your specialty in other wealthy nations?
Hey now, son. My employees all have PPO healthcare and retirement benefits. In this particular wealthy nation, that doesn't come free, or even cheap.
posted by ikkyu2 at 6:09 PM on December 19, 2008
Hey now, son. My employees all have PPO healthcare and retirement benefits. In this particular wealthy nation, that doesn't come free, or even cheap.
posted by ikkyu2 at 6:09 PM on December 19, 2008
Yeah, I'd support a system that pays me what I think I'm worth too.
Get sick with a chronic neurologic disease that renders you unable to work, and then see how you feel about having to be cared for by someone who graduated from the Medical College of The Third World in 1966, hasn't been to a neurology conference since then, and bills you his full fee up front.
Fact is, what I provide for my patients is valuable to them, and it is not easy, nor cheap, to acquire and maintain the ability to provide that service at a high level. I know it and they know it. Most "wealthy nations" understand that what I do is valuable for society too.
You ever spent time online with Microsoft tech support? They'll talk to you for as long as you want, and Microsoft doesn't pay much to have them provide this service to you. If you think docs are too wealthy and that that is the major problem facing America today, keep shouting out - you'll soon have Microsoft-quality tech support servicing your physical and mental health in this country too.
posted by ikkyu2 at 6:17 PM on December 19, 2008
Get sick with a chronic neurologic disease that renders you unable to work, and then see how you feel about having to be cared for by someone who graduated from the Medical College of The Third World in 1966, hasn't been to a neurology conference since then, and bills you his full fee up front.
Fact is, what I provide for my patients is valuable to them, and it is not easy, nor cheap, to acquire and maintain the ability to provide that service at a high level. I know it and they know it. Most "wealthy nations" understand that what I do is valuable for society too.
You ever spent time online with Microsoft tech support? They'll talk to you for as long as you want, and Microsoft doesn't pay much to have them provide this service to you. If you think docs are too wealthy and that that is the major problem facing America today, keep shouting out - you'll soon have Microsoft-quality tech support servicing your physical and mental health in this country too.
posted by ikkyu2 at 6:17 PM on December 19, 2008
Me: Or is losing 7% to a billing service actually a reasonable price to pay for sustaining a system that, while convoluted, at least allows you to bill at rates (I presume, with little evidence) greatly in excess of docs in your specialty in other wealthy nations?
ikkyu2: Hey now, son. My employees all have PPO healthcare and retirement benefits. In this particular wealthy nation, that doesn't come free, or even cheap.
Point taken, but isn't the circularity there interesting? Your patients need expensive insurance to purchase your expensive medical services, which are are expensive at least in part because you need to provide similarly expensive benefits to your staff so that they can consume other providers' expensive medical services.
In context, my comment was meant to contrast the unfairness of a system that forces you to spend substantially on an outside service to squeeze what you are owed from insurers with the fact that the same system at least allows you to increase your billing in response. An arms race ensues, and the wedge taken by the prevailing insurance system hits you (and everyone else) again and again. Sorry that it seemed worthy of condescension in reply.
Most "wealthy nations" understand that what I do is valuable for society too.
Absolutely, but those other wealthy nations -- Canada, France, UK, Germany, etc. -- do set the price (as distinct from value) for similar specialist care lower than your peers set it for themselves. Of course, as you rightly pointed out above, some of that price difference is due to administrative overhead and your need to aim high(er) than the mark so that the fractional payment you eventually recover from insurers at least vaguely approximates a fair price.
...see how you feel about having to be cared for by someone who graduated from the Medical College of The Third World in 1966...
That seems like a bit of a straw man to me. Or do you mean to imply that the US's (admittedly excellent but, again, costly to the point of dramatically curbing access) medical education system is so superior to, say, those of the other G8 countries that anyone else might as well have trained in horrible backward country X? Having just described some of the arcana that influence and distort the price of medical services, it seems odd to assume that the healthcare market is efficient enough that prices do accurately reflect the quality of service at marginally lower rates.
posted by onshi at 8:06 AM on December 22, 2008
ikkyu2: Hey now, son. My employees all have PPO healthcare and retirement benefits. In this particular wealthy nation, that doesn't come free, or even cheap.
Point taken, but isn't the circularity there interesting? Your patients need expensive insurance to purchase your expensive medical services, which are are expensive at least in part because you need to provide similarly expensive benefits to your staff so that they can consume other providers' expensive medical services.
In context, my comment was meant to contrast the unfairness of a system that forces you to spend substantially on an outside service to squeeze what you are owed from insurers with the fact that the same system at least allows you to increase your billing in response. An arms race ensues, and the wedge taken by the prevailing insurance system hits you (and everyone else) again and again. Sorry that it seemed worthy of condescension in reply.
Most "wealthy nations" understand that what I do is valuable for society too.
Absolutely, but those other wealthy nations -- Canada, France, UK, Germany, etc. -- do set the price (as distinct from value) for similar specialist care lower than your peers set it for themselves. Of course, as you rightly pointed out above, some of that price difference is due to administrative overhead and your need to aim high(er) than the mark so that the fractional payment you eventually recover from insurers at least vaguely approximates a fair price.
...see how you feel about having to be cared for by someone who graduated from the Medical College of The Third World in 1966...
That seems like a bit of a straw man to me. Or do you mean to imply that the US's (admittedly excellent but, again, costly to the point of dramatically curbing access) medical education system is so superior to, say, those of the other G8 countries that anyone else might as well have trained in horrible backward country X? Having just described some of the arcana that influence and distort the price of medical services, it seems odd to assume that the healthcare market is efficient enough that prices do accurately reflect the quality of service at marginally lower rates.
posted by onshi at 8:06 AM on December 22, 2008
FWIW, a number of doctors I know (including my own) will take most insurance *except* Oxford.
posted by reptile at 11:23 AM on December 22, 2008
posted by reptile at 11:23 AM on December 22, 2008
An arms race ensues, and the wedge taken by the prevailing insurance system hits you (and everyone else) again and again. Sorry that it seemed worthy of condescension in reply.
I do understand these things, which was why I am pointing them out.
A lot of people see my MD and think I'm personally responsible for these things, took purposeful steps to cause them of my own free will, and work at being the obstacle to correcting them. That is not correct.
I will go so far as to say that if 1% of the social benefit of my services went into my pocket as cash value, I would be fabulously wealthy. I don't think that'd be appropriate. I certainly do not demand it, nor do I ransom my patients' health.
But I think that making CEOs of Health Denial Organizations fabulously wealthy is even less apropriate.
Case in point. Got a $5 Christmas card from Medi-Cal this week. We're talking 3 different colors of reflective foil, high quality cardstock, fully embossed/engraved - way nicer than the ones I could afford to send out this year.
Week before that, same Medi-Cal organization sent me an acknowledgement of contract, in a 8 1/2 x 11 manila envelope. Handwritten on the cover letter was "We really appreciate your being available for our patients." Rubberbanded together with this envelope by the post office were several other envelopes from Medi-Cal, containing $60,000 in denials for work I'd done. Paying a percentage is one thing; this was $60,000 I'd billed, and I get a fancy Christmas card, a "thank you," and $0 in reimbursement.
You think maybe the priorities are off a little bit? What about the people - like you reading this, maybe - who think Medi-Cal ensures health care for the indigent people of California? Here is a news flash. Medi-Cal does not ensure health care. Physician charity is what got those hundreds of peoples' neurologic problems diagnosed and treated. At some point, the working doc looks at this and thinks, "Fuck it, I'm not getting out of bed at 3AM any more for this. Let some other chump do it."
posted by ikkyu2 at 6:28 PM on December 22, 2008
I do understand these things, which was why I am pointing them out.
A lot of people see my MD and think I'm personally responsible for these things, took purposeful steps to cause them of my own free will, and work at being the obstacle to correcting them. That is not correct.
I will go so far as to say that if 1% of the social benefit of my services went into my pocket as cash value, I would be fabulously wealthy. I don't think that'd be appropriate. I certainly do not demand it, nor do I ransom my patients' health.
But I think that making CEOs of Health Denial Organizations fabulously wealthy is even less apropriate.
Case in point. Got a $5 Christmas card from Medi-Cal this week. We're talking 3 different colors of reflective foil, high quality cardstock, fully embossed/engraved - way nicer than the ones I could afford to send out this year.
Week before that, same Medi-Cal organization sent me an acknowledgement of contract, in a 8 1/2 x 11 manila envelope. Handwritten on the cover letter was "We really appreciate your being available for our patients." Rubberbanded together with this envelope by the post office were several other envelopes from Medi-Cal, containing $60,000 in denials for work I'd done. Paying a percentage is one thing; this was $60,000 I'd billed, and I get a fancy Christmas card, a "thank you," and $0 in reimbursement.
You think maybe the priorities are off a little bit? What about the people - like you reading this, maybe - who think Medi-Cal ensures health care for the indigent people of California? Here is a news flash. Medi-Cal does not ensure health care. Physician charity is what got those hundreds of peoples' neurologic problems diagnosed and treated. At some point, the working doc looks at this and thinks, "Fuck it, I'm not getting out of bed at 3AM any more for this. Let some other chump do it."
posted by ikkyu2 at 6:28 PM on December 22, 2008
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This is your insurance company's way of telling your doctor to drop you as a patient.
What are your Oxford Freedom annual premiums, btw? Anything under $400/mo per person means you're not getting "first class" coverage, whatever that may be.
posted by troy at 6:07 PM on December 18, 2008