All I know is that several of the doctors my wife has been to have told either me or my wife, after being asked bluntly "how much do I owe you" and being told "oh nothing that's it" have sent us a fucking bill months after the fact.

Next time I'm getting that shit in writing and when they send me the bill fuck them they can take me to court.  Dishonest fucks.

malpractice insurance is based on year of practice. the amount you pay is based on if you do any risky procedures, surgeries, and the risk of your scope of practice.





each following year, your rates increase to cover the prevaling cost of the current year, PLUS THE ADDITIONNAL COST TO INSURE YOU FROM LAWSUITS FROM THE PREVIOUS YEARS OF PRACTICE.





i.e. you start off as a new general practice, non surgical, you may have 10k as your premium for the first year. 2nd year, 13k. 3rd year, 18k. for the 4th year, 25k, etc. up to some maximum, that then slowly increases, as you now have coverage for the previous years you are liable for.





in addtition, you also have to pay for what they call tail coverage, which means, if you change insurance companies, you have to pay for insurance for the the potential liability that you incurred at the old insurance company, unless you can get the new company to (at a higher rate) cover the prior liabilities.





So, for a general practicianer, making 110k - 180k / year, the medmal may be 25k-35k a year, not including tail coverage.





more than 3%, certainly







edit to add



and your link is biased, as the title indicates:



challenging the misleading claims of the doctor's lobby



and scanning some of the pages, what i see is misinterpretating what is going on or not factual





 

The $1M is way high.     Most Docs (I'm a Podiatrist, so our malpractice is a bit more limited) have about a 50% overhead if they are in a group, running an office (varies between 40 and 60%, so call it 50%).    If you look at the link above...the surgeon for an Appendectomy gets paid $600 to $800.    That includes the 'global period' of 90 days for a major surgery...and all follow up care for the 90 days afterwards.   To reach $1m at that rate, you'd have to do 1250 Appys a year (or 25 per week)...or 5 per day...and then see the patients for all the follow-ups afterwards.    

We had a discussion a while back on Malpractice (a couple of Docs and Attorneys were involved).    A few things not mentioned (that I saw) in the biased report above....
2/3 of all malpractice claims result in NO payment to the plaintiff (no settlement or judgement).
90% of all cases that go to trial result in the Doctor's winning.

National average to defend a Malpractice suit is about $25k.     That's for dismissed, settlements and to trial cases.    

I pointed out in the previous thread....EVERY dollar of that comes out of the Doctor's malpractice insurance.    So they are paying for the 2/3 of cases that never result in a payout.  They are paying for the Malpractice defense attorneys, the plaintiff's attorney and the expert witnesses, etc.    

And, (at least my bosses, as I'm still an Associate) the Physician's office is still a business...we still have to pay for the same stuff a storefront would....general business insurance, commercial building insurance, etc.

AFARR

I don't need to watch the video.  Lots of misinformation in this thread.

I see the rates of reimbursement for procedures and they are a multiple of what Medicare pays.  Medicare is the Walmart of healthcare, they dictate price.  If you don't like their price you're SOL because they have the largest market share.

Self pay folks do not have the luxury of a "volume discount" that Medicare and Insurance Companies do and pay the full price in many cases.

Not all appendectomies are alike, it is like saying all guns should cost the same.

The rates are set by the prevailing "how much can we get if we sue" climate in the area.    
I read a story recently of an Orthopod (I think it was) in a VERY high malpractice claim...VERY high payout area that had to pay almost $100k a year to get his minimum coverage of $250k....with a 15 year history of no claims against him.    The legal climate in the area SUCKED.   If you could get the case before the Jury, they would almost automatically award huge claims (jackpot mentality).    

They contrasted it with his brother (an Opthalmologist?) in a low malpractice area...under $10k for $1M+ coverage.    

AFARR

Try calling around to find the total cost of any procedure.  Not just doctor's fees, but OR fees, anesthesiology, pharmacy, etc..



I tried.  They can't tell you, and no one can tell you all of the bills you need to hunt down anyway.


 

I work with a guy who needed new tires on his truck. He called at least 6 places getting prices. Same fellow's doctor wants him to under go some sleep tests to find out if he has a sleep disorder. He comes back from the Doctors appointment wondering how much this is going to cost him "out of pocket".

Why don't people ever get a quote on how much a medical procedure will cost?

Didn't you read page 1?  Medical billing requires advanced knowledge of differential calculus, duh.

I work at a car dealership and wonder the same thing.  Giving estimates on modern car repairs isn't easy, but it gets done.  Granted I have no experience with Medicare, but from what you guys are saying they are no harder to deal with than getting warranty claims paid by the manufacture; and/or third party warranty companies.  

Yup, it's work and it sucks, but the bills get paid, customers get up front estimates, and the business is still profitable.  

I can go on and on and on with the parallels between the two industries, and how one does it and the other doesn't.  But at the end of the day I honestly believe the medical industry suffers from a horrible entitlement complex that they should be paid whatever they demand, and its wrong to ever question them.  The whole industry needs to grow the fuck up.

It's hard for a layman to have any sympathy for the difficulties doctors face on a daily basis, and frankly it shouldn't be expected.  I never dump the problems I face on a day to say basis on my customers, as they are my problems....

Medical billing depends on how much money they think they can get out of you.
My son had a bill denied by his insurance because the doctors office miscoded the diagnosis.
So the doctors office billed him 3 times what the insurance would have paid.
All due to their office miscoding the insurance form. I won't go into the year long hassle he's had, but he paid what the insurance would have paid, resubmitted the insurance via the doctors office with the corrected coding, and still has received notices he will be no longer able to see the doctor. They say he has a bill that has been outstanding too long - the difference between full price and what the insurance would have paid.

But how much does defensive medicine cost us every year?  You know, the MRI the doc orders so as not to miss the 1 in 10,000 chance of a tumor in a patient?

Because hospitals took lessons on pricing from the airlines?


You doc can tell you what he charges, but it is up to the patient to know what his insurance requires of him.

Doc usually doesn't get the money because the big dollar tests are imaging studies. Hospitals win big, however.

Dude comes in with ringing in one ear for one year.  1 in 10000-50000 chance it is an acoustic neuroma, a very slow growing, yet  benign brain tumor.  Only good way to find it is with a $1500-2500 MRI scan.

Chances are the doc will never miss one.  But if the doc orders the MRI, he will never get sued for missing one.  If he does miss one, get ready for a 3-5 year ordeal that most docs take very very personal. Because after dedicating a decade or more of his youth to becoming a doc, some sleaze ball is publicly calling him incompetent and uncaring.  Folks don't have a clue how personal their doc takes any sort of accusation of error or perceived error when they are busting their butt 60-70 hours per week trying to do their best..    Most docs got into medicine for the right reasons.  Sure, some didn't.  A good friend went through  the above for 6 years.  And even though he 'won', he still has to list on every application for insurance panels, hospital apps that he was sued. Kinda a bit of a mark on his record even though he has done nothing wrong. It was ten or years ago, but he still gets upset/choked up/pissed about it.

How many MRIs do you think he orders now?

oops, don't have time to type a good reply right now

Not so much.    Say you see me.  Suspect a stress fracture in the metatarsal bones from all the signs and symptoms.    

If I wanted to practice good, evidence based medicine...I'd say "Let me get you into this $10 surgical (post op) shoe so the foot won't bend, keep as much pressure off it as you can and I'll check it in a couple of weeks...it will be about a month and a half before you're back into normal shoes.  Check you a couple of times....total cost is about $200 between the initial office visit, maybe 2 follow-up visits and the surgical shoe.

However....

I have to practice defensive medicine....
Same initial exam, same surgical shoe, however instead of using my best judgement, I also order an X-ray....it gets done at the hospital (I get nothing from this).   Comes back negative (as stress fractures often do on an X-ray).    Then I order an MRI to see the edema (fluid) in the bone that indicates a stress fracture....I get nothing from this either (I don't get paid to go over the results myself or to discuss them with you).   Same course of treatment....however in addition to my $200 in office fees and the surgical shoe, you're now out $40 for the X-rays and about $1000 for the MRI foot study.
But, I've now covered my ass just in case you have some weird 1:100000 chance of an osteosarcoma in the foot.

Happens EVERY day in the US.  

Lift up something heavy and pull a chest wall muscle.       Go into the ER and tell them you strained something when you were lifting a (say) case of ammo and have some chest pain.    Rather than a quick exam, muscle relaxant and advice to take it easy....you're going to get the full Heart Attack workup.   Multiple lab draws, EKG, hours in the ER, etc.    

That's all defensive medicine.

AFARR

We realize that a Doctor's office is a business...however (aside from Dental & Chiropractic)....most Medical training is very lacking in business education.      

What most people don't realize is that the CUSTOMERS are different from any other business.

If you are a mechanic....and someone calls and says "how much to rebuild my engine"...you can ask what kind of car, age of engine, etc...and have a good idea of the labor/parts.
If a Mechanic was like a doctor....someone calls and says "how much to rebuild my engine"....but you can't know if it's a 4 Cylinder Honda engine...or a 16 Cylinder Bugatti, or how much wear, or if someone's already tried to replace some parts, etc.      
If a general contractor was like a doctor....someone wants a quote on how much it will cost to build their house if they pay cash...but you can't know if it's a 1500sq. ft ranch...or 45,000 sq ft Mansion and you might be building it in nice, dry, spring weather...or a blizzard (oh, yeah...and you may have to build it in a swamp).

AFARR  

True but most require a few days in the hospital.

Man, it was just yesterday that I was puking my guts out in center field. Watching through watered eyes as my team laughed as young kids will.

Sucker was cut out the next day.

Yes, then I believe they lied.  

It doesn't take away from your point which you've made before:  The U.S. medical system if fucked.  I find it just as frustrating being on the receiving end of care, especially when it comes to dealing with bills and who is responsible for what.

The gov't wants the medical system to fail so they can swoop in to take it over, just like VTHOKIESHOOTER points out above.

My father grew up in communist Hungary and went to medical school there.  Doctors were paid the same as a teacher or plumber.  But if you didn't pay a bribe then you got shit care.  Same as if you didn't pay your butcher a bribe you got the worst cut of meat or if you didn't pay your mechanic a bribe then it took them a month to fix your car.  It's a bastardized form of capitalism ie. you get what you pay for.

Exactly.  Even after the appendix is taken out, most people will experience various degrees of ileus from all the inflammation so they'll need IV fluids until it clears.

Please don't fall for that crap.  Insurance companies do that all the time.......deny payment and claim that all the Dr's office needs to do is some seemingly trivial clerical task...all the while benefitting from the "error."  It is a common insurance company tactic.  Then when the Dr's office resends it......it gets lost, or there is some confusion, or there is another "error".........all the while the ins. co. blames it on the Drs office and hangs on to the $$$$.  Most Dr's offices are VERY skilled at sending out claims.......gimme a break !  If it were such simple "miscoding" error and the ins co was willing to pay.......why couldn't the correction be made over the phone? or an email, or a fax ?!  Nope...ins company will not accept that....has to be mailed.  Seriously....who the hell even uses snail mail anymore !

No, it was the MD's office mistake. They coded it as "preventative" and not "diagnostic".
Even with their admitted miscoded mistake, they are still pressing for the full amount, not the insurance's scheduled amount. My son has paid that amount but they want their full charge, not the insurance's cost.
Another example of the MD's office mistake is their scheduling a test, then sending the results to a referred specialist. He took the test, went to the scheduled specialist's appt, but the test results hadn't been forwarded to the specialist. The office visit was a $250 waste of time that he was also billed for. He was only out $15 for the worthless visit that he had to go back again for another visit after they received the test results.
Now, he doesn't see any doctor until he has the test results in his hands.
I won't go into a knee replacement I had that I was billed for the entire cost because the insurance denied the claim EVEN AFTER it was submitted months previous and approved.
I was charged for services I NEVER had and wouldn't pay. The insurance finally paid the bill almost a year later but the hassle I went through was very aggravating.
The difference between what they were billing me and what the insurance finally paid was over $35000.
We have a member here that is very good friend of mine that flies the Medivac choppers. The services of a Medivac can run well over $13k.
Believe me, insurances are loathe to pay that fee and many who suffer traumas and are Medivacced face those charges without insurance even though they have medical insurance.
I had some heart trouble immediately after my first knee replacement - atrial fib. The surgical hosptial I was in got me out of there ASAP via ambulance to a cardiac hospital 5 miles away.
That ride cost me $800 for just the ride. I remember the doctor saying something like "get that SOB out of here before he dies". He didn't say it exactly that way but that was what he meant.
6 months later I get a $150 bill my insurance wouldn't pay for him to come in and look at me. All he did was read my chart, look at the EKG they'd given me, and tell them to get me out of there as quick as possible.
I can go on and on about healthcare billing. The extra charges for services not performed are what really burn my ass.

Added some comments in red above.

Thanks for your comments. I do appreciate a good doc that cares about his patients outside of just taking care of them.

My god son was caped from the University of Oklahoma two years ago. He is now serving a residency in urology in Texas. The headaches he's going to go through in his career, plus his educational loan, is not going to be an easy path.
Healthcare  and health care insurance is out of control in this nation. Too many people making a lot of money and not actually contributing to health care.
It's a very profitable business. Especially when people like the Aon honchos get paid hundreds of millions in bonuses every year.
I'm 59. At 16 it cost me $2 to see the doc. The average hourly wage was $3 or so.
Today, the average hourly wage is nowhere the $45 to $60 it takes for 10 minutes with a GP that runs a clock practice.
I don't know the answer to the problem but I do know that fraud is rampant in health care billing.
Especially to the gov't with Medicare and Medicaid.

Actually what Medicare and Medicaid consider fraud wouldn't necessarily be fraud by any reasonable standard.  

To use my analogy of a mechanic.    Medicare (and Medicaid) pay for your oil change.     In order for you to be eligible for the oil change under Medicare guidelines....you have to show that the oil was dirty enough to change.   So they expect you to pull the car in the bay, check the dipstick, match the color against a 'color chart'...if it's not brown enough, you don't get paid.    Ok....say it's brown enough to change....you have to drain the oil, put a new oil filter on, then re-fill with oil.     Then Medicare decides we're not going to pay for the filter....but you have to change it as part of the oil change.     So, they don't pay for the initial check (to be sure you're eligible to actually get the oil change done)...or the filter (but they require you to do the filter in addition to the oil change)...but they pay for the oil change.

On to the Fraud part....to Medicare it's fraud if you check the oil color...but don't record it (you can't just say 'it's dirty enough to change')....Fraud if you try to bill for the filter....Fraud if you don't document that you took the drain plug off, drained all the old oil, re-installed the plug, removed the old filter, replaced with a new filter, then put 5.3 quarts of oil in the car.   All of that has to be documented (written down).   Forget to document that you put the drain plug back in....Medicare calls it fraud.....so they can come and 'extrapolate' (pull ten charts....if you forgot to document that you put the plug back in in 5 cases....then you failed to do it for 50% of all the cars you did)....and take back 50% of ALL the money they paid for oil changes for the last year or two.    

Real fraud would be not doing the oil change and billing for it.    "Medicare Fraud" is frequently inadequate documentation for what was actually done.  

Oh, and Medicare doesn't do the auditing....they have outside contractors that are paid based on what they can recover for Medicare....so they have a real financial incentive to find any possible errors.  

AFARR

And, as an aside....the only time I saw one of my Attendings from my first year of residency (Cook Co hospital in Chicago) get pale was when one of our patients needed some Urologic issue addressed.   My attending had vast experience dealing with Gas Gangrene, Trauma, Dry Gangrene, Infections, Malignancies, Maggots in wounds, etc.......no problems.    However this patient happens to mention to us that in addition to the bad foot infection/ulcer he had..."when I pee, it doesn't come out the end"...so we get a Urology consult.    The senior Urology resident says "Call us when you're done with your surgery and we'll take care of it when he's still under anesthesia"....we do our surgery....call in Urology...some 4' nothing female Resident comes in, says to us..."Grab a Leg and make like stirrups"....grabs the guys pecker and starts ramming a rod down it to free the stricture.    My attending almost passed out.    (That guy had no insurance, so the Taxpayer was paying for everything).    More power to your godson...I wouldn't do that for a living....

I can't get into specifics but I do know of an investigation where the AG wrote an MD a "cease and desist or else" letter about $450K in questionable Medicaid charges for one year.
I've been told that happens a lot....
It's all past me anyway. There isn't much I can do about because of the golden rule - those that have the gold will make the rules.
I just know our health care system is broke and the likelihood of change is almost nil because there is so much money involved.

See how horrible the entire medical/insurance industry is ran!  It is too big of a mess to fix this system.  But WE can step in and make sure that every procedure costs the same whether you are a black man in Florida or a elderly white woman in Oregon.  No more questionable fees and no more dealing with the insurance companies.  No more having to rely on staying employed to keep insurance.  We can handle it ALL for you.

These "news" pieces are nothing but the first part of the propaganda.

This is my largest single complaint with our healthcare system.