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krpind
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Posted: 4/25/2012 1:07:22 PM
I don't have link yet, but it was just on ABC's "Medical Minute".

They said that patients on Medicare and the non-insured paid the most, which is to me. And for profit hospitals charged the most which seems like what should be happening so I'm not sure what their point on that is.

They compared non-complicated surgeries and found that patients had no way to compare costs and "shop" the price because these were mostly immediately performed.

Think about it. The most expensive surgeries were Medicare and non-insured. The range was over 100 fold in difference.

Medicare is slated to run out of money in 12 years according to the latest estimates.

I love the free enterprise system, but these guys are their own worst enemies and the free enterprise system doesn't work in cases like this. There is no way to realistically compare prices and you probably couldn't get a good estimation on the price if you tried.They are going to put themselves out of business and sticking it to uninsured people and the government isn't the best business model and these guys can't figure that out?

Thoughts?
ARFCOM.....Time well wasted.

Originally Posted By Keith_J:

Just remember to pay it forward. If someone is in need, do something positive.
VTHOKIESHOOTER
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Posted: 4/25/2012 1:08:42 PM
CBS had the same story last week. It's part of an organized push to turn our health system into government payer.
http://nrgrc.com/
krpind
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Posted: 4/25/2012 1:10:56 PM
ARFCOM.....Time well wasted.

Originally Posted By Keith_J:

Just remember to pay it forward. If someone is in need, do something positive.
krpind
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Posted: 4/25/2012 1:11:46 PM
Originally Posted By VTHOKIESHOOTER:
CBS had the same story last week. It's part of an organized push to turn our health system into government payer.


I don't think so.

Watch the video. The report I saw was condensed from that.

ARFCOM.....Time well wasted.

Originally Posted By Keith_J:

Just remember to pay it forward. If someone is in need, do something positive.
SplintNicket
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Posted: 4/25/2012 1:14:47 PM
Ask a doc how much for a procedure like that - they usually cannot tell you. You have to go in blind or go in as an emergency.

And yes, uninsured pay the most in most cases.
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stangboy555
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Posted: 4/25/2012 1:17:17 PM

Originally Posted By krpind:

They said that patients on Medicare and the non-insured paid the most, which is to me. And for profit hospitals charged the most which seems like what should be happening so I'm not sure what their point on that is.

That's because private insurance companies dictate the costs to the hospitals and clinics, the .gov and non-insurance really have no say in it.

You see it all the time at clinics, you can even hear your Dr. bitch about it if you listen close enough.

"Aetna will only pay us this much for this procedure, etc.." The Dr's file a claim and take what they can get.

Medicare and the non-insured get screwed because the .gov doesn't have to skimp to stay in business and non-insured just get fucked, what are you going to do, not pay?
Carpe diem, quam minimum credula postero.
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Posted: 4/25/2012 1:20:26 PM
It's pretty much bullshit that they can't give estimates or quotes on procedures IMO. In just about any other industry it would be illegal. For example, if you had to take your car in for regular service and they told you that you'd have to get it serviced first to find out the price that you have to pay.
krpind
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Posted: 4/25/2012 1:23:12 PM
Originally Posted By LvFreeRDie:
It's pretty much bullshit that they can't give estimates or quotes on procedures IMO. In just about any other industry it would be illegal. For example, if you had to take your car in for regular service and they told you that you'd have to get it serviced first to find out the price that you have to pay.


It's not illegal, you just wouldn't die if you didn't have your car serviced and this particular surgery isn't reallyelective. If you need it, you will likely die if you don't do it.

I think that is why they chose an Appendectomy to compare.

ARFCOM.....Time well wasted.

Originally Posted By Keith_J:

Just remember to pay it forward. If someone is in need, do something positive.
kallnojoy
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Posted: 4/25/2012 1:35:25 PM
1500?

Do they also offer to inject window and door silicon into your butt cheeks before the mad dog 20/20 anesthesia wears off?
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cm
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Posted: 4/25/2012 2:53:28 PM
[Last Edit: 4/25/2012 2:58:12 PM by cm]
propagada piece.

medicare, along with medicaid, pay the lowest rates.

insurance companies can not reinburse at a lower rate than medicare. in fact, most reinbursement rates are based off of medicare rates.

for you that complain that you can't get a price for something from a doctor, here is an overview on how medicare reinbursement rates are calculated.


http://www.medscape.com/viewarticle/433293_2

an excerpt is

Physician Payment

Since January 1, 1992, payment for physician services has been based on a fee schedule. The fee schedule also applies to chiropractors, podiatrists, optometrists, nurse practitioners, and physician assistants. The use of a fee schedule replaced the prior method of paying for "reasonable charges" because of wide geographic region-related variations in fees, a rapid rise in program payments, and the fact that payments frequently did not reflect the resources used and that physicians in different specialties could receive different payments for the same service. The new fee schedule is based on the "relative value" of the service and was recommended to the Congress by the Physician Payment Review Commission, a congressionally established advisory body. In September 1997, this committee was replaced by the Medicare Payment Advisory Commission, which is an independent federal body that advises Congress on Medicare including issues of physician payment. It is composed of physicians, nurses, osteopaths, clinical researchers, attorneys, and insurance company executives.

The fee that a physician is paid has three components: the relative value for the service, a GPCI, and a national dollar conversion factor. The relative value portion of this equation is composed of the following: 1) a physician work component that measures the time, skill, and intensity associated with the service provided –– this component accounts for 54.5% of a service's relative value; 2) a practice-related expense component that measures average practice expenses such as office rents and employee wages and that varies on a code-by-code basis depending on whether the service is performed in a facility or nonfacility setting –– this accounts for 42.3% of a service's relative value; and 3) malpractice expense component that reflects average insurance cost –– this accounts for 3.2% of a service's relative value. The GPCI is designed to account for variations in the costs of practicing medicine. A separate GPCI is determined for each of the three component of the RVU and takes into consideration median hourly earnings of workers in the area, office rents, medical equipment and supplies, and other miscellaneous expenses. There are 90 GPCI areas nationwide. The conversion factor is a dollar figure that converts the geographically adjusted relative value for a service into a dollar payment amount. The conversion factor is updated yearly. The conversion factor for 2001 was $38.2581. The law specifies that physicians who provide covered services in any rural or urban Health Professional Shortage Area (there are 2,901 such areas in the United States) are entitled to an incentive payment of 10% more than what they would otherwise be paid under the fee schedule.

The general formula for determining total RVUs is: [work RVU x work GPCI] + [practice expense RVU x practice expense GPCI] + [malpractice RVU x malpractice GPCI] = total RVU; payment = total RVU x conversion factor ($38.2581 for 2001). See for several examples of payments in Pittsburgh.

Current Procedure Terminology coding and RVUs are important not only with regard to reimbursement from Medicare but also for private insurers. Although no data have been published, there is a general notion that CPT coding and RVUs are used by most private insurers as a basis for reimbursement of physician-related services.



for example, you can look up base rates here

http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PFSLookup/index.html?redirect=/PFSlookup/02_PFSSearch.asp#TopOfPage

for an appendectomy, the base hcpcs code is 44950.
the national base rate is $638. to see how widely it varies, include all the modifiers, and choose all for carriers.

worse, the claims for services will be reviewed by medicare, who may deny claims based on (in thier determination), the wrong code being used, not enough data to support a certain code, or they lump charges together, and claim they are all part of the same treatment charge, and only one charge will be paid (called global charges - i.e. a cut is sutured, gets infected, needs to be openned and cleaned further, is seen for, say, 5 more visits - medicare will try to say all the follow up stuff was paid as part of the initial payment, covered as part of follow up care).

in general, medicare reinbursements are so low, they aren't worth the hassle, and doctors limit the number of medicare patients they carry.

the only reason they would be pushing medicare as a great thing for the medical field, is to try to spin the idea that everyone should love obama care's single payer system, and the money that they would make off of it.

edit to add hcpcs code

astrocreep96
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Posted: 4/25/2012 3:01:44 PM
Originally Posted By stangboy555:

Originally Posted By krpind:

They said that patients on Medicare and the non-insured paid the most, which is to me. And for profit hospitals charged the most which seems like what should be happening so I'm not sure what their point on that is.

That's because private insurance companies dictate the costs to the hospitals and clinics, the .gov and non-insurance really have no say in it.

You see it all the time at clinics, you can even hear your Dr. bitch about it if you listen close enough.

"Aetna will only pay us this much for this procedure, etc.." The Dr's file a claim and take what they can get.

Medicare and the non-insured get screwed because the .gov doesn't have to skimp to stay in business and non-insured just get fucked, what are you going to do, not pay?


This is completely backwards. Medicare and Medicaid pay the least and the government does not negotiate the reimbursement, they simply tell the physician they can take it or leave it. Private insurance reimbursement rates are calculated as a percentage of Medicare, say something like 120%. Uninsured patients can negotiate an amount or go to the state hospitals and likely receive free care (itself not always a bad option as usually the most skilled physicians operate out of state funded tertiary care facilities).
Kharn
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Posted: 4/25/2012 3:07:31 PM
[Last Edit: 4/25/2012 3:10:10 PM by Kharn]
My insurance company was billed a total of $22k for mine last fall, including aftercare, follow-up visits, etc. They had prenegotiated discounts to cut it down by half, and then they paid the remainder.

ETA: caught it very early, open procedure, didn't burst, no complications, no infections, so mine was about as basic as you could get

Kharn

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Keith_J
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Posted: 4/25/2012 3:12:52 PM
An uncomplicated (intact) appendectomy could be done on an outpatient basis. Hell, one was done in a submarine during WWII by the pharmacist's mate using ether anesthesia. The cost and trouble of surgery prolongs the agony for the patient and could cause more to rupture which would increase the total cost of care.


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John_Wayne777
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Posted: 4/25/2012 3:18:09 PM
[Last Edit: 4/25/2012 3:23:24 PM by John_Wayne777]
Always question what you're not being told in the propaganda that we erroneously call "news stories"....because that's what they are. Propaganda.

Appendectomy. Well, I'm not a surgeon...but as I understand surgery they can be relatively simple affairs handled on an almost outpatient basis, or they can turn into an utter nightmare if you end up with complications....complications like infection, surgical error, allergic reaction to medication, and any host of other bizarre shit that can happen when you start cutting on people's innards. Sometimes these complications from simple surgeries can put people in intensive care...sometimes even in the morgue. Now all those costs could be tallied up to "appendectomy", but if you look at the chart of the "expensive" patients then it's probably going to have a hell of a lot more involved than "appendectomy".

The fact that the most expensive ones happened to medicare patients sounds to me like common fucking sense given that older folks have more health problems and are probably more likely to experience complications from damn near any sort of medical procedure, including surgery. Doing things to people who are in relatively poorer health might be risky. Who knew? The idea that Medicare pays more than anyone is absurd, as anyone who has been on the payee end of Medicare knows they tell you what they are going to pay without giving the slightest fuck about the cost you actually incurred. What are you going to do, sue? Ha!

Yes, medicare is going to run out of money, but that's because it's a fucking stupid program...not, I think you'll find, because docs/hostpitals are charging 180 grand for an appendectomy that somebody else down the road is doing for 1,500 bucks. More than likely that 180,000 dollar patient wasn't a simple surgery whatsoever...but since you can't see that patient's chart (confidentiality) all you see is the bill, and we as the ignorant public assume an appendectomy is an appendectomy. Medicare is in trouble because from the day it started it's payed out more money than it's taken in with tax revenues.

I could be wrong, but my spidey sense tells me I'm hovering somewhere around the truth on that.

Without looking at the charts of what was actually involved in the procedure that gets labeled "appendectomy" it gets rather difficult to go arguing that X cost for a particular procedure was excessive.
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AKengineer
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Posted: 4/25/2012 3:49:21 PM
[Last Edit: 4/25/2012 3:49:57 PM by AKengineer]

Originally Posted By John_Wayne777:
Always question what you're not being told in the propaganda that we erroneously call "news stories"....because that's what they are. Propaganda.

Appendectomy. Well, I'm not a surgeon...but as I understand surgery they can be relatively simple affairs handled on an almost outpatient basis, or they can turn into an utter nightmare if you end up with complications....complications like infection, surgical error, allergic reaction to medication, and any host of other bizarre shit that can happen when you start cutting on people's innards. Sometimes these complications from simple surgeries can put people in intensive care...sometimes even in the morgue. Now all those costs could be tallied up to "appendectomy", but if you look at the chart of the "expensive" patients then it's probably going to have a hell of a lot more involved than "appendectomy".

The fact that the most expensive ones happened to medicare patients sounds to me like common fucking sense given that older folks have more health problems and are probably more likely to experience complications from damn near any sort of medical procedure, including surgery. Doing things to people who are in relatively poorer health might be risky. Who knew? The idea that Medicare pays more than anyone is absurd, as anyone who has been on the payee end of Medicare knows they tell you what they are going to pay without giving the slightest fuck about the cost you actually incurred. What are you going to do, sue? Ha!

Yes, medicare is going to run out of money, but that's because it's a fucking stupid program...not, I think you'll find, because docs/hostpitals are charging 180 grand for an appendectomy that somebody else down the road is doing for 1,500 bucks. More than likely that 180,000 dollar patient wasn't a simple surgery whatsoever...but since you can't see that patient's chart (confidentiality) all you see is the bill, and we as the ignorant public assume an appendectomy is an appendectomy. Medicare is in trouble because from the day it started it's payed out more money than it's taken in with tax revenues.

I could be wrong, but my spidey sense tells me I'm hovering somewhere around the truth on that.

Without looking at the charts of what was actually involved in the procedure that gets labeled "appendectomy" it gets rather difficult to go arguing that X cost for a particular procedure was excessive.
Ask an economics student how that plays into doing a paper on "Legislative Affects on Market Incentives in the Healthcare Industry". Makes research a pain in the ass. An unspecified pain with no detailed information other than the final bill.

krpind
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Posted: 4/25/2012 4:56:36 PM
Did y'all even watch the video?

It is possible they are lying, but they covered the complications part.
ARFCOM.....Time well wasted.

Originally Posted By Keith_J:

Just remember to pay it forward. If someone is in need, do something positive.
PBIR
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Posted: 4/25/2012 4:58:19 PM
Mine was about $16k in '08. I arrived at the ER at around 1400 and was discharged the following morning.
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Posted: 4/25/2012 4:59:46 PM
they should charge $2 million for that procedure.

Don't like it? Go somewhere else.
learath
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Posted: 4/25/2012 5:02:13 PM
Originally Posted By VTHOKIESHOOTER:
CBS had the same story last week. It's part of an organized push to turn our health system into government payer.


There is probably some truth to it, because private insurers are allowed to negotiate prices, while medicare is not. Moronic IMHO.
VTHOKIESHOOTER
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Posted: 4/25/2012 5:04:34 PM

Originally Posted By krpind:
Did y'all even watch the video?

It is possible they are lying, but they covered the complications part.

Honestly, no. My flash player keeps crashing. Is this the same one where a 20 year old girl was bitching that after her's that she was left with a $1,100 bill that insurance wouldn't cover that prevented her from going on spring break?
http://nrgrc.com/
CZ75_9MM
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Posted: 4/25/2012 5:07:29 PM
Glad I paid out of pocket for my wife's appendectomy. Hospital sent us a bill for $35,000. I called them up to see if we could negotiate on that price and they knocked it down to $13,000 if I paid out of pocket in full. I went out there that same day with a check for $13K. I guess insurance companies and medicare/medicaid must be the ones that pay the high rate.
GTwannabe
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Posted: 4/25/2012 5:08:33 PM




I mean if this goes tits up...
danc46
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Posted: 4/25/2012 5:10:05 PM
My primary physician has my blood taken and tested every three months. The cost was $98. When I became Medicare eligible, but still covered under my wife's health insurance, the price on the same blood test was raised to $214.
I can tell of some more rip offs by the health care industry but I don't want to write a book.
Services are not priced by the actual job, but who is having it done.
The sad thing is that it is allowed by gov't and actually even promoted by gov't.
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Calash
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Posted: 4/25/2012 5:17:41 PM
There has not been a free market in health care since the 40's.
Once a majority of people were covered by medical Insurance it was
pretty much all over as far as any type of competition or market forces were concerned.
Add in government mandates that hospitals have to treat anyone regardless of there ability to pay and you have the expensive mess you have now.
My wife has insurance through her work.Total cost for a family of 4 is around 25K per year. She pays 30% of the cost.
krpind
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Posted: 4/25/2012 5:18:05 PM
Originally Posted By VTHOKIESHOOTER:

Originally Posted By krpind:
Did y'all even watch the video?

It is possible they are lying, but they covered the complications part.

Honestly, no. My flash player keeps crashing. Is this the same one where a 20 year old girl was bitching that after her's that she was left with a $1,100 bill that insurance wouldn't cover that prevented her from going on spring break?


No a Doctor did the study in California because her friend was stuck with $21K that insurance wouldn't cover from a $50K+ bill. She compared bills from different hospitals that had similar surgeries with vastly different costs to the patients.

The reporters tried calling hospitals to get pricing on different surgeries and couldn't get an answer.

ARFCOM.....Time well wasted.

Originally Posted By Keith_J:

Just remember to pay it forward. If someone is in need, do something positive.
Calash
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Posted: 4/25/2012 5:30:25 PM
I have often seen those ads in magazines asking for $250 to cover the cost of repairing a cleft lip for children in third world countries.
Not to criticize the charitable work these docs are doing but I have wondered what the same surgery would cost here.
I bet it's a lot more then $250.00
Kharn
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Posted: 4/25/2012 5:35:36 PM
Originally Posted By Calash:
I have often seen those ads in magazines asking for $250 to cover the cost of repairing a cleft lip for children in third world countries.
Not to criticize the charitable work these docs are doing but I have wondered what the same surgery would cost here.
I bet it's a lot more then $250.00
Do you think Doctors Without Borders spends 50% of their revenue on malpractice insurance?

Kharn
krpind
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Posted: 4/25/2012 5:40:14 PM
Originally Posted By Kharn:
Originally Posted By Calash:
I have often seen those ads in magazines asking for $250 to cover the cost of repairing a cleft lip for children in third world countries.
Not to criticize the charitable work these docs are doing but I have wondered what the same surgery would cost here.
I bet it's a lot more then $250.00
Do you think Doctors Without Borders spends 50% of their revenue on malpractice insurance?

Kharn

Did you know that doctors pay 3% of their gross, except for gynos and they pay about 5%?

That is less than most small businesses pay for liability (general and auto) percentage wise.

Look it up.

ARFCOM.....Time well wasted.

Originally Posted By Keith_J:

Just remember to pay it forward. If someone is in need, do something positive.
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Posted: 4/25/2012 5:43:30 PM
I find it to be bullshit that if someone I know (that doesn't have insurance) goes to the doctor and then I go (I have insurance) for the EXACT SAME REASON that they will pay more for the office visit.....a lot more!

They want to pay their bill but simply cannot afford insurance as they are on a fixed income (retired) but don't qualify for Medicaid. It is sickening to me that someone that worked their whole life is left out in the cold while the scum that lives down the street has 3 kids from 3 different daddy's, doesn't work, and gets paid by the .gov for food, shelter, and medical expenses. It sickens me
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Posted: 4/25/2012 5:44:31 PM
Originally Posted By astrocreep96:
Originally Posted By stangboy555:

Originally Posted By krpind:

They said that patients on Medicare and the non-insured paid the most, which is to me. And for profit hospitals charged the most which seems like what should be happening so I'm not sure what their point on that is.

That's because private insurance companies dictate the costs to the hospitals and clinics, the .gov and non-insurance really have no say in it.

You see it all the time at clinics, you can even hear your Dr. bitch about it if you listen close enough.

"Aetna will only pay us this much for this procedure, etc.." The Dr's file a claim and take what they can get.

Medicare and the non-insured get screwed because the .gov doesn't have to skimp to stay in business and non-insured just get fucked, what are you going to do, not pay?


This is completely backwards. Medicare and Medicaid pay the least and the government does not negotiate the reimbursement, they simply tell the physician they can take it or leave it. Private insurance reimbursement rates are calculated as a percentage of Medicare, say something like 120%. Uninsured patients can negotiate an amount or go to the state hospitals and likely receive free care (itself not always a bad option as usually the most skilled physicians supervise lowly paid sleep deprived surgery residents at state funded tertiary care facilities).


FIFY.

ask me how I know.
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Posted: 4/25/2012 5:46:18 PM
[Last Edit: 4/25/2012 5:50:37 PM by Bubbatheredneck]
Medicare, medicaid, and 99% of the insurance companies have a fixed price they pay for appendectomy, gall bladder, etc etc.

IT DOESN"T MATTER WHAT THE HOSPITAL BILL SAYS, THIRD PARTY PAYORS PAY PER THEIR SET FEE SCHEDULE.


Let me repeat that for the slow folks in class.


IT DOESN"T MATTER WHAT THE HOSPITAL BILL SAYS, THIRD PARTY PAYORS PAY PER THEIR SET FEE SCHEDULE.


The ONLY folks affected by the funny money bills are those without insurance. They are charged sticker price. And the once in a blue moon insurance company that pays on the % and not a fixed schedule.

Bubbatheredneck
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Posted: 4/25/2012 5:49:28 PM
Originally Posted By jlficken:
I find it to be bullshit that if someone I know (that doesn't have insurance) goes to the doctor and then I go (I have insurance) for the EXACT SAME REASON that they will pay more for the office visit.....a lot more!

They want to pay their bill but simply cannot afford insurance as they are on a fixed income (retired) but don't qualify for Medicaid. It is sickening to me that someone that worked their whole life is left out in the cold while the scum that lives down the street has 3 kids from 3 different daddy's, doesn't work, and gets paid by the .gov for food, shelter, and medical expenses. It sickens me





Don't forget how much you pay for health insurance. At the end of the year, what you spent vs what they spent will reveal you spent a bunch more.

Friend with no insurance goes to doc and pays $150 for visit because he has no insurance.

You go and pay $20 copay and your insurance co kicks in another $50 for a total of $70. But don't forget the $6000 you paid in insurance premiums that year.

You paid $6020 for that visit while your buddy paid $150.

Still mad?
krpind
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Posted: 4/25/2012 5:51:14 PM
Originally Posted By Bubbatheredneck:
Medicare, medicaid, and 99% of the insurance companies have a fixed price they pay for appendectomy, gall bladder, etc etc.

IT DOESN"T MATTER WHAT THE HOSPITAL BILL SAYS, THIRD PARTY PAYORS PAY PER THERE SET FEE SCHEDULE.


Let me repeat that for the slow folks in class.


IT DOESN"T MATTER WHAT THE HOSPITAL BILL SAYS, THIRD PARTY PAYORS PAY PER THERE SET FEE SCHEDULE.


The ONLY folks affected by the funny money bills are those without insurance. They are charged sticker price. And the once in a blue moon insurance company that pays on the % and not a fixed schedule.



And what started this was the hospital billed the Dr's friend the remaining balance.
ARFCOM.....Time well wasted.

Originally Posted By Keith_J:

Just remember to pay it forward. If someone is in need, do something positive.
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Posted: 4/25/2012 6:05:05 PM
[Last Edit: 4/25/2012 6:08:36 PM by Bubbatheredneck]
Originally Posted By krpind:
Originally Posted By Bubbatheredneck:
Medicare, medicaid, and 99% of the insurance companies have a fixed price they pay for appendectomy, gall bladder, etc etc.

IT DOESN"T MATTER WHAT THE HOSPITAL BILL SAYS, THIRD PARTY PAYORS PAY PER THERE SET FEE SCHEDULE.


Let me repeat that for the slow folks in class.


IT DOESN"T MATTER WHAT THE HOSPITAL BILL SAYS, THIRD PARTY PAYORS PAY PER THERE SET FEE SCHEDULE.


The ONLY folks affected by the funny money bills are those without insurance. They are charged sticker price. And the once in a blue moon insurance company that pays on the % and not a fixed schedule.



And what started this was the hospital billed the Dr's friend the remaining balance.


Then he has crappy insurance. All that fine print, read it. It is a contract. Don't like it? Find another company and contract with better terms. Plus there a zillions of factors to consider that are never mentioned. In network vs out of network, pre existing condition, etc etc etc

And here is the background on the doc that brought all this 'injustice' to light.

http://academiclifeinem.blogspot.com/2009/06/faculty-spotlight-dr-renee-hsia.html

What is your academic niche and how did you decide upon it?
I am absolutely passionate about the clinical practice of EM and, without a doubt, being in the emergency department forms not only the basis of my work, but also provides the impetus behind my research. Beyond the clinical practice, I spend a lot of time thinking about the development of health systems and its impact on populations, both domestically and globally. I can pinpoint when this broader perspective came alive to me to a brief period of my life when I lived in South Africa for six months. As a “colored” in that society, I realized on a very personal level that systems matter, and that almost all of the disparities I saw — and experienced — stemmed from policies that were intentionally and systematically designed to not only create, but also maintain, these injustices.

After that, I spent small bits of my life in different parts of the world between and after medical school, mainly in sub-Saharan Africa, from Rwanda to Senegal to Eritrea. After some pretty wild experiences (spanning the spectrum of becoming delirious with malarial fevers to ducking gunfire from the Congo), I decided to commit to developing my interests in health policy and finance at the London School of Economics and the London School of Hygiene and Tropical Medicine.


Hmmmm, I am sure she doesn't have an agenda.

Propaganda piece to support Obamacare and Obama.





sparty
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Posted: 4/25/2012 6:10:00 PM
Originally Posted By krpind:
Originally Posted By Kharn:
Originally Posted By Calash:
I have often seen those ads in magazines asking for $250 to cover the cost of repairing a cleft lip for children in third world countries.
Not to criticize the charitable work these docs are doing but I have wondered what the same surgery would cost here.
I bet it's a lot more then $250.00
Do you think Doctors Without Borders spends 50% of their revenue on malpractice insurance?

Kharn

Did you know that doctors pay 3% of their gross, except for gynos and they pay about 5%?

That is less than most small businesses pay for liability (general and auto) percentage wise.

Look it up.



Which can run between $10,000 to $250,000 a year.

I did look it up. Using rates can be deceptive when the actual numbers tell a different story.
C-4
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Posted: 4/25/2012 6:11:18 PM
Originally Posted By krpind:
Did y'all even watch the video?

It is possible they are lying, but they covered the complications part
.


No flame, but I didn't see where they covered the complication part.

I suspect that the $1529 bill was as follows:

16 y/o teenager with symptoms consistent with appendicitis and an equivocal CT of the abdomen. The appendix was surgically removed but was normal.

I suspect that the $183,000 bill was as follows:

76 y/o diabetic smoker with a 20+ medication list who came in with appendicitis and had a prolonged ICU stay complete with a trach, PEG, C. Diff. colitis from all the antibiotics, etc.
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modnar
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Posted: 4/25/2012 6:11:49 PM
Didn't know there was that big a spread with appendectomy costs. I have no clue how much my emergency appendectomy cost.
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Posted: 4/25/2012 6:16:01 PM
Originally Posted By sparty:
Originally Posted By krpind:
Originally Posted By Kharn:
Originally Posted By Calash:
I have often seen those ads in magazines asking for $250 to cover the cost of repairing a cleft lip for children in third world countries.
Not to criticize the charitable work these docs are doing but I have wondered what the same surgery would cost here.
I bet it's a lot more then $250.00
Do you think Doctors Without Borders spends 50% of their revenue on malpractice insurance?

Kharn

Did you know that doctors pay 3% of their gross, except for gynos and they pay about 5%?

That is less than most small businesses pay for liability (general and auto) percentage wise.

Look it up.



Which can run between $10,000 to $250,000 a year.

I did look it up. Using rates can be deceptive when the actual numbers tell a different story.


Percentage of gross cannot be misleading. There is no way.

What is your point? Auto insurance alone can cost the numbers you posted.

ARFCOM.....Time well wasted.

Originally Posted By Keith_J:

Just remember to pay it forward. If someone is in need, do something positive.
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Posted: 4/25/2012 6:16:50 PM
Originally Posted By C-4:
Originally Posted By krpind:
Did y'all even watch the video?

It is possible they are lying, but they covered the complications part
.


No flame, but I didn't see where they covered the complication part.

I suspect that the $1529 bill was as follows:

16 y/o teenager with symptoms consistent with appendicitis and an equivocal CT of the abdomen. The appendix was surgically removed but was normal.

I suspect that the $183,000 bill was as follows:

76 y/o diabetic smoker with a 20+ medication list who came in with appendicitis and had a prolonged ICU stay complete with a trach, PEG, C. Diff. colitis from all the antibiotics, etc.


Then they lied, because they claimed the services provided were the same.
ARFCOM.....Time well wasted.

Originally Posted By Keith_J:

Just remember to pay it forward. If someone is in need, do something positive.
Bartholomew_Roberts
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Posted: 4/25/2012 6:16:55 PM
Originally Posted By krpind:
I don't have link yet, but it was just on ABC's "Medical Minute".

They said that patients on Medicare and the non-insured paid the most, which is to me.
Thoughts?


Part of that is that health insurance providers can compare costs and know what things should cost - so they drive a harder bargain with healthcare providers - and healthcare providers are more willing to accept it because they don't want to lose a huge chunk of business by being cut off from that healthcare providers patients.

Non-insured pays out the nose because they pay "list" price; plus they have no information to compare or leverage to use with the healthcare provider.

Medicare pays out the nose because it tends to cover higher-risk patients, has higher administrative costs, and just in general, it is run by the government who doesn't seem to ever manage costs well.

Those are my almost completely uninformed thoughts on the matter. I know one big problem I see is a disconnect between patient, insurance and provider. My provider recommened some vaccine that I was 99% sure I had already received in the military. He said, "Hey, your insurance covers this. Why not be safe and get the vaccine since we aren't sure?" I agreed. Later on, I learned the vaccine costs $100/pop. There is no way I would have paid it if it had been coming out of my pocket.
EvanWilliams
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Posted: 4/25/2012 6:18:51 PM
Originally Posted By Bubbatheredneck:
Medicare, medicaid, and 99% of the insurance companies have a fixed price they pay for appendectomy, gall bladder, etc etc.

IT DOESN"T MATTER WHAT THE HOSPITAL BILL SAYS, THIRD PARTY PAYORS PAY PER THEIR SET FEE SCHEDULE.


Let me repeat that for the slow folks in class.


IT DOESN"T MATTER WHAT THE HOSPITAL BILL SAYS, THIRD PARTY PAYORS PAY PER THEIR SET FEE SCHEDULE.


The ONLY folks affected by the funny money bills are those without insurance. They are charged sticker price. And the once in a blue moon insurance company that pays on the % and not a fixed schedule.



What he said.
The anesthesia is also billed per unit. Medicare and Medicaid have a set number per unit. Your insurance has negotiated one a little higher. The uninsured guy gets a whatever the fuck the dept charges full freight. Of course, he will stiff us.
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Posted: 4/25/2012 6:21:44 PM
[Last Edit: 4/25/2012 6:22:56 PM by krpind]
Originally Posted By Bartholomew_Roberts:
.


I think the uninsured costs are two fold.

One they bill that in an attempt to constantly raise rates so insurance companies will pay more and I suspect there is some kind of tax advantage for the for profit hospitals. Depending on how creative their accounting is, they are probably calling it a loss and really large a write off on their taxes for people who don't pay.

ARFCOM.....Time well wasted.

Originally Posted By Keith_J:

Just remember to pay it forward. If someone is in need, do something positive.
sparty
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Posted: 4/25/2012 6:37:49 PM
Originally Posted By krpind:
Originally Posted By sparty:
Originally Posted By krpind:
Originally Posted By Kharn:
Originally Posted By Calash:
I have often seen those ads in magazines asking for $250 to cover the cost of repairing a cleft lip for children in third world countries.
Not to criticize the charitable work these docs are doing but I have wondered what the same surgery would cost here.
I bet it's a lot more then $250.00
Do you think Doctors Without Borders spends 50% of their revenue on malpractice insurance?

Kharn

Did you know that doctors pay 3% of their gross, except for gynos and they pay about 5%?

That is less than most small businesses pay for liability (general and auto) percentage wise.

Look it up.



Which can run between $10,000 to $250,000 a year.

I did look it up. Using rates can be deceptive when the actual numbers tell a different story.


Percentage of gross cannot be misleading. There is no way.

What is your point? Auto insurance alone can cost the numbers you posted.



Its like saying Romney only pays 14% in income tax. Never mind that 14% for him is $6,200,000.

Sure 3% of gross doesn't sound like much but it can be a lot of money to be paying in for insurance on the doc. Multiply that by 4 or 5 docs in a practice and you could be paying $1,000,000 a year. It is a major expense of the practice, sometimes actually equaling or surpassing the physician's salary.

I doubt the plumber or electrician is paying $150,000 a year in auto insurance on his fleet of 5 vans for his business.


krpind
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Posted: 4/25/2012 6:44:15 PM
Originally Posted By sparty:


Its like saying Romney only pays 14% in income tax. Never mind that 14% for him is $6,200,000.

Sure 3% of gross doesn't sound like much but it can be a lot of money to be paying in for insurance on the doc. Multiply that by 4 or 5 docs in a practice and you could be paying $1,000,000 a year. It is a major expense of the practice, sometimes actually equaling or surpassing the physician's salary.

I doubt the plumber or electrician is paying $150,000 a year in auto insurance on his fleet of 5 vans for his business.






Percent of gross is not misleading at all.

If a doctor does gross sales of $1M and pays $30K in liability, he pays 3%.

If a widget maker has $1M in gross sales and his insurance costs are $30K it is 3%

Insurance is a major expense for all businesses. The reason doctors think it is so much because they mainly sell labor. They don't have COGS running at 50% so of course insurance looks huge on their P&L.

Doctors don't pay any more for insurance that any other business, in fact the numbers say they pay less percentage wise. That is just a fact.

ARFCOM.....Time well wasted.

Originally Posted By Keith_J:

Just remember to pay it forward. If someone is in need, do something positive.
jmccoy
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Posted: 4/25/2012 7:19:05 PM
Originally Posted By Calash:
I have often seen those ads in magazines asking for $250 to cover the cost of repairing a cleft lip for children in third world countries.
Not to criticize the charitable work these docs are doing but I have wondered what the same surgery would cost here.
I bet it's a lot more then $250.00

By the very nature of medical missions, nobody is making any money. How much would you pay a skilled physician to fix your child's cleft lip? How much would you pay the anesthesiologist to make sure your kid wakes up and isn't brain damaged?
AFARR
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Posted: 4/25/2012 7:46:15 PM
Originally Posted By krpind:
Originally Posted By Bubbatheredneck:
Medicare, medicaid, and 99% of the insurance companies have a fixed price they pay for appendectomy, gall bladder, etc etc.

IT DOESN"T MATTER WHAT THE HOSPITAL BILL SAYS, THIRD PARTY PAYORS PAY PER THERE SET FEE SCHEDULE.


Let me repeat that for the slow folks in class.


IT DOESN"T MATTER WHAT THE HOSPITAL BILL SAYS, THIRD PARTY PAYORS PAY PER THERE SET FEE SCHEDULE.


The ONLY folks affected by the funny money bills are those without insurance. They are charged sticker price. And the once in a blue moon insurance company that pays on the % and not a fixed schedule.



And what started this was the hospital billed the Dr's friend the remaining balance.


Then either the hospital didn't bill correctly, or the patient (and Doctor) didn't understand the bill or EOB (Explanation of Benefits). That is quite literally like taking a $500 gift certificate into your local electronics store...buying a TV at the wonderful, on sale price of $600....down from the suggested retail of $1000...so you give them the gift certificate and $100...then when the clerk says "You saved $400 on the price of the TV over our normal price"...you pull out an extra $400 and give it to them....

I watched the video...paused on the bill. From the bill (and, by the way...it doesn't have the surgeon's bill on there...just the hospital part)...he went in through the ER, got a CT scan, and was an inpatient for a period of time....so presumably, the 'routine' appendectomy they mention was probably emergent.

Mentioned above....Medicare, by LAW gets the best rates. They've gone after drug companies who gave rebates to large insurance providers because the drug (after rebates) wound up being a few pennies cheaper than Medicare pays. Any Medicare patient paying large $$ for an appendectomy probably has a great deal of other things complicating the surgery....the CPT (Current Procedural Termnology) was mentioned above...and the hospital only gets a flat rate for the time/surgery fees.....the DRG (Diagnosis Related Group)...based on the diagnosis the patient was admitted with. If the patient develops an infection in the hospital...Medicare isn't going to pay any extra for treatement.

Here's a link to Payments for various parts of an Appendectomy....the DRG, the Surgeon's fees, etc...

AFARR
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AFARR
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Posted: 4/25/2012 7:51:46 PM
Originally Posted By krpind:
Originally Posted By sparty:


Its like saying Romney only pays 14% in income tax. Never mind that 14% for him is $6,200,000.

Sure 3% of gross doesn't sound like much but it can be a lot of money to be paying in for insurance on the doc. Multiply that by 4 or 5 docs in a practice and you could be paying $1,000,000 a year. It is a major expense of the practice, sometimes actually equaling or surpassing the physician's salary.

I doubt the plumber or electrician is paying $150,000 a year in auto insurance on his fleet of 5 vans for his business.






Percent of gross is not misleading at all.

If a doctor does gross sales of $1M and pays $30K in liability, he pays 3%.

If a widget maker has $1M in gross sales and his insurance costs are $30K it is 3%

Insurance is a major expense for all businesses. The reason doctors think it is so much because they mainly sell labor. They don't have COGS running at 50% so of course insurance looks huge on their P&L.

Doctors don't pay any more for insurance that any other business, in fact the numbers say they pay less percentage wise. That is just a fact.



If a Doctor does Gross sales of 1 Million...say a 50% overhead...his 'salary' is about $500k. That would put him in the top Neurosurgeon, top Orthopedic Surgeon, fee for service Plastic Surgeon range...with Malpractice of $100k a year (or more). So that's 10%. Just got an e-mail with a salary survey...average Radiologist and Ortho surgeons make $300k.....and Ortho's pay (in this geographic area) about $75k to $120k in malpractice (depends on what surgeries they do...backs pay more than knees/hips, etc.).

AFARR
“We live in a society of excuses, pleading for second chances, and unwillingness to take responsibility for our actions,”
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Posted: 4/25/2012 7:52:14 PM
Originally Posted By AFARR:

Then either the hospital didn't bill correctly, or the patient (and Doctor) didn't understand the bill or EOB (Explanation of Benefits). That is quite literally like taking a $500 gift certificate into your local electronics store...buying a TV at the wonderful, on sale price of $600....down from the suggested retail of $1000...so you give them the gift certificate and $100...then when the clerk says "You saved $400 on the price of the TV over our normal price"...you pull out an extra $400 and give it to them....

I watched the video...paused on the bill. From the bill (and, by the way...it doesn't have the surgeon's bill on there...just the hospital part)...he went in through the ER, got a CT scan, and was an inpatient for a period of time....so presumably, the 'routine' appendectomy they mention was probably emergent.

Mentioned above....Medicare, by LAW gets the best rates. They've gone after drug companies who gave rebates to large insurance providers because the drug (after rebates) wound up being a few pennies cheaper than Medicare pays. Any Medicare patient paying large $$ for an appendectomy probably has a great deal of other things complicating the surgery....the CPT (Current Procedural Termnology) was mentioned above...and the hospital only gets a flat rate for the time/surgery fees.....the DRG (Diagnosis Related Group)...based on the diagnosis the patient was admitted with. If the patient develops an infection in the hospital...Medicare isn't going to pay any extra for treatement.

Here's a link to Payments for various parts of an Appendectomy....the DRG, the Surgeon's fees, etc...

AFARR


So a patient that gets a bill for $21K after his insurance pays $30K doesn't understand the hospital's bill? Yeah that's an understatement.
ARFCOM.....Time well wasted.

Originally Posted By Keith_J:

Just remember to pay it forward. If someone is in need, do something positive.
AFARR
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Posted: 4/25/2012 8:00:31 PM
Originally Posted By krpind:
Originally Posted By AFARR:

Then either the hospital didn't bill correctly, or the patient (and Doctor) didn't understand the bill or EOB (Explanation of Benefits). That is quite literally like taking a $500 gift certificate into your local electronics store...buying a TV at the wonderful, on sale price of $600....down from the suggested retail of $1000...so you give them the gift certificate and $100...then when the clerk says "You saved $400 on the price of the TV over our normal price"...you pull out an extra $400 and give it to them....

I watched the video...paused on the bill. From the bill (and, by the way...it doesn't have the surgeon's bill on there...just the hospital part)...he went in through the ER, got a CT scan, and was an inpatient for a period of time....so presumably, the 'routine' appendectomy they mention was probably emergent.

Mentioned above....Medicare, by LAW gets the best rates. They've gone after drug companies who gave rebates to large insurance providers because the drug (after rebates) wound up being a few pennies cheaper than Medicare pays. Any Medicare patient paying large $$ for an appendectomy probably has a great deal of other things complicating the surgery....the CPT (Current Procedural Termnology) was mentioned above...and the hospital only gets a flat rate for the time/surgery fees.....the DRG (Diagnosis Related Group)...based on the diagnosis the patient was admitted with. If the patient develops an infection in the hospital...Medicare isn't going to pay any extra for treatement.

Here's a link to Payments for various parts of an Appendectomy....the DRG, the Surgeon's fees, etc...

AFARR


So a patient that gets a bill for $21K after his insurance pays $30K doesn't understand the hospital's bill? Yeah that's an understatement.


Look at the link I posted above (PDF of average Medicare reimbursements for inpatient stays/outpatient stays, etc.) to get a true picture of what Medicare pays. If the Hospital bill the guy had was $53k....and his insurance paid $30k, either the hospital mistakenly billed him for the remainder (possible...happens more than you'd think due to the screwed up process of how bills go through the system)...or he screwed up.

Anything from ABC/CBS/CNN, etc at this point is suspect to me....way too much political agenda there for them to have any reasonable journalistic standards.

AFARR
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Posted: 4/25/2012 8:15:52 PM
Originally Posted By AFARR:
Originally Posted By krpind:
Originally Posted By sparty:


Its like saying Romney only pays 14% in income tax. Never mind that 14% for him is $6,200,000.

Sure 3% of gross doesn't sound like much but it can be a lot of money to be paying in for insurance on the doc. Multiply that by 4 or 5 docs in a practice and you could be paying $1,000,000 a year. It is a major expense of the practice, sometimes actually equaling or surpassing the physician's salary.

I doubt the plumber or electrician is paying $150,000 a year in auto insurance on his fleet of 5 vans for his business.






Percent of gross is not misleading at all.

If a doctor does gross sales of $1M and pays $30K in liability, he pays 3%.

If a widget maker has $1M in gross sales and his insurance costs are $30K it is 3%

Insurance is a major expense for all businesses. The reason doctors think it is so much because they mainly sell labor. They don't have COGS running at 50% so of course insurance looks huge on their P&L.

Doctors don't pay any more for insurance that any other business, in fact the numbers say they pay less percentage wise. That is just a fact.



If a Doctor does Gross sales of 1 Million...say a 50% overhead...his 'salary' is about $500k. That would put him in the top Neurosurgeon, top Orthopedic Surgeon, fee for service Plastic Surgeon range...with Malpractice of $100k a year (or more). So that's 10%. Just got an e-mail with a salary survey...average Radiologist and Ortho surgeons make $300k.....and Ortho's pay (in this geographic area) about $75k to $120k in malpractice (depends on what surgeries they do...backs pay more than knees/hips, etc.).

AFARR


My general liability isn't based on my salary, but my gross dollar sales. It is about 3% then you got to add all the other insurance we pay.

How else would malpractice insurance be based? It certainly should be based on gross not salary since the higher the gross theoretically the more exposure the insurance company would have.

Insurance for doctors isn't any higher that most any other business percentage wise. Total dollars matter not. It is percentages that are important in these issues.

Besides I would be willing to bet that any Dr who is a specialist who does any kind of procedure grosses WAY more than $1M.

This says it is 3.9%, but granted it could be seriously biased

ARFCOM.....Time well wasted.

Originally Posted By Keith_J:

Just remember to pay it forward. If someone is in need, do something positive.
cm
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Posted: 4/25/2012 8:20:27 PM

Originally Posted By krpind:
Originally Posted By sparty:


Its like saying Romney only pays 14% in income tax. Never mind that 14% for him is $6,200,000.

Sure 3% of gross doesn't sound like much but it can be a lot of money to be paying in for insurance on the doc. Multiply that by 4 or 5 docs in a practice and you could be paying $1,000,000 a year. It is a major expense of the practice, sometimes actually equaling or surpassing the physician's salary.

I doubt the plumber or electrician is paying $150,000 a year in auto insurance on his fleet of 5 vans for his business.






Percent of gross is not misleading at all.

If a doctor does gross sales of $1M and pays $30K in liability, he pays 3%.

If a widget maker has $1M in gross sales and his insurance costs are $30K it is 3%

Insurance is a major expense for all businesses. The reason doctors think it is so much because they mainly sell labor. They don't have COGS running at 50% so of course insurance looks huge on their P&L.

Doctors don't pay any more for insurance that any other business, in fact the numbers say they pay less percentage wise. That is just a fact.


please provide a the background and/or a link that shows that insurance rates for doctors are based on percentage of gross revenues, or, if that is not the intended statement you are trying to make, provide information on the insurance rates various doctors are paying, and their specialties?

I think that the amounts you think doctors are paying for insurance is incorrect.

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