Quoted: The Mrs had to have some surgery a few months back. The hospital part of the bill was just short of $11,000, insurcance only paid $950 and said we had to pay about $500. Now if we did not have insurance we would be on the hook for $11,000. But yet the insurance only had to pay $950 and it's even. What's up with that?

Good Freakin luck with that mess.

Here’s a little bit of my experience...

My hospital bill came to 11k, the ambulance and outside specialists cost another 8k.

The insurance helped, but not to the degree I had assumed.  

Instead of agreeing to accept a lesser payment in return for quick payment immediately, most of the doctors/specialists rejected the lowball offers being made by my insurance co.   One doc’s bill was $1300, they offered a lowball of around $250.

The insurance company reimbursed my payments, but only to the lowball amounts they offered the docs.   I had to make up the difference.   And they may be doctors first, but being a businessman is a close second.   Most gave me 30-60 days to pay in full, then turned it over to collections agencies, while also adding interest and other fees.   They didn’t want to understand that I was now disabled, had no income but still monthly living expenses.   Sold the house, the cars, most everything I owned to pay these bills and reduce my expenses.   I’m sure one reason for the hardball stance was because this was New Mexico, where illegals have sent several hospitals into bankruptcy and strangled a few more.



I demanded the hospital adjust my bill for $90 in meals (I couldn’t eat anything and they did not deliver these meals) and a few other obvious discrepancies.   They did adjust it, openly admitting the mistakes.   Their itemized bill was amazing. Apparently, some person keeps tabs on every medical supply item ever used on you.   Almost 200 syringes and IV needles for me alone!   I’m only surprised they didn’t track the squares of toilet paper  used.   I never saw anyone in the hospital recording all these items, although I’m sure it must have been a full-time job just to track my usage.   This was 1997, and this hospital didn’t have any kind of computerized tracking system.

Learned a neat trick docs use.   One evaluates your x-rays, then sends them to his buddy for a second evaluation, who sends them to his buddy, etc. etc.  Four different doctors tried to charge me for looking at the same set of x-rays.  I saw them myself, clear as day.   A freakin monkey could have deduced that one lung was 2/3rds infected, other lung ½ infected.  Got two of these doctors to reduce their fees after suggesting some TV exposure of their diagnostic skills.    Whenever I hear a doctor say he’s doing it because he “wants to help people” I have a hard time not laughing.


And didja know everything in an ambulance is worth it’s weight in gold.  Apart from the hellacious mileage fees, they charged  outrageous amounts for every stinkin bandage/tongue depressor/needle/ect they opened.   As if they actually keep track of every single swab!  Oh, and my crappy insurance co. did not cover any ambulance fees either.   I will admit, the 10 milligrams of morphine was well worth the $$$.


Gotta love the prescription drug coverage companies too.   I went to refill several and the pharmacy’s computer lit up and said to call the insurance co.   They told the pharmacist they were declining to cover them anymore because I had not refilled them on time, suggesting I was not taking the meds on schedule.   I used ever expletive known to inform them I was only taking them in emergency situations, per doctor’s agreement.   The side effects were so severe they would drop me to the floor, which usually cause a good deal of confusion/ambulance calls, and leave me unable to drive home.   After a few threats, they decided to honor their obligation.   And they only paid for cheap meds.   My doc wanted to prescribe the latest greatest stuff, but it was not on the “Approved Meds” list, and retailed for around $400 for a month supply, too pricy for my wallet.

Quoted: Quoted: Quoted: My wife works at a hospitol and after I had a surgery I needed some extra bandages.  These were just normal gauze, about 8"x4".  The hospitol billed my insurance $18 a piece for these.  BC/BS paid $2 something and the hospitol wrote off the rest.  If you don't have insurance you get screwed. If we DIDN'T charge $18 we'd end up giving you the bandage for free, because we wouldn't get paid for it at all at it's regular price. Insurance companies are the minions of Satan. SG That's fine but what about the poor SOB with a family that for some reason can't or doesn't have insurance, should he get stuck paying $18 for a $2 bandage just because he is down on his luck.

No.

And at my hospital, he won't...we have a very good program to basically write off the bills of those that truly cannot pay. Some hospitals do, some don't.

The rest of you, well, you get charged 18 for a 2 dollar bandage becuse that's the only way we get paid ANYTHING , courtesy of the insurance bloodsuckers.

SG

Quoted: Quoted: Not really,  I think he has strong opinions.  But not more so then others here.  But in this case he is correct.  The infusion of females into this profession is one of the causes of the decline in income inaddition to all the other factors such as insurance and the use of technology.   Long boring papers have been written that has compared our system and those of others that are dominated by women.  In each case, the income is significantly lower.   Where the hell does income of doctors come into this discussion? I would like to see you post any credible links to support the fact that "an influx of women into the medical profession"( even if they are girly men) has in anyway caused a decline in the payment of insurance or especially the use of technology. If you don't think that drjarhead has anger issues against women you are blind.

Dude google is your friend.   This is a true fact.

Quoted: Thanks ARDOC. I'm a law school graduate.  I know that I could never challenge the insurance company on my "pre-existing" condition.  So, I'm just screwed for life.

Get a job with the US Government, their health insurance contracts do not allow for preexisting condition exceptions.  

Kharn

Quoted: In a word: Contractuals. We as a Healthcare organization are forced to accept whatever the Insurance assholes deem as "reasonable and customary" which is akin to allowing the car dealer to tell YOU what you're willing to pay. For example, the "reasonable and customary" money that BCBS and Mediscare pay my department on a $3000.00 charge is not enough to cover the cost of the technicians that run it. In short, You probably had a $500 copay for surgery, the Hospital was paid a "Reasonable and customary" fee of $950 of their  $11,000 charge and wrote the rest off as contractual deductions.

So why not stick to your guns and say that the patient has to cover whatever portion of the fees their insurance didn't pay for.


If my car gets totaled in a car wreck and insurance only pays me 90% of the cost to replace it I don't expect the car dealer to reduce their price for me.

Quoted: Hospitals suck, doctors suck and insurance companies suck the most.

Nonono...Insurance companies and HMO's are all run by Satan.

Get it right!

Seriously, though. Insurance Co's and HMO's will routinely refuse a charge and unless you KNOW who to call and what to say, YOU get the bill.

When I worked in a Doc's office, even if the secretaries made errors and billed the wrong code, they'd mail the refusal of the HMO to the Patient and tell the Patient  THEY were responsible for the bill. A lot of times, the Patient would PAY because they didn't knowthe refusal was based on an error. I get bills from my insurance company telling me I owe all the time. I call, find out it's an error and they apologize and remove the charge.

Challenge EVERY bill you get from the insurances. Because SOME of them will routinely deny claims they KNOW are legit because SOME people don't fight them and will pay, saving them lots of money.

Quoted: Quoted: I just got an Explanation of Benefits from my Insurance Co.  I had some labwork done and the billed amount was $178.50 and the amount paid was $22.58. These things I find irritating, but what really irks me is my Doc prescribed medicine that we thought would benefit me and the insurance co refuses to cover it.  I am glad somebody that is sitting behind a desk God knows where is able to determine what medication I should be taking.  Because clearly my family doc is a quack. The best part is that, some high school drop out is over-ruling your doctor for the correct course of treatment.

The ins companies employ doctors, not highschool dropouts, to come up with guidelines like the ones that lead the company to only cover one drug over another similar one. They'll cover the more expensive drugs if there's a reason other than "my doc gets more kickbacks from that drug company" that one drug is preffered over another.

Quoted: Tagged for insight into the 'advantages' of 'Private Medicine' over 'Socialised Medicine'... ANdy

I dunno that it isn't "socialized" to some degree. Our insurance premiums are used to pay for the indigent cases, many state govts have ruled that Pharmacies MUST substitute the generic over the name brand when Docs write scripts and the medicare/medicaid debacle is a huge govt problem. Add that to "Reasonable and Customary" definitions <snort> and you get the mess that blurrs the line bewtween Private and Socialist healthcare.

Just my humble rant.

I think that the changes in medicine have far less to do with the influx of females into the healthcare profession than the intellectual drainage of aggressive, educated males into the business, insurance, and legal professions. Physicians, even back when it was a male dominated profession, have always been very poor business men as a whole. It was just a matter of time before the big business insurance companies and medical-legal empire learned from the low-level scammers how defenseless physicians were in this aspect.

Quoted: Tagged for insight into the 'advantages' of 'Private Medicine' over 'Socialised Medicine'... ANdy

When you or your relatives are flying over here for prompt care then you will have the answer. There is only an advantage to the individual who has urgent/timely needs of a specialized nature. For routine preventative healthcare I would argue that socialized medicine has the advantage, for now.

I have had patients that fly  from India, Taiwan, GBR, Turkey, Canada, France, for surgery. I have never heard of anyone flying out of country for surgery other than the occasional Tijiuana botched boob job.

Quoted: First of all, DrJarhead is far from dumb or sexist.  The truth is that ANY profession is which women have made inroads have suffered declining income.  This is fact.  Any economist will tell you this. For example take my profession.  More and more OB/GYNS are women.  Since the influx of women into this field the nominal pay has dropped precipitously. My partner who is a female will tell you, its all the bitches that are making our pay go down.  She was in practice with all the guys and can tell you when doctors made real money.  She hates working with other women and says they are much more difficult to work with and have a real partnership with one.  She considers me her little brother and takes care of me and watch my back and I do the same for her.  We will go to the mat for each other.  But in large female dominated groups the back stabbing and fighting is awesome. There are several reasons for this.  First female docs work about half the hours that male OB/GYNs do.  This is due to children, choice and lifestyle options.  Most men like me are workaholics and will work until we drop.  Some of the females, like my partner are also like that.  But there are several women docs that work half time.  They work less and get paid more. Obviously, HMOs and insurance have also cause a decline in the income. Another good example is in Russia.  Where most of the doctors are female. There is little respect and the pay is even less. There is no sexism here, but only the pragmatic truth.

Oh Christ! I give up...when the hubby gets home, I am gonna hand him my hair and let him drag me around the freaken cave all nite.

When will the freaken generalities cease in this place where females are concerned?

On Arf we don't dare make shots against races or religions and if we even type the evil "T" word, we're all going to hell...but say that all women are bitches and you get a freaken green lite.
Ardoc, how would YOU feel if someone said that due to the influx of Asians the pay scale has gone down?

Man up, people. Quit blaming women, the right to vote and Steinham for all that's wrong with the world and your place it.

Rant freaken off

Quoted: Tagged for insight into the 'advantages' of 'Private Medicine' over 'Socialised Medicine'... ANdy

Better Docs*, little waiting for procedures... one of the ex-gf's (from Europe, now dual citizen) tells horror stories about healthcare back in Scandinavia, it may be cheap, but half the stuff isn't done, and when it is, you have to wait 6 months or longer. She also lived in London for a few years, anytime anything medical was needed, head for the states.

Might be screwy, (with all the billing and after-effects from too many ambulance chasing lawyers) but it's the best in the world.



*there are a some quacks, but there are more than a few phenomenally bright ones.

Quoted: Quoted: Quoted: I just got an Explanation of Benefits from my Insurance Co.  I had some labwork done and the billed amount was $178.50 and the amount paid was $22.58. These things I find irritating, but what really irks me is my Doc prescribed medicine that we thought would benefit me and the insurance co refuses to cover it.  I am glad somebody that is sitting behind a desk God knows where is able to determine what medication I should be taking.  Because clearly my family doc is a quack. The best part is that, some high school drop out is over-ruling your doctor for the correct course of treatment. The ins companies employ doctors, not highschool dropouts, to come up with guidelines like the ones that lead the company to only cover one drug over another similar one. They'll cover the more expensive drugs if there's a reason other than "my doc gets more kickbacks from that drug company" that one drug is preffered over another.

I had to go through a series of tests FOUR TIMES to convince the ins. company Doc that a problem was legitimate and that a certain remedy was needed.

Irony was, the cost of the four tests (to prove my Doc was right in the first place) cost more than the treatment the ins co was trying to get out of.

My guess is insurance companies base bonuses on percentages of claims denied.

Quoted: Man up, people. Quit blaming women, the right to vote and Steinham for all that's wrong with the world and your place it. Rant freaken off

Were 40,000 people a year killed on the road before the 19th amendment passed? I think not.

The defense rests.

Quoted: If only I had access to my moms medical bills. All told she racked up about $1.2 mil in bills over 10 years of cancer (7 of that in remission). That's what the insurance company paid. The amounts actually billed were even higher, probably +60%. Then there's my Dad's eye surgery. The doctor billed $105K. $98K of that was an "accounting error" nobody could figure out, something to do with laser time. The sad thing is, he caught the error, not the insurance company. They were going to pay the inflated amount.

Cheeky buggers. Our hospital tried to pull that crap. I ticked off the mistakes and told the billing dept manager I was taking it to Birmingham to the Federal Prosecuter for a RICO indictment. This was only a bluff, since the Fed couldn't convict Richard Scrushy. Hospital was not amused, but they cleaned up their bill.

Quoted: Quoted: Man up, people. Quit blaming women, the right to vote and Steinham for all that's wrong with the world and your place it. Rant freaken off Were 40,000 people a year killed on the road before the 19th amendment passed? I think not. The defense rests.

and your great state was one of the first to ratify the amendment.
Congratulations!

Quoted: Quoted: Quoted: Man up, people. Quit blaming women, the right to vote and Steinham for all that's wrong with the world and your place it. Rant freaken off Were 40,000 people a year killed on the road before the 19th amendment passed? I think not. The defense rests. and your great state was one of the first to ratify the amendment. Congratulations!

bblmedia.com/women_drivers.html

Quoted: Quoted: Quoted: Man up, people. Quit blaming women, the right to vote and Steinham for all that's wrong with the world and your place it. Rant freaken off Were 40,000 people a year killed on the road before the 19th amendment passed? I think not. The defense rests. and your great state was one of the first to ratify the amendment. Congratulations!

I'm hoping Merrell was kidding with this. I mean, I think I see his tongue in his cheek since there were not 40,000 people ON the road prior to then.
Merrell...you're a bad boy. Go to Angelina's room and wait there...with her brother.

Quoted: Quoted: Quoted: Quoted: Man up, people. Quit blaming women, the right to vote and Steinham for all that's wrong with the world and your place it. Rant freaken off Were 40,000 people a year killed on the road before the 19th amendment passed? I think not. The defense rests. and your great state was one of the first to ratify the amendment. Congratulations! I'm hoping Merrell was kidding with this. I mean, I think I see his tongue in his cheek since there were not 40,000 people ON the road prior to then. Merrell...you're a bad boy. Go to Angelina's room and wait there...with her brother.

* waves *

Quoted: Quoted: First of all, DrJarhead is far from dumb or sexist.  The truth is that ANY profession is which women have made inroads have suffered declining income.  This is fact.  Any economist will tell you this. For example take my profession.  More and more OB/GYNS are women.  Since the influx of women into this field the nominal pay has dropped precipitously. My partner who is a female will tell you, its all the bitches that are making our pay go down.  She was in practice with all the guys and can tell you when doctors made real money.  She hates working with other women and says they are much more difficult to work with and have a real partnership with one.  She considers me her little brother and takes care of me and watch my back and I do the same for her.  We will go to the mat for each other.  But in large female dominated groups the back stabbing and fighting is awesome. There are several reasons for this.  First female docs work about half the hours that male OB/GYNs do.  This is due to children, choice and lifestyle options.  Most men like me are workaholics and will work until we drop.  Some of the females, like my partner are also like that.  But there are several women docs that work half time.  They work less and get paid more. Obviously, HMOs and insurance have also cause a decline in the income. Another good example is in Russia.  Where most of the doctors are female. There is little respect and the pay is even less. There is no sexism here, but only the pragmatic truth.   Oh Christ! I give up...when the hubby gets home, I am gonna hand him my hair and let him drag me around the freaken cave all nite. When will the freaken generalities cease in this place where females are concerned? On Arf we don't dare make shots against races or religions and if we even type the evil "T" word, we're all going to hell...but say that all women are bitches and you get a freaken green lite. Ardoc, how would YOU feel if someone said that due to the influx of Asians the pay scale has gone down? Man up, people. Quit blaming women, the right to vote and Steinham for all that's wrong with the world and your place it. Rant freaken off

The average male OB works around 80 hours per week.  Females about 60.  Those were the numbers several years ago.

Quoted: Quoted: Quoted: First of all, DrJarhead is far from dumb or sexist.  The truth is that ANY profession is which women have made inroads have suffered declining income.  This is fact.  Any economist will tell you this. For example take my profession.  More and more OB/GYNS are women.  Since the influx of women into this field the nominal pay has dropped precipitously. My partner who is a female will tell you, its all the bitches that are making our pay go down.  She was in practice with all the guys and can tell you when doctors made real money.  She hates working with other women and says they are much more difficult to work with and have a real partnership with one.  She considers me her little brother and takes care of me and watch my back and I do the same for her.  We will go to the mat for each other.  But in large female dominated groups the back stabbing and fighting is awesome. There are several reasons for this.  First female docs work about half the hours that male OB/GYNs do.  This is due to children, choice and lifestyle options.  Most men like me are workaholics and will work until we drop.  Some of the females, like my partner are also like that.  But there are several women docs that work half time.  They work less and get paid more. Obviously, HMOs and insurance have also cause a decline in the income. Another good example is in Russia.  Where most of the doctors are female. There is little respect and the pay is even less. There is no sexism here, but only the pragmatic truth.   Oh Christ! I give up...when the hubby gets home, I am gonna hand him my hair and let him drag me around the freaken cave all nite. When will the freaken generalities cease in this place where females are concerned? On Arf we don't dare make shots against races or religions and if we even type the evil "T" word, we're all going to hell...but say that all women are bitches and you get a freaken green lite. Ardoc, how would YOU feel if someone said that due to the influx of Asians the pay scale has gone down? Man up, people. Quit blaming women, the right to vote and Steinham for all that's wrong with the world and your place it. Rant freaken off The average male OB works around 80 hours per week.  Females about 60.  Those were the numbers several years ago.

Well, just when are they supposed to make SAMMICHES???? GODDAMMIT!

Quoted: The average male OB works around 80 hours per week.  Females about 60.  Those were the numbers several years ago.

THAT is your argument?

Please. OK...let's say those figures are accurate (and I'm not), are you saying that the less hours worked by the female OB Docs results in YOU getting a lower salary???
I don't think so. There is no linear equasion for that math...
Stop going emotional doc...that's MY territory. Gimme hard numbers that support YOUR crappy pay with the supposition that they are working fewer hours.

I recently had an office visit with my Dr that went about $400.  I paid $15, the insurance company paid around $180.

I'd just love to know how they hell they can charge $400 for 20 minutes worth of office time and a blood test.  

Quoted: Well, just when are they supposed to make SAMMICHES???? GODDAMMIT!

Quoted: Quoted: Well, just when are they supposed to make SAMMICHES???? GODDAMMIT! img.photobucket.com/albums/v699/sushiii/Kawaii/kittySandwichMaker_02.jpg

I NEED ME ONE OF THOSE!!!!!

Hello Kitty Sammich Maker

Quoted: I recently had an office visit with my Dr that went about $400.  I paid $15, the insurance company paid around $180. I'd just love to know how they hell they can charge $400 for 20 minutes worth of office time and a blood test.

They DON'T, that's the point.

Quoted: Quoted: Quoted: I just got an Explanation of Benefits from my Insurance Co.  I had some labwork done and the billed amount was $178.50 and the amount paid was $22.58. These things I find irritating, but what really irks me is my Doc prescribed medicine that we thought would benefit me and the insurance co refuses to cover it.  I am glad somebody that is sitting behind a desk God knows where is able to determine what medication I should be taking.  Because clearly my family doc is a quack. The best part is that, some high school drop out is over-ruling your doctor for the correct course of treatment. The ins companies employ doctors, not highschool dropouts, to come up with guidelines like the ones that lead the company to only cover one drug over another similar one. They'll cover the more expensive drugs if there's a reason other than "my doc gets more kickbacks from that drug company" that one drug is preffered over another.

It is true that ins co's will deny the higher priced name brand drugs if less expensive generics are available.  But in my case this is not what they did.  They denied payment of the drug saying it was not necessary, not that they wanted me to use something cheaper.  So in effect, the folks at my inssurance co. are telling me that they know what is best without even seeing me.  

The specifics are that the labs revealed I have a level of a certain value that is just at the low end of "normal".  Say the normal range is "100-1500".  My level came back at 101.  My personal doc, because of other signs/symptoms I am experiencing said that I would benefit from taken this specific class of meds.  The insurance company flat out refuses because I fall within the normal range.  So my only choice is to pay the additional $200/mo for the drug, or hope that the next time my labs are done the level drops by .001% so I will be covered.

I understand the fact that many folks are medicated for no reason and the insurance companies are trying to prevent unnecessary treatments, but in my case, they are sticking by a number and not looking at the patient.  My doc has tried to talk to them but they just won't listen and that is not right.  

Normal ranges are not the end all in diagnosis.  To use numbers but deny what you see physically in a patient makes no sense at all to me.  But hey, what do I know.

Quoted: yammer yammer yammer yammer

Here. Look at this happy family. Women at home happily practicing domestic chores. Is this not wonderful?

Quoted: Quoted: yammer yammer yammer yammer Here. Look at this happy family. Women at home happily practicing domestic chores. Is this not wonderful? lib2.store.yahoo.co.jp/lib/allspeed/hello-kitty-omoti-maker01.jpg

Practicing?
Hah! I no longer need practice. I'm an expert.

Quoted: The ins companies employ doctors, not highschool dropouts, to come up with guidelines like the ones that lead the company to only cover one drug over another similar one. They'll cover the more expensive drugs if there's a reason other than "my doc gets more kickbacks from that drug company" that one drug is preffered over another.

Ins companies, especially workman's comp do employ physicians as part of the utilization review process. This is to control costs and curb fraudulent claims. These physicians are either retired from practice, no longer able to stay in practice (license revoked, or too many lawsuits), or were never in practice at all. While they do reduce costs, their goal is not to achieve the optimal care for any given patient at all. It is almost like a defense attorney vs a prosecutor's mindset.

I see some shit continued on here last night after I left.

First, thanks ARDOC for the support.

Second, it may make some of you losers here feel better to think that someone who has scored more ass in one month than some of you have in your entire life has "issues with women" but it means nothing to me because I don't respect your opinion and I have more confidence than some of you could ever hope to have.

At least half of you here are emotionally disturbed, of that I have never had any doubt. Maybe higher now after the influx of socialists over the past year and a half. It is truly a mental disorder that some of you carry into everything you do, everyday.

Third, you may huff and puff and try to inflate your own shallow self esteem by trying to make it seem that you are the advocate of women against "troglodytes" such as me but in the end it only underscores how pathetic some of you are.

Fourth, and for the last fucking time, my comment about "women" in this thread referred primarily to pussified males. The same as some of you nutless wonders. Whether you think so or not matters not one iota to me as, again, your opinions are as important to me as you are. IOW not one bit.

Fifth, my venom is not launched at women here or even pussified males like some of you. It is launched at PC dickheads who couldn't get their nuts out of a jar if they begged for them on their hands and kness. BFD. FOAD. Your fathers must be so proud of what nutless wonders some of you have turned out to be. I'd disown my kid if he turned into a pussy like some of you.


As for my experience with women,

Dated about 150 of them
Worked for 4 years in a lab where I was the only man working with 15 women
Nurses and female docs far outnumber men in medicine
80% of my patient visits everyday were with women
Been married to one for 23 years

Now if you don't like what I say that is one thing, not that I really give a shit what most here think. I come here for the group who's opinion I value. However, the inclination of the emotionally disturbed around here to turn every thread into a pissing contest or jump on every little thing if you don't like the wording is BS. And I am going to tell each and every one of you who do so to fuck off bigtime. Every chance I get. If you don't like it too fucking bad. Some of you are a pathetic waste of flesh, not to mention testosterone.

NO ONE IS GOING TO PAY ONLY $1450 FOR AN $11,000 PROCEDURE. IT AIN'T GOING TO HAPPEN

DrJarHead, I guess you don't take Medicaid?  


Example from the Podiatrist's office:

Patient schedules office visit for pain in their foot.

Simple office visit (call it an existing patient for simplicity).

15-20 minutes in the room.

Simple Dx:  Plantar Fasciitis.

Discussed problem with patient and treatments.  Patient defers injection at this time, so no "additional" charges.

Billed as $80 for the office visit (this is to cover everything, Dr's time, Secretary, Billing, etc. and normal office overhead).

Now how is it paid:

Patient with PPO Blue Cross/Blue Shield:  
$10 to $20 Copay on visit  + Insurance.    Blue Cross approves $55 total (Dr. gets $55 -- 1 bill to insurance co.)

Patient with Medicare.
20% copay and Medicare approves $38  (Dr. Receives $38--2 bills  to medicare and patient)

Patient with Medicaid (Public Assistance)
No Copay--Medicaid approves $17 (Dr. Receives $17--1 bill to insurance co.)

Patient with No insurance, cash out of pocket--$40 flat fee, paid on the spot.


AFARR

What I learned reading this thread: Dr. Jarhead was a "playa"

The insurance company reimbursed my payments, but only to the lowball amounts they offered the docs. I had to make up the difference.

Are you legally required to make-up the difference?

My nephew recently had a short hospital visit and surgery that resulted in a $95k bill.  His insurance company paid around $20k which left about $75k remaining.  His insurance company sent him a letter telling him that it was illegal for the hospital or doctors to bill him the difference.  Due to the amount of money involved, I talked to a lawyer for him, and the lawyer said that was true.  That doesn't make any sense.  We tell our best and brightest that they have to accept a fraction of what they charge and then make it illegal to try to collect the rest?  That's ridiculous.

Of course this sets-up the vicious circle where rates have to increase since the doctors only get a fraction of what they bill.  Then the price the poorest have to pay goes-up even more which the rich continue to pay only a fraction.  As the lawyer said, my nephew would have been liable for the entire $95k if he didn't have health insurance.

I'm still waiting on cash-only doctors to appear.  Most people I know don't have health insurance, and being able to pay the same price as everyone else (rather than the inflated price that the poor pay while the rich are allowed a discount) would really make a difference for the good.  We have a system that screws-over the poor.z

Quoted: NO ONE IS GOING TO PAY ONLY $1450 FOR AN $11,000 PROCEDURE. IT AIN'T GOING TO HAPPEN DrJarHead, I guess you don't take Medicaid?   Example from the Podiatrist's office: Patient schedules office visit for pain in their foot. Simple office visit (call it an existing patient for simplicity). 15-20 minutes in the room. Simple Dx:  Plantar Fasciitis. Discussed problem with patient and treatments.  Patient defers injection at this time, so no "additional" charges. Billed as $80 for the office visit (this is to cover everything, Dr's time, Secretary, Billing, etc. and normal office overhead). Now how is it paid: Patient with PPO Blue Cross/Blue Shield:   $10 to $20 Copay on visit  + Insurance.    Blue Cross approves $55 total (Dr. gets $55 -- 1 bill to insurance co.) Patient with Medicare. 20% copay and Medicare approves $38  (Dr. Receives $38--2 bills  to medicare and patient) Patient with Medicaid (Public Assistance) No Copay--Medicaid approves $17 (Dr. Receives $17--1 bill to insurance co.) Patient with No insurance, cash out of pocket--$40 flat fee, paid on the spot. AFARR

Oh yeah, I took Medicare. No choice in corporate medicine.
If you read on I specifically excluded medicare/medicaid and the initial post was about private ins.

I'd be very surprised if this plays out as the final word on the subject but plenty seem to be saying they've had similar experiences. I have not heard of such a disparity between billing and payment with regards to private ins in my area.

Just to underscore, my first job out of residency was in an area where Medicare was at least 80% of what I did, and the average age of my patients was probably ~75. No shit. Great pt population but remibursement sucked and they all took 30 minutes at least, after scheduling 15 min appts. I was on 24/7/365(no shit) and after having no private or personal life for 2 years I moved on. Miss those pts but that is about it. My last job was a good job, decent hours, good pay, good partners, best group of nurses I have worked with(yeah, plenty have emotional issues and baggage but not too bad in this bunch) but it was 60% medical assistance, always trying to screw the system, waste resources, get drugs, etc. If I could have put the best from those 2 jobs together I would be happy for life. Not to be.

Quoted: I'm still waiting on cash-only doctors to appear.

I would love to run that kind of practice.
I cannot tell you how much.

I'm going for a hike in the forest. First sunny day here in 3 weeks and it is too nice to waste on this thread!

Quoted: I see some shit continued on here last night after I left. First, thanks ARDOC for the support. Second, it may make some of you losers here feel better to think that someone who has scored more ass in one month than some of you have in your entire life has "issues with women" but it means nothing to me because I don't respect your opinion and I have more confidence than some of you could ever hope to have.

I will put any month of your life against any month of mine, when it come to prowess in the "scoring of ass". Just your general attitude about this issue should be enough to show your real character. (just as an aside.....I left this thread at 10 pm, because one of the local Bud girls wanted me to go to a party with her and her friends) I'm over 40 and they still call me to go out. It is good to be me.

At least half of you here are emotionally disturbed, of that I have never had any doubt. Maybe higher now after the influx of socialists over the past year and a half. It is truly a mental disorder that some of you carry into everything you do, everyday. Third, you may huff and puff and try to inflate your own shallow self esteem by trying to make it seem that you are the advocate of women against "troglodytes" such as me but in the end it only underscores how pathetic some of you are.

As I have stated here and to my friends and to stangers.....I am absolutely the luckiest man on earth. I am 41, basically retired, with a large income of disposable cash. I can go and do ANY fucking thing I want ANY fucking time, and do it with style. I have zero self esteem issues....Hell I am a little too confident so much so I often come off as arrogant.

Fourth, and for the last fucking time, my comment about "women" in this thread referred primarily to pussified males. The same as some of you nutless wonders. Whether you think so or not matters not one iota to me as, again, your opinions are as important to me as you are. IOW not one bit.

Whatever......you were being a jackass and I asked you about it and you flew off the handle like a little spoiled brat.

Fifth, my venom is not launched at women here or even pussified males like some of you. It is launched at PC dickheads who couldn't get their nuts out of a jar if they begged for them on their hands and kness. BFD. FOAD. Your fathers must be so proud of what nutless wonders some of you have turned out to be. I'd disown my kid if he turned into a pussy like some of you.

My father died when I was 11......I have wondered if he would be proud of me and the man I am. Would he be upset over the numerous relationships or would he understand.
I have been successful in business and I like to think I am a generous person.....my weakness has always been women and the fact that i can't seem to find the perfect one. I have had a shit load of fun TRYING to locate her though

As for my experience with women, Dated about 150 of them Worked for 4 years in a lab where I was the only man working with 15 women Nurses and female docs far outnumber men in medicine 80% of my patient visits everyday were with women Been married to one for 23 years

Congratulations on 23 years of marriage......it is the only thing I can find to admire about you in regards to your attitude about women.

Now if you don't like what I say that is one thing, not that I really give a shit what most here think. I come here for the group who's opinion I value. However, the inclination of the emotionally disturbed around here to turn every thread into a pissing contest or jump on every little thing if you don't like the wording is BS. And I am going to tell each and every one of you who do so to fuck off bigtime. Every chance I get. If you don't like it too fucking bad. Some of you are a pathetic waste of flesh, not to mention testosterone.

You should read that last paragraph you wrote.....it is a description of yourself.

I would take my life over yours anyday........you see I am really happy.(my business is not being socialized by women or pussified men....lol) I could not ask for anything more in life.

Quoted: The insurance company reimbursed my payments, but only to the lowball amounts they offered the docs. I had to make up the difference. Are you legally required to make-up the difference? My nephew recently had a short hospital visit and surgery that resulted in a $95k bill.  His insurance company paid around $20k which left about $75k remaining.  His insurance company sent him a letter telling him that it was illegal for the hospital or doctors to bill him the difference.  Due to the amount of money involved, I talked to a lawyer for him, and the lawyer said that was true.  That doesn't make any sense.  We tell our best and brightest that they have to accept a fraction of what they charge and then make it illegal to try to collect the rest?  That's ridiculous.

I believed I was.

The collections people made it clear in every piece of correspondence that I was personally responsible for the entire bill, regardless of what my insurance company did.    They went after me like sharks, with 2-3 dozen phone calls and letters every week.   They specifically stated they had declined the offers from my insurance company.

These bills were from doctors and specialists who were not under a binding contract to accept whatever my insurance company offered.  

This was before the internet really blossomed into a usable tool, I had no one to tell me otherwise, and I accepted it as my personal responsibility to pay my bills, even when  I felt most of them were grossly inflated.

Back to the original question.

I have seen insurance companies pay bills in installments.

Could the $950 only be the first installment on the $11,000?

Quoted: IThird, you may huff and puff and try to inflate your own shallow self esteem by trying to make it seem that you are the advocate of women against "troglodytes" such as me but in the end it only underscores how pathetic some of you are.

No shallow self esteem here, I just know a classless guy when I see one, regardless of the letters behind your name. Your reply only proves it.

Primarily because the hospital and the insurance companies take turns trying to screw each other. Example: I have to use a respiratory machine for my sleep apnea at night. The mask broke. The hospital wants $310.00 for replacement mask.  I can buy one online for $48.00.  They charged me $2700.00 for the machine in the first place.  Online?  Less than $800.00. The hospitals overcharge for everything because they know the insurance company is going to short them.  The insurance company knows the hospital is trying to screw them, so they underpay the claim.  It's a game of fuck your buddy.  The ones who pay in the end are the patients through outrageous premiums. Compare two bills for the same surgery.  The person with no insurance will most likely have a much lower bill.

The person with no insurance will most likely have a much lower bill.

That's illegal.  The person paying cash must be charged the highest rate.  That's why the poor in this country are billed much more for medical care than the rich.z

Quoted: Quoted: IThird, you may huff and puff and try to inflate your own shallow self esteem by trying to make it seem that you are the advocate of women against "troglodytes" such as me but in the end it only underscores how pathetic some of you are. No shallow self esteem here, I just know a classless guy when I see one, regardless of the letters behind your name. Your reply only proves it.

Means nothing to me coming from human refuse. Try again.

DrJarhead,

Got stuck in Radiology this AM (rotation) and reading Path slides this PM (again, rotation)--so I spent my day in a dimly lit room or with my eyes stuck to a microscope--would have liked to have gotten outside!!



The way the insurance goes (a bit over simplified):

You get Insurance X from your job.  Insurance X covers your basic and major medical.  There may be limitations on going to a Primary Care Dr. first (HMO) and getting a referral, or being able to go to anyone in the network with no referral (PPO).  

Regardless--let's say for simplicity sake you have a PPO with a $10 office Copay (paid directly to the office at the time of visit), and a $50 outpatient procedure copay.  We'll be generous and say you have a $1 million cap.  You pay $100/month out of your paycheck (the company picks up the remaining $500 for family coverage).

Then the Doctor and Hosptial come into the picture.

Let's start (again) with simple foot (heel) pain that you want to go to a Podiatrist to get it treated.

You call the office to make an appointment.  They ask who your insurance is.  They take Insurance X, so the secretary makes your appointment.  

Now, because the Doctor "Takes" your insurance, he had to fill out a 10+ page form (done annually or bi-annually) to get "Credentialed" (the insurance makes shure he is 'competant' to treat you--done more to hassle the Doctor who has already completed a residency, passed boards, got state licenses, paid malpractice and paid a good bit of money to start his business).   Once he is "Credentialed", he accepts the insurance plan--his contract with the insurance says that an office visit that he normally bills $80 for will get him $55--the insurance co. pays $45 and the patient pays $10.   In exchange, the Insurance company will "Allow" their clients to go to the Dr. and list the Doctor as being on their plan.   The Dr. is stuck, especially if Insurance X is the 500lb gorilla in the area (all the major employers buy that plan).  If he doesn't agree, he won't have patients--they will go to doctors that "Accept" their insurance.  If they happen to go to him, the insurance company will likely only pay $25 to the Doctor and expect him to bill the patient for the remaining $55 on the bill.  The larger insurance companies can blackmail the local doctors into taking their rates with the threat of going bankrupt if they don't.  

Ok, so from the Patient's standpoint he just called to make the appointment.

He shows up and pays his $10 copay.

Sees the Doctor for his 30 minute initial visit.  Doctor builds a chart, takes an History and Physical, and makes a diagnosis.  Gives the patient some treatment options.  Patient again defers a shot.

Patient goes home and (sometimes) follows the Dr's instructions.

Comes back in one month (again paying a $10 copay) and now wants the shot--foot didn't get better.

Gets a Shot.  Dr. bills Insurance X for the $45 remaining from the office visit and $100 for the shot--the shot is reimbursed at $38 (covers the materials and medicine), so the Dr's office has to eat the $62 difference (called a "Write Off").

Two months later, the patient comes back and still has pain.  Now he wants Surgery (a bit oversimplified--surgery for Plantar Fascitiis is usually later in the game).  Again, a $10 copay, $45 from the insurance company.

Doctor goes over consent form, schedules patient for surgery, has the pre-op labs/chest X-ray/EKG ordered.  Depending on patient history, Dr. may want clearance from Primary Care Doctor (say the patient had a heart condition--but, for simplicity sake, we'll forego that and assume no clearance is needed).

Patient goes to hospital for labs/EKG/Chest X-ray.   Hospital bills $350 for all the above, insurance reimburses $97 ($23 for labs, and remainder for CXR & EKG).

Patient shows up for day of Surgery.  

Surgery--under 1 hour is uneventful, done under local anesthesia with IV Sedation.   Patient goes home on pain meds.

2 Followups in Doctor's Office (included in the Surgery "Global" period, so no billing or co-pay--which means the patient used up a couple of slots that could have been used for paying patients).

Hospital Bill Comes:  $2800
Anesthesia Bill Comes $300 (IV Sedation, remember?).
Surgeon's Bill Comes $700.

The Patient pays $50 copay.
The Insurance pays the Hospital $950 (negotiated fee for 1 hour OR including Pre/Post Op time).
They pay the Anesthesia $147.
They Pay the Surgeon $398.

The Hospital is in the same boat as the Doctor, as if they Don't take Insurance X, they won't have any patients.

OK, now let's break that down:
Total billing for Hospital and Doctor's Office/Anesthesia/Surgery (this is the BILLED amount, not the agreed upon fee) is $4490 (that is for 3 office visits, pre-op workup and the surgery).

The Patient has paid his 3 Co-Pays and the $50 outpatient surgery fee, so that is $80 total.

The Insurance company has paid their negotiated amounts--totaling $1765.

So, of the total billed $4490, only $1845 was paid, leaving $2645 to be written off.

Now, let's assume that Insurance X is MEDICARE!!.  The Fed.Gov can come in and tell you that if you don't take their fee, or try to overcharge, etc. you are guilty of Fraud and will go to jail and get hit with massive fines and/or jail time.   If you Opt Out of medicare, you won't have any patients over 65, as they can go to someone else and pay less.  If you opt in, you are stuck with what Medicare wants to pay (I believe this year is a 4% CUT from last year??).    Blue Cross, etc. etc. generally follow what Medicare does--they usually pay a bit more (as someone mentioned earlier--usually it is 1.x times what medicare pays--and the 0.x is only 0.2 or 0.3 in many cases).

AFARR

AFARR, you are telling me nothing I don't already know. Shame you had to type all of that!

In my experience I have not seen wide disparities between billing and reimbursement outside of meidcare or med assistance. IOW, private ins in my area pays pretty much what we bill with minor variances.

I figured out once that after overhead and taxes I made about $8.50 for a Medicare visit. Hardly worth it to be honest considering the amount of BS you go thru with these pts and the gov't. However, when you work for corporate medicine you do what you have to. If not for that docs whould have put an end to this bullshit a long time ago.

If I ever decide to go back into medicine it would likely be on a cash basis and I would bill much less than current rates. I'm at a point in my life where I want to make a decent living for what I do but  job satisfaction is more important than money. That's me though and when I had big med school loans hanging over my head money was a larger factor.

Quoted: Quoted: Quoted: IThird, you may huff and puff and try to inflate your own shallow self esteem by trying to make it seem that you are the advocate of women against "troglodytes" such as me but in the end it only underscores how pathetic some of you are. No shallow self esteem here, I just know a classless guy when I see one, regardless of the letters behind your name. Your reply only proves it. Means nothing to me coming from human refuse. Try again.

I don't need to; you keep proving my original take on your personality.

I go to work and shit hits the fan when I come back online!