<p>I second moonchild - drop that dentist and get a new one - there are plenty of them out there.</p>
<p>When one consults a doctor/dentist (or mechanic, or any other service industry person) they’re not just dealing with the individual person with the technical skills, but the entire office which includes the admins, nurses/hygienists, office environment, etc. as a whole package and if it’s considered a ‘fail’ then it’s time to leverage your pocketbook power and seek the services elsewhere.</p>
<p>Intparent, can the consumer (patient) demand a statement from the insurer as to what they paid and then demand of the provider that only 20 percent is owed? I will start to do that from now on.</p>
<p>Moonchild, Anthem? Sounds like a good company; is it? What state are they in?</p>
<p>And might I add that having to deal with different insurers in different states is, IMHO, a problem.</p>
<p>^ With many insurance companies, you as a subscriber can get an on-line account where you can see the “Explanation of benefits” which lists what service was provided on what day and how much the provider charged, how much the insurance designates as the allowable amount (and hence the non-chargeable amount), what the insurance payment is, and what is the subscriber’s responsibility.</p>
<p>Realize that most doctors offices and other specialists don’t intend to screw you as the consumer and patient. They are often willing to discuss the issues with you and try to work with you as much as possible. We work with our patients regularly regarding their bills, but sometimes it comes down to we have to have payment. Healthcare professionals have to get paid just like anyone else. </p>
<p>I had an accountant telling me yesterday (we were talking about healthcare law in the gym) about one of his clients who he had at one point that was a physician. This particular period of time the client’s “accounts receiveable” was like $250k, but the client told him he would actually only bring in about $40k of that because of the insurances!</p>
<p>hops_scout, I agree with you that most doctors and their staff are just trying to follow the billing rules set up by insurance companies. As it sounds like you are too well aware, the rules for billing the umpteen insurance companies almost every provider deals with are byzantine. Not wanting to go political, but I actually think that is one of the better arguments in favor of a single payor system. The hoops that providers have to go through to follow all the different billing rules are just crazy. Having just one place to bill and one set of rules to follow would definitely cut back office costs for medical providers.</p>
<p>intparent, while I understand what you’re saying and agree with you in large part, that single payor can’t be the government. They are some of the worst! There are many insurance companies who have rules simply to have rules so they can say “well you didn’t do ____ so we don’t have to pay you.” And Medicare is one of the worst about it from what I’ve seen…</p>
<p>As a retired physician I can speak to the charges for vaccines. For most vaccines the physician receives reimbursement at or below the cost of the vaccine and often nothing from third-party payers to cover the cost of administering the vaccine, usually estimated at approximately $25 per vaccine for equipment, personnel, and storage. So the physician who charged $50 for the vaccine may have made no profit or may even have provided it at a loss, and of the $35 charged for administration may have realized a profit of $10. Many physicians will give a discount to patients who pay out of pocket even though to do so is to violate the terms of their contracts with insurance companies and also federal law. The term ‘extended visit’ refers both to the total length of time the physician and staff spend with the patient and to the complexity of the patient visit. Contact your doctor’s office if you feel that you have been billed in error.</p>
<p>If you look more closely into the problems of delivery and cost of American medical care you will find that it is insurance companies that are making the obscene profits, not doctors. In the last ten years of my practice as a pediatrician my ‘salary’ remained the same even as my patient load and overhead increased.</p>
But don’t most Medicare recipients think it works just fine?</p>
<p>My favorite billing story–my hospital billed my insurer for two C-sections in one day! (Wouldn’t that have been a rough day?) When I called the insurer to alert them to the error, they had no way to accept the info from me, as if I were not a relevant party, even though the cost would count against my lifetime maximum.</p>
<p>I realize this is anecdotal, but both mom (83) and MIL (91) have had nothing but positive experiences with medicare. My mom has been using them for 18 years, and my MIL for the last 26 years. Both have had several surgeries and other procedures, and the coverage has been excellent. My MIL was in the hospital last month with CHF for two days, lots of drugs, doc visits, physical therapies, lab work, etc., and her total bill, including the copay, came to $250.00. Not bad, if you ask me.</p>
<p>And the amazing part is that she actually got the bill in a timely fashion!</p>
<p>Thanks for your input, Irishdoc. I wish medical charges weren’t such a mystery. I wish, just like other businesses, doctors’ charges could be posted on the wall at the checkout station where they ask me to sign before billing my insurance company.</p>
<p>I made an appointment to get my vision checked annually, but the woman from billing told me (secretly) that I should complain of some kind of eye-related ailment. That way, the bill is covered by insurance. Otherwise, my (very generous POP) plan does not pay for annual vision checks. What’s with that? Apparently they cover eye problems, but not vision problems. Is that standard?</p>
<p>Well, those of us who favor a single payer system are looking out for the interests of the population as a whole, not the medical profession. But I’m gonna end this side discussion, because I’m veering into prohibited political talk.</p>
<p>Many of the discrepancies in billing/payment is how the office staff submit procedures/diagnosing.</p>
<p>I do documentation improvement and analysis for medical data, I see doctors offices losing major revenue just because of improper wording,lack of proof. Do not expect the insurance companies to inform the office they have coded it improperly, they are more than happy to deny payment.</p>
<p>One ob/gyn office had lost over 50K in revenue based on how staff coded pap smears and well woman visits. </p>
<p>You would be surprised how poorly some hospitals interpret doctor data/charts. Medicare changes its documentation rules every 12 months or so, if a doctors billing staff is not keeping up with the changes doctor loses out in payment. </p>
<p>A doctors initials on a xray report acknowledging someone has pneumonia is not addressing the problem, and yes some doctors that is the only documentation stating a patient has pneumonia. Not a word in the chart except antibiotic prescription. Electronic charting is making a huge dent, but believe it or not, alot is being missed in regards to payments to doctors.</p>
<p>“I realize this is anecdotal, but both mom (83) and MIL (91) have had nothing but positive experiences with medicare. My mom has been using them for 18 years, and my MIL for the last 26 years. Both have had several surgeries and other procedures, and the coverage has been excellent. My MIL was in the hospital last month with CHF for two days, lots of drugs, doc visits, physical therapies, lab work, etc., and her total bill, including the copay, came to $250.00. Not bad, if you ask me”</p>
<p>Not bad for them, no doubt, they are getting expensive medical care and sounds like they’re paying next to nothing. Unfortunately, though, it doesn’t come out of thin air. The providers and the taxpayers are sucking it up.</p>
<p>I’m not going to get worked up about the nickels and dimes from the doctor. Not when I had to pay the entire cost of an MRI out of pocket because Blue Cross, in its wisdom, decided it wasn’t medically necessary. My doctor seemed to think it was but hey, what does she know? Obviously the Blue Cross Claim Denial Department has a better handle on my health needs than my own MD does.</p>
<p>I hope someone someday will sue Big Insurance for practicing medicine without a license.</p>
<p>LasMa, I don’t know whether your old MRI was necessary or not, but I’m sure you’re aware that some docs get $$$ for sending a patient to get one. I don’t think having the insurance company look over the docs’ shoulders is a bad thing. The really bad thing is when the patient gets caught in the middle, as you did, and winds up paying out of pocket.</p>
<p>“Pre-certification” is a PITA but can sometimes be a good thing.</p>
<p>LasMa - Ha! The insurance companies have already thought of that. The “practicing medicine without a license” is already dealt with, since the utilization management departments are heady by a licensed physician. </p>
<p>busdriver, moonchild’s family is not necessarily “getting expensive medical care and sounds like they’re paying next to nothing”. They paid premiums every month, and for years before they had any medical expenses. Medicare is insurance. My mother paid premiums for 30 years into the system, and died at home without any hospital bills. Her premiums, along with the premiums of thousands of others, pay for moonchild’s family. It is out of kilter because the cost of medical treatment is going up, but the concept of insurance doesn’t mean moonchild’s family is getting something for nothing.</p>