<p>I don’t want to get too far into this thread because the issues make me so angry.</p>
<p>BUT…I swear that some dentists attend seminars on how to make more money. I hate mine because whenever I go, they determine my annual insurance benefits and give me a list of what to have done that year, bug me before I leave to schedule the appointments, then call me to follow up when I don’t.</p>
<p>I feel like I live in a completely different world. When I’ve called our various doctors over the years and said “I have a question about my bill”, the answers have been sensible and coherent, and either I’ve made a mistake or they have, and no one seemed to be attempting to commit any kind of fraud or overbilling. </p>
<p>Our dentist gives us a copy of the treatment plan and its costs to check over before any work is done, as well as faxing it to the insurance company for verification. </p>
<p>I have found the vast majority of people that I deal with, in all professions, are honest. The exceptions seem to be those who attempt to buy goods from our business with fraudulent credit cards. Oh, and a few accountants I’ve run into along the way…</p>
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@limabeans - I believe this is standard. An eye-related ailment is considered medical and would therefore be covered under the medical portion of your plan. A routine annual vision check might be covered under a plan with vision care benefits, but otherwise not. I think she’s out of line in suggesting that patients misrepresent their reason for seeking care in order to obtain payment for routine services. The routine eye exam is usually not that expensive; I’d personally rather pay for it than claim benefits fraudulently.</p>
<p>"Worst health care system in the universe. "</p>
<p>May I suggest you travel more? I have been to Honduras, Ethiopia and Ecuador on medical mission trips and I guarantee you, you would be SO much more grateful for what we have!</p>
<p>For example, in Honduras you get injured and somehow your family manages to get you to the big ER where you wait for hours or a day. Then the doctor examines you and determines you need an operation with pins, plates, etc. They give your family the prescription where they must go and buy the parts and bring them back. if they cannot , then they have them in this sort of traction set up with bottles ( very crude) for a couple of days until they send them home. Their leg doesn’t heal and they can’t work. </p>
<p>Here you would get the surgery regardless of whether you can pay or not. My husband writes off tons of er cases… I’m guessing 75 percent of the work he does in the er when he is on call, he doesn’t get a dime from.</p>
<p>Health Insurance is not that profitable of an industry, actually:
[Fortune</a> 500 2009: Top Performers - Most Profitable Industries: Return on Revenues](<a href=“http://money.cnn.com/magazines/fortune/fortune500/2009/performers/industries/profits/]Fortune”>Fortune 500 2009: Top Performers - Most Profitable Industries: Return on Revenues)</p>
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<p>I was just reviewing the info on a new policy we are considering and it stated:</p>
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<p>Isn’t that the purpose of the Pre-Cert?</p>
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It’s setting up a straw man to compare US healthcare to that in third world countries–compared to other modern, industrialized nations, not “the universe”, the US fares quite poorly. CNN’s Sanjay Gupta did a fascinating show on healthcare systems in several nations–many different approaches, all doing a better job than we do.</p>
<p>Here’s what I would like to see as the subject of sincere national debate: Is it a good idea to have a healthy workforce? Does a person’s good health benefit anyone besides himself and his immediate family?</p>
<p>OP: For the last several years I have appealed almost every medical bill I’ve received. This is after changing to a private insurance policy with a high deductible, free preventative care, but I pay for all other charges until I meet the deductible. If the bill is coded for preventative care it is covered. The billing errors are always coding errors. I had an annual checkup in February and just resolved that bill, because it was coded for checking on a preexisting condition, which I do have, but required no attention in the visit. It took only three months to have a colonoscopy correctly coded. </p>
<p>Because it is so difficult to get them on the phone, I go into my insurance office and meet with a representative after receiving a statement and ask them why they haven’t paid the full amount. They tell me it wasn’t coded for preventative care and I should request the doctor’s office resubmit with correct code. I call the doctor’s office and speak with the woman in charge of billing. She connects me with someone in charge of coding. Invariably that individual agrees to resubmit the charges. This sometimes takes months and requires follow-up. After the insurance company receives the new bill with correct coding they pay the entire amount.</p>
<p>Rather time consuming for me. For everyone else, too.</p>
<p>^^what an annoying waste of time for you and everybody else, alh. Sounds like it all goes back to the person in charge of coding, who apparently needs more training.</p>
<p>" 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>
<p>I understand what you’re saying, and I don’t blame anyone for utilizing the system that they had no choice about participating in. But my point is that someone is paying for it. Whether it’s other people who have paid into it for decades and then never got sick or died and never utilized it, whether it’s the debt that is on our children’s and grandchildren’s back’s for their lifetime, or the doctors that are taking a loss/minimal payment to treat them.</p>
<p>But you must acknowledge that the reality of the medicare system is that if you utilize it for 30-40 years, including expensive surgeries and treatments, unless you have spent your entire adult life paying into it at million dollar salary rates, you have not covered your own costs. The fact that most people do not put much money into it (particularly older generations where many women didn’t work for much of their lives), yet people are living till their nineties…it is unsustainable. People utilize it too early, and the premiums are too low, it just doesn’t cover the costs.</p>
<p>I have been to various doctors for check-ups, skin exams, minor surgery, colonoscopy, urology exams, and have always only paid my co-pay, $25, $35, $50 once for urgent care. Every once in a while I get one of those itemized statements titled, “This is NOT a bill” that shows $1000s billed by the various doctors. Sometimes I am shocked at the amounts, but I have never seen something totally unfamiliar and I have never reported anything to the insurance company as suspicious. If this is their control mechanism it is not a very strong one.</p>
<p>I haven’t read this whole thread because I am not comfortable with the doctor-bashing, but wanted to respond to one issue. There is a difference between a COPAY (usually a flat amount, like $20) and COINSURANCE which is a percentage of the allowable amount. Some insurance policies use a copay, others a coinsurance, and sometimes you might have both- like a copay for one kind of visit (eg a procedure) and coinsurance for another kind of visit (a diagnostic or office visit). These distinctions are usually determined by the procedure code. Its complicated, but it isn’t up to the doctor providing the service, its determined by the insurer and their policies and procedures. So get angry at the right people. Please.</p>
<p>My son had to go to the emergency room for a short time while at college, and the bill was over 3K…what a crazy price. We have very good insurance, that covers everything, and he gave them a copy of his insurance card. They still sent the bill to us for over 3K. Of course I ignored it, because I know that our ins pays for it and good luck getting back any money I send to the hospital! Then they started calling us, in threatening tones, telling us that he needed to pay the bill or it would show up on his credit.</p>
<p>They called me at 7am, woke me up, and I said, “Hey, haven’t you filed through his insurance, it should cover everything. What’s the problem, here?” She said the claim had gotten denied because the insurance company needed to verify eligibility in case he had other insurance. Which cracked me up, as if a college student has other insurance when they are on their parents policy. So I called my insurance company who said they’d take care of it and give them a call. The hospital STILL kept sending me the 3K bills, until I called and emailed, and told them I’d even verified that they were paid, so knock it off!</p>
<p>It just seems like a scam to send the bill to the consumer, stating you need to pay NOW, while also filing with the insurance company. Seems like it would be illegal to keep monies from the patient that were also reimbursed by insurance. And how ridiculous that you have to pay triple if you pay out of pocket, as opposed to your ins company paying.</p>
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<p>Well then people shouldn’t claim one thing if they mean another. If we have “the worst healthcare system in the universe” then it includes EVERYWHERE including 3rd world countries. </p>
<p>And we still have some of the best healthcare in the world available; it’s just the funding aspect of it which is screwed up and completely inefficient.</p>
<p>If a claim is not paid for it goes uncollected, especially if the insurance company is required to pay it. Insurance company doesn’t have to pay it either if it goes beyond a certain time frame. Hospitals will threaten etc., because they know the clock is ticking. Poorly coded, poor billing department, etc., is not your problem, it is the hospitals.</p>
<p>I know of hospital billing departments that employ poorly trained, low paid employees. </p>
<p>One person I know said when hired, she found uncashed checks from insurance companies stuffed in drawers/files that were never logged from previous years. Massive loss of revenue. </p>
<p>Ignore the harassment,</p>
<p>post 52: YES</p>
<p>I do not believe doctor’s offices created this coding system. As far as I can tell it causes all sorts of extra work for them. If I pay my incorrectly coded bill, the insurance company benefits because they do not have to pay as much to the doctor, since I am paying part of what they should cover. If I challenge it, the insurance company pays. Either way the doctor gets paid… eventually.</p>
<p>I am buying a private insurance policy for X amount a month with a large deductible of Y. I pay out of pocket for all medical expenses, except preventative health care, until I meet the deductible at which point my expenses are covered 100%. The maximum I could owe annually is X (times 12 months) + Y. X + Y = Z</p>
<p>If I was covered under my spouse’s employer sponsored insurance, it would cost A monthly with a deductible of B and lots of co-pays of c, d, e, etc. The maximum annual cost of this insurance is A (times 12 months) + B + some various co-pays. Some may go towards deductible. Some won’t. After reaching the deductible I would pay 20% to another amount. A + B = (a number greater than Z)</p>
<p>I don’t know how well I am explaining this. It took a rather complicated spreadsheet. But for me, it was potentially much less expensive to go with the large deductible policy.</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.”</p>
<p>I am curious about this. In my state, that is illegal. There may be some indirect benefit to a group, if the group owns the MRI, but I have not heard of direct “kickbacks” in at least ten years. </p>
<p>With regard to folks paying “more than their share” of a negotiated rate, that doesn’t happen in my office. If you are with a company that negotiated down from 100 to 80, you pay 16, they pay 64, and I get 80…after spending 10 dollars to get it. I might agree to offer a lower rate for not having to deal with your insco, but maybe not down to the “reasonable and customary” your insco offers in exchange for “volume”.</p>
<p>In terms of medicare, I don’t have much experinece with it, as I do not accept it. I DO here many patinets with medicare calling, and sharing it is impossible to find someone in my specialty that takes it. MediCal ( Medicaid in California) is even more difficult. I amsure there are those who say physicians should accept those rates and those patinet out of the goodness of being a physician, but it costs less to see the patient for free. I think if you are a “Medicare provider”, that is against the law.</p>
<p>I aggree that we should be looking out for the population as a awhole, but think over time we will all be affected by the shifting ground under the physicians feet.</p>
<p>Everyone gets a list of charges for my services that they sign at inake, with the expectation that they will be responsible if that service is not covered by their insurance. </p>
<p>With regard to the post below this one regarding opportunity to give performance evaluation, I am curious about how many on this thread have NOT had an opportunity to “evaluate” thier physician or group? If not through surveys, then “yelp”, then some other public forum. Do non physicians know about “Press Ganey”? </p>
<p>Not sure about the spelling…
<a href=“http://www.pressganey.com/index.aspx[/url]”>http://www.pressganey.com/index.aspx</a></p>
<p>With regard to a “pass” for billing errors, as alluded to above, I am pretty sure most billing errors work AGAINST the doctr, and not in his/her favor. billing errors account for thousands of dollars of lost revenue for me, and it is considered part of the cost of doing business, up to a certain amount. And as we all know, it is easier to get out of a doctor bill than it is to get out of a school loan.</p>
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<p>I think we are all just venting about an area in which many of us feel pretty powerless. I think that the bell curve applies to just about every profession, doctors and dentists included, yet when do we ever have the opportunity to give them a performance evaluation? </p>
<p>Again, I don’t think that most of us are educated consumers. Let’s say you go to the doctor with a sore knee. Are you presented with a list of options?
a. go home and see if it gets better, just pay for office visit? $
b. do a, plus go to the drug store and buy a brace? $+
c. have an xray or mri? $$$$
d. do c, plus schedule physical therapy? $$$$$
e. do PT only? $$</p>
<p>We make decisions like this all the time other aspects of real life…no ACT prep; buy a prep book $; take a short prep course $$; hire a private tutor $$$…but with our health, many times we are shuttled around for tests with the option of not doing them even given to us.</p>
<p>Also, query - as the professional whose services are being delivered, does the doctor just get a bye for billing/coding errors? If one of my clients gets a bill that is way out of whack, it comes back to me - I am the one responsible.</p>
<p>Doctors are expected to provide perfect service. If they don’t, patients may sue. This seems to me a problem and may possibly lead to higher medical care costs than might be necessary.</p>
<p>Are lawyers sued when a client has a bad outcome? Not snarky - I honestly don’t know.</p>
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<p>Here is a huge difference: lawyers are advised to never sue their clients for unpaid bills because the collection lawsuits virually always draw a counterclaim for malpractice. I’m really amazed that anyone ever pays their legal bills because there is a huge chance that you can walk the bill with no consequences. Can you imagine if patients sued their doctors for malpractice every time a collection agency tried to collect a doctor’s bill?</p>
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<p>Perhaps where the stakes are high (death or disablity) … but I believe that every day, below average doctors do a below average job for their patients (like below average teachers and cops and lawyers do below average jobs) without fear of law suit. If it takes 3 trips to the doctor to diagnose something that a better doctor could have diagnosed in one trip, and if there are no lasting problems, the patient doesn’t sue - she just pays for the 3 office visits. </p>
<p>The thing is, we’re not educated - it’s a mystery for us. When I had my eye issue, once the specialist told me the cause of my problem, I thought DUH, because my regular doctor totally should have known that. I didn’t know it - I thought I had something exotic - but once I heard the cause, I was amazed that even ***I ***didn’t figure it out, much less my doctor. But anyway, of course I didn’t sue. It cost me thousands in doctors bills because the original doctor did not catch something very simple, but of course I didn’t sue.</p>