<p>The hospital that I worked for does not perform any elective surgery until the entire bill is paid up front. They do the pre-cert. with the insurance companies and contact you with the balance. You must pay in full, if you have a problem with the reimbursement, you can’t even dispute it until the procedure is over because the final billing is not into the insurance company. The doctors follow the same routine. They must be paid in full as well. When I worked in the ER and we had to call in a specialist “on call”, the first question that they asked was “what is the patient’s insurance info”. Then they decided if they would see the patient and drop them or also see them for the follow up. What a mess!</p>
<p>So much for the Hippocratic Oath.
I know they can’t endlessly treat people who don’t pay, but some of this gets out of hand. The overall average compensation for anesthesiologists seems to run at least 330k. Per one survey, 45% do not feel they are fairly compensated. Make of it what you will.</p>
<p>It’s getting worse.</p>
<p>The insurance premiums for an anesthesiologist is probably north of $100k per year. I used to work for one (as a babysitter) and he left private practice because he was paying such a ridiculous amount in malpractice premiums.</p>
<p>Good point, but I’d wonder if the doc is paying that or the practice, as a business expense.</p>
<p>Adding: And, I’m seeing far lower costs for malpractice insurance- “In 2013, the average premium for mature $1 million/$3 million policies for anesthesiologists was $19,594 (range of $3,911 to $50,621). Premiums varied markedly based upon state, rural versus urban practice and physician claims history.” Am Soc of Anesthesiologists. No idea about this org or the study. Sorry for the detour. My point was, some docs complain, but the salary averages are quite high.</p>
<p>Malpractice insurance for anesthesiologists aren’t so bad. But many work for corporations and have as much say towards the bill as the receptionist at IBM.</p>
<p>Deleted (by me. Posted erroneously). </p>
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<p>Looks like the limitation is on information on individual employees, as opposed to aggregate or other information without individual identification.</p>
<p><a href=“http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/”>http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/</a></p>
<p>Indeed, one should expect employers to be looking at aggregate information. For example, many employers have wellness or stop-smoking assistance programs which they presumably measure against whether use of employer paid medical insurance has been reduced due to employees getting healthier.</p>
<p>Isn’t Medicare the elephant in the room here? Medicare has a reputation of low reimbursement per procedure, but not questioning whether procedures are necessary, so it effectively encourages overtreatment, so that physicians and patients tend to get the idea that more medical care is normal, even if it does not necessarily mean better medical care. Of course, that drives up the overall cost of medical care, which in the US is the highest by far among rich countries without measurably better outcomes overall.</p>
<p>My state (along with some others) implemented insurance laws that do not allow balance billing if a provider (like an anesthesiologist or radiologist) isn’t contracted as long as the hospital and primary surgeon are contracted.
<a href=“Surprise Medical Bills Lead to Protection Laws: Health - Bloomberg”>http://www.bloomberg.com/news/2014-04-04/surprise-medical-bills-lead-to-protection-laws-health.html</a></p>
<p>ucb, the HIPAA Privacy Rule prohibits [“unauthorized</a> disclosure [of] any personally-identifiable health information.”](<a href=“http://www.twc.state.tx.us/news/efte/hipaa_basics.html]"unauthorized”>http://www.twc.state.tx.us/news/efte/hipaa_basics.html) This doesn’t necessarily mean disclosing the employee/patient’s name. AOL may only have been given the aggregate cost of “distressed babies,” but AOL employees had a pretty good idea about which two of their fellow employees were to blame for the cuts in their retirement benefits. </p>
<p>Disclosing aggregate data when there are only a few individuals included (e.g. the two babies with expensive care) would be risky in terms of revealing who the few individuals are. On the other hand, a large company saying that two thirds of employees over 45 years of age are on prescription drugs reveals nothing in particular about any individual employee.</p>
<p>That’s true, but where do we draw the line? Disclose blood pressure medication, but not cancer treatment? Disclose a common cancer, but not a rare one?</p>
<p>And in small companies or family run businesses is the employer really entitled to information such as how many employees are on antidepressants, birth control, blood pressure meds? It wouldn’t take a rocket scientist to figure out who was on what and if all employees are on something (in other words, 100 percent of employees are on antidepressants), then the employer knows their medical situations.</p>
<p>Well, if you want your employer to pay for something, the employer does end up knowing at least some information about what it pays for.</p>
<p>Note that aggregate information is commonly used in research.</p>
<p>ucb, For research, I can understand the aggregated reporting. But that still doesn’t tell me why the employer needs it.</p>
<p>EPTR, yep, that’s true. Company size also matters. A medical condition which would blend into the background at a very large company, might be very easily “personally identifiable” at a small one. For example, at my small company, if our employee portion got raised, and “a case of prostate cancer” was used to justify it, well, we’d all exactly know who was to blame. HIPAA is in place precisely to prevent a spotlight being shined on people’s private medical issues in this way.</p>
<p>Hanna wrote:</p>
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<p>And if it turned out to be more, would the doctor stand by her estimate? I doubt it. We tried to get an estimate on our out of pocket cost for a cardiac MRI. After calling the specialist and our insurance company, who both professed not to know, a clerk at the hospital said “$70”. We were relieved, felt foolish to have worried, the family member went in for the test. We ended up actually having to pay about $800. The hospital said their staff member’s estimate was based on a misunderstanding, they can’t be liable for estimating what insurance will do, of course, while insurance said they can’t predict what codes, what physician, yadayadayada.</p>
<p>healthcarebluebook.com
Fair Prices- which of course gives some wiggle room.
In my zip:<br>
Heart MRI, no contrast: Fee: $897 Price includes the total amount for both physician (interpretation) and technical (imaging) fees. Sometimes the test will be billed in two parts but they should add up to the listed price. Physician interpretation and technical imaging combined fee.</p>
<p>With and without contrast: Fee:$1,342 Price includes the total amount for both physician (interpretation) and technical (imaging) fees. Sometimes the test will be billed in two parts but they should add up to the listed price. Physician interpretation and technical imaging combined fee.</p>
<p>But you have to know exactly what they will be doing. And it’s subject to the insurer’s negotiated rates, assuming you go in-net. And the doc cannot give an estimate of what another medical service will charge you. </p>
<p>So why didn’t the clerk give a better answer? Don’t know. What did you ask her? I’m assuming she worked in Billing. </p>
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<p>As someone else reported, the insurance premiums for anesthesiologists are nowhere near that. And this is due to a huge success story. It used to be that anesthesiology was fairly dangerous: there was a risk, higher than one might have thought, that someone who was put under anesthesia would never wake up, due to problems with anesthesia. To their great credit, anesthesiologists developed procedures and checklists that have, over the past 30 years, dramatically reduced mortality, even as older and sicker patients can now undergo surgery.</p>
<p>Managing the family’s health insurance claims has become a job. When a procedure is planned, due diligence can be done, but even then, the patient can’t know if every professional involved is in network (referencing the stories about anesthesiologists and radiologists here). I just assume I will have to make follow-up calls to receive whatever coverage our plan entitles us to.</p>
<p>The most extreme case I ever handled was when my daughter’s ice dance partner broke his hand. He went to the ER, had a variety of tests, and was subsequently admitted to the hospital for surgery. He was in the hospital for fewer than 24 hours, and that bill alone–excluding all tests, the radiologist, the anesthesiologist, the ER doctor, the surgeon, and anyone else who may have touched him–was $36,000. (Yes, I typed that number correctly.) The bills for all the rest were similarly shocking. </p>
<p>This young man was from another country and had no health insurance at the time. I called every billing office personally and was able to negotiate the fees way down. What would have cost $45-50,000 all in ended up costing $10,000. Interestingly, none of the billing offices I spoke to had any concerns about confidentiality. I just said his English wasn’t up to the task of the phone call and that I was speaking on his behalf.</p>