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<p>You can pull up all the articles you’d like. the patient and the Dr. need to work together. And yes, bottom line, the patient is ultimately responsible for their care. But as I said several pgs ago, of course patient care involves good customer service. If patients arent happy they dont stay under a drs care and they spread the word to friends and referral sources. I think you are arguing over semantics.</p>
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<p>While i admire his dedication and endurance, I have to say this concerns me if I’m the person with the scheduled surgery the next day. I don’t think I’d like the idea of being operated on by sometime who’s had 3 or 4 hours’ sleep. </p>
<p>Somebody let me know when we do contractors!</p>
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<p>This is a very strange question. The doctor has agreed, by contracting with the insurance carrier and then treating me, to take $2500 in payment. “Charging” $5000 in this case has no meaning. Some rich guy with no insurance comes in, charge whatever you like (hopefully agreed in advance with the customer-patient). Let’s call the $2,500 the discounted rate for the insurance company providing a lot of customers and being sure to pay up.</p>
<p>Of the $2,500, who paid the bill? I paid ALL OF IT. Either I paid for the insurance directly myself, or it was part of my salary/benefits package from my employer. I could ask my employer to drop the insurance and just give me extra money every month. If I had no insurance, I bet I could find a doctor who would do the procedure for $2500 cash, crisp new bills.</p>
<p>I went in today and ordered scrambled eggs with toast at a chain restaurant. The cashier said “I’m sorry, all the cooked breakfasts are taking 10 minutes this morning, do you mind waiting”. Is that sort of politeness so difficult?</p>
<p>you dont seem to understand how this billing is handled sorghum. The provider charges their regular fee and later writes off the non covered part after insurance pays. Too complex to explain here and its late. </p>
<p>Jym, I understand perfectly well. I suspect you don’t know much about money. “Charging” $5,000 knowing you are going to end up with $2,500, and being satisfied with $2,500 (otherwise don’t do it) is just an accounting fiction. It isn’t real money that you lost. </p>
<p>I usually can call and negotiate the price down without insurance carrier. I can remember what but I was able to negotiate some charge down. So I think some of what was charged are bluff money.</p>
<p>No you do not understand how medical billing is done, but thats a conversation for another time.</p>
<p>There is truth to the billing silliness, though. More than once I have lived it. No insurance basically means a big discount. I know it’s complicated. But it’s all much, much cheaper with cash.</p>
<p>how do they arrive on a fee?</p>
<p>I could have had my TKR with an orthopedic surgeon who has done the surgery many time in his 30 some years of practice, including on professional athletes & the governors wife.
His practice includes an inpatient facility, so you don’t have to go to a hospital.
Of course this Dr refused the surgery until I was 10 years older, even though I no longer was able to go around the block using a cane. He did give me an rx for a full leg brace.
My insurance was great, his care sucked especially since I spent over a year following his advice and getting progressively more depressed as I lost mobility.</p>
<p>You can have your experienced specialists, give me a young enthusiastic Dr, who wants to improve his patients health, even if it means a long & grueling surgery.
It’s hard to believe that I had it just about 15 months ago.
I am doing virtually everything I was doing 10 years ago, ( except no jumping or running)
It infuriates me that I let my previous Dr convince me that I could wait longer.</p>
<p>Making a patient wait to be seen is pretty minor compared to inadequate care.</p>
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<p>You don’t understand that it is just an ordinary business pricing model, complete with list prices, discounts, bulk contracts, cash flow considerations and all. Like a department store or an airline. You are not “losing” $2500 of a fictitious $5000 that you would like to have.</p>
<p>You are saying you don’t see a difference between the business pricing model of medicine and that of deparment stores? Airlines might be similar, because I understand there are a LOT of government influences and regulations. Still; most people don’t seem to feel entitled to flying the way we do to health care (okay, we DO want tl recline), and the resources doesn’t seem limited in the same way, and I believe that influences the model. </p>
<p>In some cases, perhaps for many in private practice, those discounts represent real money. </p>
<p>What exactly are we talking about now?</p>
<p>Every discount in any business represents a loss, relative to the preferred but unrealistic situation of everyone paying in cash in full as much as you arbitrarily want to charge them. If you can fill your practice with full-pay, non-insurance patients, go ahead. Otherwise the insurance payment is money in your pocket that you wouldn’t otherwise get.</p>
<p>We are talking about the $2500 that Jym did receive, from my insurance provider, and my claim that all of that $2500 is paid by me, and therefore I am indeed a customer.</p>
<p>Oh, thats right. And I am suggesting that I cannot fill my practice with self pay patients and often feel that not only the patient is my customer (with whom I am punctual and eternally apologetic) , but also the insurance company. I think you are saying you are the only one I need to answer to.</p>
<p>And by the way, what I charge is not arbitrary. They are mostly the same rates I have charged for years. They are the rates that many insurance companies agreed to pay before they all got bought up by just one or two companies, who then made me an offer I could accept or refuse. So sometimes I accept, but I just won’t do what I used to. I am still punctual and apologetic; I just don’t knowingly take the crazy difficult cases (no pun intended!). </p>
<p>" I could ask my employer to drop the insurance and just give me extra money every month. If I had no insurance, I bet I could find a doctor who would do the procedure for $2500 cash, crisp new bills."</p>
<p>I guess it depends on the procedure, but I don’t know about that. Your employer might only need $2500 for your procedure, and you may only need a $2500 procedure, but your relative wellness is what make the whole system work. </p>
<p>I better get to sleep so I can be punctual tomorrow!</p>
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<p>No, I said I am “a” customer. You also have to serve the needs of the insurance compnay, if you want to do business with them. </p>
<p>"I too have gotten used to the phone ringing multiple times a call night, and him leaving to do an emergency procedure at 3am with a full schedule of either surgery or clinic the next day.</p>
<p>While i admire his dedication and endurance, I have to say this concerns me if I’m the person with the scheduled surgery the next day. I don’t think I’d like the idea of being operated on by sometime who’s had 3 or 4 hours’ sleep."</p>
<p>That’s what residency is for. To learn how to make immediate, snap, good quality decisions on no sleep. How do you think your ob delivers babies? H can go from sound asleep to instantly awake and barking out whatever solution, meds, etc, are needed for a given situation. And if he’s in a call room, he can be in the OR within 60 seconds; at home, 3 min (that’s with me putting up the garage door while he throws on scrubs). That’s the whole point of training. It’s just part of what you sign up for. </p>
<p>“This is a very strange question. The doctor has agreed, by contracting with the insurance carrier and then treating me, to take $2500 in payment. “Charging” $5000 in this case has no meaning. Some rich guy with no insurance comes in, charge whatever you like (hopefully agreed in advance with the customer-patient). Let’s call the $2,500 the discounted rate for the insurance company providing a lot of customers and being sure to pay up.”</p>
<p>Wow, you don’t understand how this works at all. There IS no “rich guy with no insurance” any more paying the full $5,000 to offset the 99 patients whose insurance pays $2,500 for the $5,000 procedure. I don’t think you get it - I, as a professional, get to set my rates at $X per hour / $X per project. My H doesn’t. If the ins co wants to pay $500 on the $5,000 procedure, that’s all he gets. </p>