[rubicon]

Originally Posted by suesiegel

We just recently turned old enough to get onto medicare.
Frankly while some of you complain, private healthcare insurance cost us roughly twice what medicare costs.

Our entire system of medical payment is insane.

What other field doe the government and insurance companies tell you what you will be paid?

I've read that 80% of all medical care is paid for by either insurance or the government. I expect your $27 vs $700 was an exaggeration brought about by your frustration.
I had a sort of similar event years ago with QUEST where AETNA was my insurance company. My doctor ordered a series of blood tests we received a letter from QUEST that Aetna would not pay for one of the tests and they were billing us, if I recall it was like 250 for this test. They bothered my doctor for a letter explaining why the test was necessary and Aetna still refused to pay. A quick check on the internet and I discovered AETNA would have paid $50 for this test-that would have been payment in full. YOU WOULD NOT WANT TO TO BE THE PERSON AT QUEST TRYING TO TELL ME WHY THEY WOULD TAKE $50 AS PAYMENT IN FULL FROM AETNA BUT WOULD CHARGE ME
$250. I paid $50 noting on the check PAYMENT IN FULL along with the name of the poor lady who took my call.
THE BILL WAS PAID IN FULL AT THE RATE AETNA WOULD HAVE PAID.

We paid 12,000 for private healthcare insurance the last year before I was old enough to qualify for medicare. Of course I considered self insuring. I spent 4 days at the Villages Hospital and the bill was 50,000. AETNA settled the bill in full for 30,000. WHY AN UNINSURED PERSON WOULD PAY 50,000 BUT AN INSURANCE COMPANY PAYS 30,000 CANNOT BE JUSTIFIED. You as a consumer are forced to support an insurance company to be able to get medical care at what is market rate.

You mention in your post about a doctor writing off 500 on a 1,000 bill because the insurance company paid him 500 against his $1,000 bill. I've heard that thought before and asked my accountant about it. Actually I had a similar event in my business. You cannot write off money not paid.

Today, the private single doctor practice is gone. It was killed by the paperwork, dealing with not only the patients but with the insurance companies to get paid AND THE OUTRAGEOUS COST OF MAL PRACTICE INSURANCE.

People are all upset due to overbooking on the airlines.
Typical-you have a 3:00 doctors appointment so you get there 2:45. At 3:15 to 3:45 you are let into the backroom to wait another half hour to forty-five minutes. Your doctor is now working 2-3 patients including you AND HE HAS 15 MINUTES TO SPEND WITH YOU.

"You state what other fields does the government and insurance companies tell you what you will be paid. "

My first response is that generally speaking every business transaction requires a "willing buyer and a willing seller" both having an understanding of market coming to an agreement on price. However that is too broad a discussion and will carry us away from your valid question.

Government and insurance are the sole payers of healthcare costs. they have a fiduciary obligation to be prudent spenders of taxpayer/policyholders taxes and premiums. History is replete with examples of "build it" and unethical opportunist will surely come. This is not to slight anyone but human nature is such that if no one is looking and I can get more, well then...........

I do not like the idea that government or insurance get so involved but I do understand the why of it.

Personal Best Regards:

[Mikeod]

Originally Posted by blueash

I am not sure where you missed the whole point of this thread, that there is likely going to be a change in Medicare to change that rule that has existed since the Omnibus bill of 1989, thus the title "Medicare to allow balance billing"

Dr Tom Price who is the new head of HHS, has very strongly indicated he wants to change it on multiple occasions. He had introduced bills to do exactly that as a member of congress. It will require a change in the law, but he is very much in a position to do it, and has the support of the AMA. So this thread is a heads up to inform this Medicare using community of what is coming soon to a doctor's office near you. Higher costs for medical care if this is enacted. See the links for more information.

How about the words "may be" instead. This isn't final.

[chachacha]

years ago when i had no insurance i questioned why a private person paid more than an insured person....the reply was that insurance companies pay to be accepted at hospitals (not sure about private doctors) so they have an agreement with the hospital to accept a reduced payment from any patients insured by that company. in my experience, people with no insurance are also able to negotiate a reduced payment on large bills because the hospital does not want the payment to drag on for years.

[autumnspring]

Originally Posted by dillywho

Unless something has changed, when I had my surgery years ago when they first started the keratectomy procedures for vision correction, it was not covered by my insurance plan so, I had to pay for it. They told me that it was $800 per eye without insurance, and something like (don't remember the exact figure) $1500 per eye with insurance. I just remember there was a big gap.

I sure don't like the idea of balance billing for all Medicare, though. It cost me quite a bit for my ear surgery at Mayo Clinic in Jacksonville because Mayo does not accept assignment from any insurance, including Medicare. They will file the paperwork for you. The checks are sent to you and then you pay what Mayo bills you. I didn't know it until I went there, but all the doctors at Mayo are salaried. This could explain why they draw only the best, because they all work together as a team and not in competition. That was explained to me by my surgeon there the first day I saw him. My ear specialist here knows him and says he is the best there is, and that he did a beautiful job. I have excellent hearing and do not have to have hearing aids, despite 4 surgeries on the one ear.

Re: Your discount on a non-insured eye surgery
The people who did that for you were simply GOOD PEOPLE
an act of HUMANITY. I've heard of doctors that will accept less if you pay CASH. Just like your plumber, gardener etc
they declare every dollar-there is a bridge in Brooklyn you might wish to buy.

Re: mayo clinic
I too have heard good things about them BUT
The truth-who knows.
You will be shocked to discover almost all medical mal practice cases are settled. The reason is simple. The dirtbag atty can always find something wrong or something he/she/it can suggest to a jury is wrong. Not only will a jury award ridiculous damages to the injured patient but the case will then be public record. If, the mal practice insurance company settles the case they know what the cost is and part of the settlement is the case is sealed.

[blueash]

Originally Posted by Mikeod

How about the words "may be" instead. This isn't final.

that might have been clearer, suggestion well made

[manaboutown]

Tom Price has been hammering away at this for years. Of course now he is in a powerful position. (Shudder!) Nonetheless, "It ain't over 'til the fat lady sings."

[blueash]

Originally Posted by suesiegel

You will be shocked to discover almost all medical mal practice cases are settled. The reason is simple. The dirtbag atty can always find something wrong or something he/she/it can suggest to a jury is wrong. Not only will a jury award ridiculous damages to the injured patient but the case will then be public record. If, the mal practice insurance company settles the case they know what the cost is and part of the settlement is the case is sealed.

80% of malpractice claims are closed with zero dollar payment to the plaintiff. All claims whether settled or determined by a jury where there is a payment no matter how small are reported to the National Practitioner Data Bank which can be accessed by state boards, hospitals, insurance companies, and other authorized entities, but not the general public. All actions where a suit was filed are public record even if they are dropped. But you would have to go to the court to find the documents in almost all jurisdictions.

Lawyers who represented injured plaintiffs are not dirtbags. They are there to protect those harmed by someone else and attempt to make them or their heirs as whole as possible when a doctor deviates from standard of care. The legal process also can be a motivation for improving care as it provides guidance on what kind of errors are unacceptable [not all errors are malpractice]. You want the sponge count done before they close the incision, thank a malpractice lawyer. You want the doctor to double check whether it is your left kidney not your right to remove? Or to know the side effects of the medication and inform you? Or to read your mammogram carefully?

Yes, all doctors never intend to harm a patient [I hope] but when they do it is the tort system which holds them accountable. It is no different than a driver who for 30 years never had a ticket or sped, but that one day failed to see a stop sign and injured an innocent pedestrian. We all understand the driver didn't mean to do it, never did it before, promises to be more attentive in the future.. but there will be and should be a mechanism to compensate the injured. In Florida and most other states as a precondition for filing a medical malpractice case you must have an affidavit from a medical professional stating that you have a valid medical malpractice claim. So it is not the "dirtbag" who says there was possible malpractice it was a medical professional who reviewed the case prior to filing.

[Paper1]

Originally Posted by blueash

80% of malpractice claims are closed with zero dollar payment to the plaintiff. All claims whether settled or determined by a jury where there is a payment no matter how small are reported to the National Practitioner Data Bank which can be accessed by state boards, hospitals, insurance companies, and other authorized entities, but not the general public. All actions where a suit was filed are public record even if they are dropped. But you would have to go to the court to find the documents in almost all jurisdictions.

Lawyers who represented injured plaintiffs are not dirtbags. They are there to protect those harmed by someone else and attempt to make them or their heirs as whole as possible when a doctor deviates from standard of care. The legal process also can be a motivation for improving care as it provides guidance on what kind of errors are unacceptable [not all errors are malpractice]. You want the sponge count done before they close the incision, thank a malpractice lawyer. You want the doctor to double check whether it is your left kidney not your right to remove? Or to know the side effects of the medication and inform you? Or to read your mammogram carefully?

Yes, all doctors never intend to harm a patient [I hope] but when they do it is the tort system which holds them accountable. It is no different than a driver who for 30 years never had a ticket or sped, but that one day failed to see a stop sign and injured an innocent pedestrian. We all understand the driver didn't mean to do it, never did it before, promises to be more attentive in the future.. but there will be and should be a mechanism to compensate the injured. In Florida and most other states as a precondition for filing a medical malpractice case you must have an affidavit from a medical professional stating that you have a valid medical malpractice claim. So it is not the "dirtbag" who says there was possible malpractice it was a medical professional who reviewed the case prior to filing.

You are correct, attorneys are not dirtbags. I do disagree with your accessment that they are there to protect the people. Many are there to take advantage of our tort system. If you are telling me the trolling that goes on 24/7 on TV are lawyers looking to help people I respectfully have to disagree.

[retiredguy123]

Any medical provider who accepts Government subsidized insurance should be required to post their prices on a website and charge the same amount to everyone. Patients should be required to participate by paying a percentage of the cost out-of-pocket. That would bring done the cost of health care.

[Radioman41]

From what I understand, a provider in this situation, can charge up to 15% more than what Medicare approves.

[golfing eagles]

Originally Posted by retiredguy123

Any medical provider who accepts Government subsidized insurance should be required to post their prices on a website and charge the same amount to everyone. Patients should be required to participate by paying a percentage of the cost out-of-pocket. That would bring done the cost of health care.

Originally Posted by Radioman41

From what I understand, a provider in this situation, can charge up to 15% more than what Medicare approves.

While "prices" (this is not a grocery store) are not posted on a website, Medicare participants are paid EXACTLY the same amount from everyone. And...

A provider can "charge" whatever they want---15% more, 60% more, 500% more---but they still only get the Medicare approved amount

[bob47]

Can somebody in the medical field shed light on this issue?

You receive a service and the provider charges Medicare, for example, $1550 and the provider receives and accepts a payment in full of $480. What is the actual fair value of the service? $480? $1550? Something in between?

What needs to change so that what is billed and what is accepted are more closely aligned?

[golfing eagles]

Originally Posted by bob47

Can somebody in the medical field shed light on this issue?

You receive a service and the provider charges Medicare, for example, $1550 and the provider receives and accepts a payment in full of $480. What is the actual fair value of the service? $480? $1550? Something in between?

What needs to change so that what is billed and what is accepted are more closely aligned?

I agree, and that is why we always kept our charges right about the level of the best payer, as above

As far as fair value goes, who knows. This is what Dr. Hsiao tried to address with RVRBS. If I spent 1/2 hr with you trying to diagnose and treat a complicated problem, I could charge a 99214, bill would be $120, Medicare would pay $104.70 and BC would pay $117.60. No point in charging $275 like many do. Meanwhile, an ophthalmologist would take 12 minutes to do a cataract, charge $2100 and Medicare pays $762. So what is fair??????

Those physicians who "charge" a very high amount over the Medicare allowable are creating a potential problem. Since they carry very high accounts receivable, a large part of which they will never receive, if they pass on, their widow is stuck with those accounts receivable, which are fully taxable.

Before anyone complains about how much they were billed, remember it is all funny money, the only thing that counts is what is stated on your EOB---what was paid. Add to that office overhead in primary care averages 50-55% of receipts and state and federal taxes takes another 40%, so I was lucky to take home 28% of receipts, which was about 22% of billing.

[golfing eagles]

Originally Posted by blueash

I am not sure where you missed the whole point of this thread, that there is likely going to be a change in Medicare to change that rule that has existed since the Omnibus bill of 1989, thus the title "Medicare to allow balance billing"

Dr Tom Price who is the new head of HHS, has very strongly indicated he wants to change it on multiple occasions. He had introduced bills to do exactly that as a member of congress. It will require a change in the law, but he is very much in a position to do it, and has the support of the AMA. So this thread is a heads up to inform this Medicare using community of what is coming soon to a doctor's office near you. Higher costs for medical care if this is enacted. See the links for more information.

I guess I "missed" it since it was not mentioned in the OP, but yes, Tom Price is in love with this idea, God only knows why. Sounds pretty stupid to me, it will just stick seniors with more out of pocket expense and doctors with more collection problems. In fact, when the participating provider program started in the 80's, the big attraction was that doctors got paid directly and avoided those collection issues. I'm not sure that has changed. And since 93% of physicians accept Medicare, why the "need" to have more physicians participate. Let's hope smarter people prevail on this one.

Originally Posted by blueash

80% of malpractice claims are closed with zero dollar payment to the plaintiff. All claims whether settled or determined by a jury where there is a payment no matter how small are reported to the National Practitioner Data Bank which can be accessed by state boards, hospitals, insurance companies, and other authorized entities, but not the general public. All actions where a suit was filed are public record even if they are dropped. But you would have to go to the court to find the documents in almost all jurisdictions.

Lawyers who represented injured plaintiffs are not dirtbags. They are there to protect those harmed by someone else and attempt to make them or their heirs as whole as possible when a doctor deviates from standard of care. The legal process also can be a motivation for improving care as it provides guidance on what kind of errors are unacceptable [not all errors are malpractice]. You want the sponge count done before they close the incision, thank a malpractice lawyer. You want the doctor to double check whether it is your left kidney not your right to remove? Or to know the side effects of the medication and inform you? Or to read your mammogram carefully?

Yes, all doctors never intend to harm a patient [I hope] but when they do it is the tort system which holds them accountable. It is no different than a driver who for 30 years never had a ticket or sped, but that one day failed to see a stop sign and injured an innocent pedestrian. We all understand the driver didn't mean to do it, never did it before, promises to be more attentive in the future.. but there will be and should be a mechanism to compensate the injured. In Florida and most other states as a precondition for filing a medical malpractice case you must have an affidavit from a medical professional stating that you have a valid medical malpractice claim. So it is not the "dirtbag" who says there was possible malpractice it was a medical professional who reviewed the case prior to filing.

Paragraph 1---VERY GOOD
Paragraph 2---Not so much. They're not dirtbags, they just act like them. Their number 1 motivation---WINNING--it's a game to them, with $$$$ not far behind. Protecting the rights of the injured and maintaining the fairness of the system---bottom of the list (for most). The lawyers DO NOT set the standard of care, physicians do. Lawyers EXPLOIT it for financial gain. Want a sponge count? Thank a surgeon (or a nurse) who thought it was a great idea and the other surgeons and nurses that agreed. Lawyers have no part in it, and deserve no thanks.
Want correct side surgery? That's been the principle since Hippocrates (who btw didn't have to deal with lawyers), it is only a handful of well publicized mistakes that made this a national issue. Inform patient of medication side effects??? I spent more time disabusing them of the content of the "pharmacy disinformation brochure" that lists every bad effect that ever occurred, because it was written by lawyers. Want a good mammogram reading---who doesn't, that's why radiologists train for many years. You make it sound like a lawyer is in the film room making it a good interpretation. Lawyers do have their role, but let's not glorify them or give them some role of importance that they clearly do not possess.

Paragraph 3. Do not be misled by the "certification of merit by a physician" clause---it is a total joke. A lawyer will play a round of golf with a physician friend and have him sign about 30 of these between the 6th green and 7th tee---and that's no exaggeration, I've been asked to do it. And my lawyer friend was actually shocked that I wanted to read it through to see if it actually did have merit---I doubt that ever happened to him before.

[Radioman41]

Mayo Clinic does not accept Medicare assignments, however, they will bill medicare and the check will come to the patient. I was advised that they can bill up to 15% more than what medicare allows. If this turns out to be how it works, it won't be too bad. I presume the secondary insurance will reimburse their 20% on what medicare allows.