To the doctors on the forum

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Gus
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Re: To the doctors on the forum

Post by Gus » Thu Jan 18, 2018 12:10 pm

Here's the conversation I had with my son's pediatrician at his last visit for a medication check (10 minutes sitting with her discussing how the medication is working and whether she wants to make any changes).

Me: These visits are very expensive.
Dr.: How much are they? I don't handle the billing so I don't know what they charge.
Me: You bill $325. The negotiated rate is $220. We're on an HDHP so we pay the full $220.
Dr. How much do you want to pay?
Me: The going rate if we took him to a specialist is $140.
Dr.: OK. You will now pay $140.

I'm now going to negotiate every visit with every doctor we see.

Ollie123
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Re: To the doctors on the forum

Post by Ollie123 » Thu Jan 18, 2018 12:19 pm

Gus - obviously can't speak to your exact situation, but believe it or not they are quite likely not allowed to do that based on their insurance contract. So be prepared for some potential issues down the line by going that route (including their billing department giving them a flat out "no" and billing you for the balance in the near future). And if they do, the insurer may not count it towards your deductible.

One more reason the system is a mess...

Gus
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Re: To the doctors on the forum

Post by Gus » Thu Jan 18, 2018 1:03 pm

Ollie123 wrote:
Thu Jan 18, 2018 12:19 pm
Gus - obviously can't speak to your exact situation, but believe it or not they are quite likely not allowed to do that based on their insurance contract. So be prepared for some potential issues down the line by going that route (including their billing department giving them a flat out "no" and billing you for the balance in the near future). And if they do, the insurer may not count it towards your deductible.

One more reason the system is a mess...
She said that they would still bill $325 and would apply an adjustment to bring the bill to $140 after the insurance claim is handled. The insurance company won't know that she gave me an $80 discount.

livesoft
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Re: To the doctors on the forum

Post by livesoft » Thu Jan 18, 2018 1:05 pm

I had the MRI discussion with my orthopedist last year. We discussed all MRI places within about a 10 mile radius and there were several of them. His reasoning for recommending a specific one was quite interesting: He liked the reports from the radiologist* that read the MRIs which also showed up in a timely fashion.

Then it turned out that the place he recommended was not covered by my insurance, but if I walked into the same exact place through a different door which had a different name on it, then it was covered by my insurance. Yep, same place, same machine (MRI), same tech, same radiologist, but different name, and much much cheaper all around. My orthopedist did not know about the other door.

*radiologist was not co-located with MRI.
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Pajamas
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Re: To the doctors on the forum

Post by Pajamas » Thu Jan 18, 2018 1:23 pm

White Coat Investor wrote:
Thu Jan 18, 2018 12:08 pm

Universal care may very well be the best way. But I think this idea that it is a right not a privilege is just a sound bite and indicates someone doesn't quite get it.

Is food a right? Why not? You can live longer without health care than without food. Why can't I walk into the grocery store and take out whatever I want? What about housing? Why can't I just walk into the Marriott and sleep in their beds? Why would health care somehow be on a higher plane than food and shelter?
Bad analogy.

You certainly can get WIC, SNAP or other nutritional support and in many cities, shelter if you have nothing to eat and no place to live. However, you can't just walk into any grocery store or restaurant or hotel or apartment that you choose and demand food and shelter.

I also don't know of any "universal health care environments" where you can just walk into any doctor's office, pharmacy, or hospital and that you choose and demand health care services. However, you can get basic health care services under defined conditions in designated places.

Sad to say, we don't even have the right to clean air to breathe and safe water to drink. In some places, even sleeping in public has been criminalized, although people do not even have control over sleeping, just as they don't have any control over the need to breathe or drink water. So I would agree that we need to take a look at what ought to be some basic universal rights and also that health care is not the most important of those.

voodoo72
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Re: To the doctors on the forum

Post by voodoo72 » Thu Jan 18, 2018 1:35 pm

Gus wrote:
Thu Jan 18, 2018 1:03 pm
Ollie123 wrote:
Thu Jan 18, 2018 12:19 pm
Gus - obviously can't speak to your exact situation, but believe it or not they are quite likely not allowed to do that based on their insurance contract. So be prepared for some potential issues down the line by going that route (including their billing department giving them a flat out "no" and billing you for the balance in the near future). And if they do, the insurer may not count it towards your deductible.

One more reason the system is a mess...
She said that they would still bill $325 and would apply an adjustment to bring the bill to $140 after the insurance claim is handled. The insurance company won't know that she gave me an $80 discount.
Technically, if the doctor is in contract (ie in network) they arent allowed to do that, they would consider that fraud how you described it. Any doctor doiong that is taking a certain risk. Now what are the chances of getting caught proabably close to zero, but if you get that one onery patient who complains for any reason you could find yourself on the other side of an audit by the insurance company and I assure you it isnt alot of fun.

jayk238
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Re: To the doctors on the forum

Post by jayk238 » Thu Jan 18, 2018 1:37 pm

Not once did I learn about billing until this year as a third year resident and thats only because I asked- even then I have less time to do that considering I am learning for my boards (1000 pages of text), caring for patients - on average 60 hrs a week, and learning additional medicine thats not board tested (why is this?!) - including advanced diabetes management, biologics for rheumatologic management, pharmacotherapy, reading ekgs, reading imaging, the list goes on.

Finally, when I do start my job, my second job will be learning how to code properly to avoid medicare and medicaid fraud and to make sure I maximize profit for each visit -ethically, legally, and properly- so I can actually keep my job.

No where along these lines do I actually have the time to learn what the prices are for each patient, their insurance, and the contract bw their insurance for their plan for their employer with my hospital

staythecourse
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Re: To the doctors on the forum

Post by staythecourse » Thu Jan 18, 2018 1:45 pm

Gus wrote:
Thu Jan 18, 2018 12:10 pm
Here's the conversation I had with my son's pediatrician at his last visit for a medication check (10 minutes sitting with her discussing how the medication is working and whether she wants to make any changes).

Me: These visits are very expensive.
Dr.: How much are they? I don't handle the billing so I don't know what they charge.
Me: You bill $325. The negotiated rate is $220. We're on an HDHP so we pay the full $220.
Dr. How much do you want to pay?
Me: The going rate if we took him to a specialist is $140.
Dr.: OK. You will now pay $140.

I'm now going to negotiate every visit with every doctor we see.
Umm... No. That is illegal for several reasons. The doctor has a CONTRACT with the payer that if they bill xxxxx they get paid y. They can't just decide to whatever they want. Again it is NOT up to the doctor it is what they negotiated contract states. The other reason it is illegal is what if the next patient is little Tommy who has the SAME insurance as you and now they have to pay the going rate and you didn't. That is charging 2 folks with the same insurance 2 different rates. That is insurance fraud. Your doctor is either dumb or incompetent and either is bad.

My advice for every patient is the same, go to the doctor and pay x or don't go and don't pay x. Do you go to McDonalds and say well the burger at Burger King is Y so I want to pay Y? I get that you are trying to get the cheapest deal you can for the best quality, but that conversation would have let me show you the door and kicked you out of my practice.

Good luck.
"The stock market [fluctuation], therefore, is noise. A giant distraction from the business of investing.” | -Jack Bogle

Ollie123
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Re: To the doctors on the forum

Post by Ollie123 » Thu Jan 18, 2018 1:47 pm

Yup. Depends on the contract obviously, but everyone I've seen would not allow what is being done.

Shouldn't impact you in any way Gus (as that's between the doc and insurer) and certainly not trying to dissuade you from negotiating in the future. Just trying to set some expectations for likely success in doing so. Most practitioners would not want to take the risk, even though its unlikely something like that would get caught (given the number of underpaid bills that just get written off I doubt this would raise any red flags).

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White Coat Investor
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Re: To the doctors on the forum

Post by White Coat Investor » Thu Jan 18, 2018 1:49 pm

Pajamas wrote:
Thu Jan 18, 2018 1:23 pm
White Coat Investor wrote:
Thu Jan 18, 2018 12:08 pm

Universal care may very well be the best way. But I think this idea that it is a right not a privilege is just a sound bite and indicates someone doesn't quite get it.

Is food a right? Why not? You can live longer without health care than without food. Why can't I walk into the grocery store and take out whatever I want? What about housing? Why can't I just walk into the Marriott and sleep in their beds? Why would health care somehow be on a higher plane than food and shelter?
Bad analogy.

You certainly can get WIC, SNAP or other nutritional support and in many cities, shelter if you have nothing to eat and no place to live. However, you can't just walk into any grocery store or restaurant or hotel or apartment that you choose and demand food and shelter.

I also don't know of any "universal health care environments" where you can just walk into any doctor's office, pharmacy, or hospital and that you choose and demand health care services. However, you can get basic health care services under defined conditions in designated places.

Sad to say, we don't even have the right to clean air to breathe and safe water to drink. In some places, even sleeping in public has been criminalized, although people do not even have control over sleeping, just as they don't have any control over the need to breathe or drink water. So I would agree that we need to take a look at what ought to be some basic universal rights and also that health care is not the most important of those.
Exactly. It's more complicated than the sound bite. But within universal health care systems, I have had patients who basically did the equivalent of walking into the Marriott and demanding a free room. (ED visits just to get a $5 bottle of tylenol are common in the military for instance.)

A homeless clinic, sliding scale clinic, or community health center is the equivalent of WIC/SNAP. Going to the hospital to get emergency care you will never be able to pay for, demanding MRIs, surgeries, and expensive medications is the equivalent of walking into the grocery store and taking whatever you like.

I don't disagree with some basic form of health care being offered to all of our citizens without regard to their ability to pay for it with those costs being covered by tax dollars. But the devil is in the details, and there are A LOT of details.
1) Invest you must 2) Time is your friend 3) Impulse is your enemy | 4) Basic arithmetic works 5) Stick to simplicity 6) Stay the course

theplayer11
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Re: To the doctors on the forum

Post by theplayer11 » Thu Jan 18, 2018 1:53 pm

the problem is that doctors can sometimes order different types of tests for the same problem. The patient with a HD plan might want to be able to pick what test according to price, but they rarely get that choice.

theplayer11
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Re: To the doctors on the forum

Post by theplayer11 » Thu Jan 18, 2018 1:57 pm

staythecourse wrote:
Thu Jan 18, 2018 1:45 pm
Gus wrote:
Thu Jan 18, 2018 12:10 pm
Here's the conversation I had with my son's pediatrician at his last visit for a medication check (10 minutes sitting with her discussing how the medication is working and whether she wants to make any changes).

Me: These visits are very expensive.
Dr.: How much are they? I don't handle the billing so I don't know what they charge.
Me: You bill $325. The negotiated rate is $220. We're on an HDHP so we pay the full $220.
Dr. How much do you want to pay?
Me: The going rate if we took him to a specialist is $140.
Dr.: OK. You will now pay $140.

I'm now going to negotiate every visit with every doctor we see.
Umm... No. That is illegal for several reasons. The doctor has a CONTRACT with the payer that if they bill xxxxx they get paid y. They can't just decide to whatever they want. Again it is NOT up to the doctor it is what they negotiated contract states. The other reason it is illegal is what if the next patient is little Tommy who has the SAME insurance as you and now they have to pay the going rate and you didn't. That is charging 2 folks with the same insurance 2 different rates. That is insurance fraud. Your doctor is either dumb or incompetent and either is bad.

My advice for every patient is the same, go to the doctor and pay x or don't go and don't pay x. Do you go to McDonalds and say well the burger at Burger King is Y so I want to pay Y? I get that you are trying to get the cheapest deal you can for the best quality, but that conversation would have let me show you the door and kicked you out of my practice.

Good luck.
kick them out for what? In his example, the dr asked him how much he wanted to pay.

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Ruprecht
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Re: To the doctors on the forum

Post by Ruprecht » Thu Jan 18, 2018 2:24 pm

White Coat Investor wrote:
Thu Jan 18, 2018 12:08 pm
WoodSpinner wrote:
Thu Jan 18, 2018 10:55 am


I am really puzzled by this comment. It feel 1000% the opposite—looking for a simple Universal Care plan.

My perspective is that Health Care is a right, not a privilege.

WoodSpinner :?:
Universal care may very well be the best way. But I think this idea that it is a right not a privilege is just a sound bite and indicates someone doesn't quite get it.

Is food a right? Why not? You can live longer without health care than without food. Why can't I walk into the grocery store and take out whatever I want? What about housing? Why can't I just walk into the Marriott and sleep in their beds? Why would health care somehow be on a higher plane than food and shelter?

Second, "health care" includes a whole lot of stuff. When you say it should be a right, define exactly what you mean by it. You mean someone should be able to go see the doctor as much as they want for whatever reason they want at any time they want no matter what it costs? Do you include MRIs that are questionably indicated, Viagra, and cosmetic surgery? What about essential oils, chiropractors, and acupuncture? Vaccines? Which ones? Medications? Which ones? Some cost 10 times more than others that are almost as good. Should we have a right to the best ones?

Those who think "health care should be a right" likely haven't thought through most of these questions. I've interacted with three universal health care environments (US military, UK system, and the Qatari system.) If you want to give health care to everyone, you've got to define it carefully, be ready to tell people "no" on a lot of stuff they think they have a right to, and even then expect it to cost a great deal.
+1,000,000

staythecourse
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Re: To the doctors on the forum

Post by staythecourse » Thu Jan 18, 2018 2:36 pm

theplayer11 wrote:
Thu Jan 18, 2018 1:57 pm
staythecourse wrote:
Thu Jan 18, 2018 1:45 pm
Gus wrote:
Thu Jan 18, 2018 12:10 pm
Here's the conversation I had with my son's pediatrician at his last visit for a medication check (10 minutes sitting with her discussing how the medication is working and whether she wants to make any changes).

Me: These visits are very expensive.
Dr.: How much are they? I don't handle the billing so I don't know what they charge.
Me: You bill $325. The negotiated rate is $220. We're on an HDHP so we pay the full $220.
Dr. How much do you want to pay?
Me: The going rate if we took him to a specialist is $140.
Dr.: OK. You will now pay $140.

I'm now going to negotiate every visit with every doctor we see.
Umm... No. That is illegal for several reasons. The doctor has a CONTRACT with the payer that if they bill xxxxx they get paid y. They can't just decide to whatever they want. Again it is NOT up to the doctor it is what they negotiated contract states. The other reason it is illegal is what if the next patient is little Tommy who has the SAME insurance as you and now they have to pay the going rate and you didn't. That is charging 2 folks with the same insurance 2 different rates. That is insurance fraud. Your doctor is either dumb or incompetent and either is bad.

My advice for every patient is the same, go to the doctor and pay x or don't go and don't pay x. Do you go to McDonalds and say well the burger at Burger King is Y so I want to pay Y? I get that you are trying to get the cheapest deal you can for the best quality, but that conversation would have let me show you the door and kicked you out of my practice.

Good luck.
kick them out for what? In his example, the dr asked him how much he wanted to pay.
The attitude of trying to get the bottom cost out of my time. My time is worth x. The patient obviously believes it is not worth x. They want it for something less. I can't stand that attitude. That is why it would be see you later. I have kicked out patients for less. No big deal either the patient can now find a doc. that fits their financial parameters. The MOST important aspect of a patient doctor relationship is trust. This seems like the patient just wants to bargain the lowest cost. It is demeaning to the provider. It is NOT a bazaar in India, but a doctor's office.

What a NORMAL patient would have asked in that situation goes something like this: "Hey doc these visits are costing us a lot is there any way we can just call you and let you know how the new drug is working and see if there is a need to come in at that point?" Not, an attempt at low balling the doctors time.

Good luck.
"The stock market [fluctuation], therefore, is noise. A giant distraction from the business of investing.” | -Jack Bogle

Bacchus01
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Re: To the doctors on the forum

Post by Bacchus01 » Thu Jan 18, 2018 2:44 pm

The most standard response I’m seeing, if I have this right, is “not my problem”

Okay

theplayer11
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Re: To the doctors on the forum

Post by theplayer11 » Thu Jan 18, 2018 2:45 pm

staythecourse wrote:
Thu Jan 18, 2018 2:36 pm
theplayer11 wrote:
Thu Jan 18, 2018 1:57 pm
staythecourse wrote:
Thu Jan 18, 2018 1:45 pm
Gus wrote:
Thu Jan 18, 2018 12:10 pm
Here's the conversation I had with my son's pediatrician at his last visit for a medication check (10 minutes sitting with her discussing how the medication is working and whether she wants to make any changes).

Me: These visits are very expensive.
Dr.: How much are they? I don't handle the billing so I don't know what they charge.
Me: You bill $325. The negotiated rate is $220. We're on an HDHP so we pay the full $220.
Dr. How much do you want to pay?
Me: The going rate if we took him to a specialist is $140.
Dr.: OK. You will now pay $140.

I'm now going to negotiate every visit with every doctor we see.
Umm... No. That is illegal for several reasons. The doctor has a CONTRACT with the payer that if they bill xxxxx they get paid y. They can't just decide to whatever they want. Again it is NOT up to the doctor it is what they negotiated contract states. The other reason it is illegal is what if the next patient is little Tommy who has the SAME insurance as you and now they have to pay the going rate and you didn't. That is charging 2 folks with the same insurance 2 different rates. That is insurance fraud. Your doctor is either dumb or incompetent and either is bad.

My advice for every patient is the same, go to the doctor and pay x or don't go and don't pay x. Do you go to McDonalds and say well the burger at Burger King is Y so I want to pay Y? I get that you are trying to get the cheapest deal you can for the best quality, but that conversation would have let me show you the door and kicked you out of my practice.

Good luck.
kick them out for what? In his example, the dr asked him how much he wanted to pay.
The attitude of trying to get the bottom cost out of my time. My time is worth x. The patient obviously believes it is not worth x. They want it for something less. I can't stand that attitude. That is why it would be see you later. I have kicked out patients for less. No big deal either the patient can now find a doc. that fits their financial parameters. The MOST important aspect of a patient doctor relationship is trust. This seems like the patient just wants to bargain the lowest cost. It is demeaning to the provider. It is NOT a bazaar in India, but a doctor's office.

What a NORMAL patient would have asked in that situation goes something like this: "Hey doc these visits are costing us a lot is there any way we can just call you and let you know how the new drug is working and see if there is a need to come in at that point?" Not, an attempt at low balling the doctors time.

Good luck.
so taking $140 for 10 minutes isn't enough and you would rather not see them at all? Sure, you can certainly choose to do that, but blaming the patient for trying to get the best price is kind of the attitude we are talking about on this thread. Yes, I realize that legally you might not be sable to negotiate the price, but don't blame someone for trying.

theplayer11
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Re: To the doctors on the forum

Post by theplayer11 » Thu Jan 18, 2018 2:48 pm

Bacchus01 wrote:
Thu Jan 18, 2018 2:44 pm
The most standard response I’m seeing, if I have this right, is “not my problem”

Okay
seems that way..I'm a small business owner and I'm in charge of every aspect in running my business..production, marketing, billing, customer service, quality control, ect

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Munir
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Re: To the doctors on the forum

Post by Munir » Thu Jan 18, 2018 2:54 pm

staythecourse wrote:
Wed Jan 17, 2018 11:03 pm
Why would the doctor's office know how much an MRI costs? When you go to McDonalds do they know how much your accountant bills you for? It ISN"T the doctor's office billing for the MRI it is the MRI centers doing the billing. Why not ask the individual MRI centers what their billing is? OF course, that will be different as well as each one may or may not be in network with your insurance (out or in network benefits) AND/ OR have different contracts with the insurance companies. Folks don't seem to understand it is ILLEGAL for one medical provider to know how much they are getting paid for the same service as another provider even from the same insurance. It lends itself to collusion.

Now if you ask your doctor's office how much they are going to charge for something THEY are going to do then a solo guy like me or a true old school private practice guy who sees their own EOBs knows of the top of their head. If it is an employed doc or any new doc who doesn't understand the business of medicine they would have to refer you to their billing service who can get you that answer if you tell them what the CPT billing codes you are inquiring about.

Good luck.
I am a retired M.D. and agree with staythecourse in this comment above.
Last edited by Munir on Thu Jan 18, 2018 3:05 pm, edited 1 time in total.

cutterinnj
Posts: 262
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Re: To the doctors on the forum

Post by cutterinnj » Thu Jan 18, 2018 3:03 pm

theplayer11 wrote:
Thu Jan 18, 2018 2:45 pm
staythecourse wrote:
Thu Jan 18, 2018 2:36 pm
theplayer11 wrote:
Thu Jan 18, 2018 1:57 pm
staythecourse wrote:
Thu Jan 18, 2018 1:45 pm
Gus wrote:
Thu Jan 18, 2018 12:10 pm
Here's the conversation I had with my son's pediatrician at his last visit for a medication check (10 minutes sitting with her discussing how the medication is working and whether she wants to make any changes).

Me: These visits are very expensive.
Dr.: How much are they? I don't handle the billing so I don't know what they charge.
Me: You bill $325. The negotiated rate is $220. We're on an HDHP so we pay the full $220.
Dr. How much do you want to pay?
Me: The going rate if we took him to a specialist is $140.
Dr.: OK. You will now pay $140.

I'm now going to negotiate every visit with every doctor we see.
Umm... No. That is illegal for several reasons. The doctor has a CONTRACT with the payer that if they bill xxxxx they get paid y. They can't just decide to whatever they want. Again it is NOT up to the doctor it is what they negotiated contract states. The other reason it is illegal is what if the next patient is little Tommy who has the SAME insurance as you and now they have to pay the going rate and you didn't. That is charging 2 folks with the same insurance 2 different rates. That is insurance fraud. Your doctor is either dumb or incompetent and either is bad.

My advice for every patient is the same, go to the doctor and pay x or don't go and don't pay x. Do you go to McDonalds and say well the burger at Burger King is Y so I want to pay Y? I get that you are trying to get the cheapest deal you can for the best quality, but that conversation would have let me show you the door and kicked you out of my practice.

Good luck.
kick them out for what? In his example, the dr asked him how much he wanted to pay.
The attitude of trying to get the bottom cost out of my time. My time is worth x. The patient obviously believes it is not worth x. They want it for something less. I can't stand that attitude. That is why it would be see you later. I have kicked out patients for less. No big deal either the patient can now find a doc. that fits their financial parameters. The MOST important aspect of a patient doctor relationship is trust. This seems like the patient just wants to bargain the lowest cost. It is demeaning to the provider. It is NOT a bazaar in India, but a doctor's office.

What a NORMAL patient would have asked in that situation goes something like this: "Hey doc these visits are costing us a lot is there any way we can just call you and let you know how the new drug is working and see if there is a need to come in at that point?" Not, an attempt at low balling the doctors time.

Good luck.
so taking $140 for 10 minutes isn't enough and you would rather not see them at all? Sure, you can certainly choose to do that, but blaming the patient for trying to get the best price is kind of the attitude we are talking about on this thread. Yes, I realize that legally you might not be sable to negotiate the price, but don't blame someone for trying.
It’s economics.
I’m in a high demand, low supply specialty.
If a patient doesn’t agree to my terms, then it’s probably not a great fit with my practice, and we ask that he goes elsewhere for his care.

SlowMovingInvestor
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Re: To the doctors on the forum

Post by SlowMovingInvestor » Thu Jan 18, 2018 3:07 pm

staythecourse wrote:
Thu Jan 18, 2018 1:45 pm
Gus wrote:
Thu Jan 18, 2018 12:10 pm
Here's the conversation I had with my son's pediatrician at his last visit for a medication check (10 minutes sitting with her discussing how the medication is working and whether she wants to make any changes).

Me: These visits are very expensive.
Dr.: How much are they? I don't handle the billing so I don't know what they charge.
Me: You bill $325. The negotiated rate is $220. We're on an HDHP so we pay the full $220.
Dr. How much do you want to pay?
Me: The going rate if we took him to a specialist is $140.
Dr.: OK. You will now pay $140.

I'm now going to negotiate every visit with every doctor we see.
Umm... No. That is illegal for several reasons. The doctor has a CONTRACT with the payer that if they bill xxxxx they get paid y. They can't just decide to whatever they want. Again it is NOT up to the doctor it is what they negotiated contract states. The other reason it is illegal is what if the next patient is little Tommy who has the SAME insurance as you and now they have to pay the going rate and you didn't. That is charging 2 folks with the same insurance 2 different rates. That is insurance fraud. Your doctor is either dumb or incompetent and either is bad.

My advice for every patient is the same, go to the doctor and pay x or don't go and don't pay x. Do you go to McDonalds and say well the burger at Burger King is Y so I want to pay Y? I get that you are trying to get the cheapest deal you can for the best quality, but that conversation would have let me show you the door and kicked you out of my practice.
if I have an HDHP and say I'm willing to pay out of pocket. so no submission to the insurance at all, how is it insurance fraud and remotely illegal ? Is that any different from my asking a pharmacy what their cash rate for a medication would be ?

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goodenyou
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Re: To the doctors on the forum

Post by goodenyou » Thu Jan 18, 2018 3:39 pm

SlowMovingInvestor wrote:
Thu Jan 18, 2018 3:07 pm
staythecourse wrote:
Thu Jan 18, 2018 1:45 pm
Gus wrote:
Thu Jan 18, 2018 12:10 pm
Here's the conversation I had with my son's pediatrician at his last visit for a medication check (10 minutes sitting with her discussing how the medication is working and whether she wants to make any changes).

Me: These visits are very expensive.
Dr.: How much are they? I don't handle the billing so I don't know what they charge.
Me: You bill $325. The negotiated rate is $220. We're on an HDHP so we pay the full $220.
Dr. How much do you want to pay?
Me: The going rate if we took him to a specialist is $140.
Dr.: OK. You will now pay $140.

I'm now going to negotiate every visit with every doctor we see.
Umm... No. That is illegal for several reasons. The doctor has a CONTRACT with the payer that if they bill xxxxx they get paid y. They can't just decide to whatever they want. Again it is NOT up to the doctor it is what they negotiated contract states. The other reason it is illegal is what if the next patient is little Tommy who has the SAME insurance as you and now they have to pay the going rate and you didn't. That is charging 2 folks with the same insurance 2 different rates. That is insurance fraud. Your doctor is either dumb or incompetent and either is bad.

My advice for every patient is the same, go to the doctor and pay x or don't go and don't pay x. Do you go to McDonalds and say well the burger at Burger King is Y so I want to pay Y? I get that you are trying to get the cheapest deal you can for the best quality, but that conversation would have let me show you the door and kicked you out of my practice.
if I have an HDHP and say I'm willing to pay out of pocket. so no submission to the insurance at all, how is it insurance fraud and remotely illegal ? Is that any different from my asking a pharmacy what their cash rate for a medication would be ?
It is an inducement, plain and simple. It is fraud to undercharge anyone that you have agreed, by contract. to charge a required rate. Charges are a way to limit utilization. If you meet your deductible in a fraudulent manner, the insurance company will then have to pay next dollar. You are in a PLAN not cash-paying. It is the same reason doctors cannot write off co-pays and deductibles.
"Ignorance more frequently begets confidence than does knowledge" | "The best years you have left are the ones you have right now"

Index guy
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Re: To the doctors on the forum

Post by Index guy » Thu Jan 18, 2018 3:44 pm

Private practice physician here...

I would imagine that the MAJORITY of physicians have absolutely no idea how much is being charged for their services. This can be for one of several reasons:

1. The doctor is an employee of the big corporation/University hospital/health system etc. These doctors are on a salary and have absolutely zero to do with the financial aspect of medicine.
2. The doctor is in private practice (this is me). These doctors are essentially small business owners and are a little bit more in touch with the practice finances. However, rather than dealing with exact dollar amounts, I only ensure that the correct CPT code is rendered for all of my services. Every service in medicine is given a code, and this code is what is eventually translated into payment.

Every CPT code that I utilize is tied to a specific dollar amount that my practice bills, but it is RARE to get paid what we bill...

The issue is that the payment will vary depending on the type of insurance. I can perform the exact same service for three different patients and get three different payments. In my most common coded service, I may get paid $20 for taking care of a Medicaid patient, $40 for a Medicare patient, and $100 dollars for a private insurance patient, even though my "charge" is higher than this. Medicare/Medicaid dictate what they will pay for a certain service and we get what we get. For private insurance, a practice will usually be contracted with an insurance carrier for a certain percentage of what Medicare pays (for example, it is common that the insurance says we will pay you 200% of the going Medicare rate for this service). For uninsured patients, we have the right to bill what we want, although circumstances often result in a lower bill.

If a patient called me and asked what they are going to pay for a service, I would honestly have no idea of the exact amount they will pay. I could research and find my practices published charges, but this would not correlate with how much insurance would ask them to pay. The insurance carrier is much more likely to give an accurate amount owed.

SlowMovingInvestor
Posts: 750
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Re: To the doctors on the forum

Post by SlowMovingInvestor » Thu Jan 18, 2018 3:50 pm

goodenyou wrote:
Thu Jan 18, 2018 3:39 pm
SlowMovingInvestor wrote:
Thu Jan 18, 2018 3:07 pm
staythecourse wrote:
Thu Jan 18, 2018 1:45 pm
Gus wrote:
Thu Jan 18, 2018 12:10 pm
Here's the conversation I had with my son's pediatrician at his last visit for a medication check (10 minutes sitting with her discussing how the medication is working and whether she wants to make any changes).

Me: These visits are very expensive.
Dr.: How much are they? I don't handle the billing so I don't know what they charge.
Me: You bill $325. The negotiated rate is $220. We're on an HDHP so we pay the full $220.
Dr. How much do you want to pay?
Me: The going rate if we took him to a specialist is $140.
Dr.: OK. You will now pay $140.

I'm now going to negotiate every visit with every doctor we see.
Umm... No. That is illegal for several reasons. The doctor has a CONTRACT with the payer that if they bill xxxxx they get paid y. They can't just decide to whatever they want. Again it is NOT up to the doctor it is what they negotiated contract states. The other reason it is illegal is what if the next patient is little Tommy who has the SAME insurance as you and now they have to pay the going rate and you didn't. That is charging 2 folks with the same insurance 2 different rates. That is insurance fraud. Your doctor is either dumb or incompetent and either is bad.


if I have an HDHP and say I'm willing to pay out of pocket. so no submission to the insurance at all, how is it insurance fraud and remotely illegal ? Is that any different from my asking a pharmacy what their cash rate for a medication would be ?
It is an inducement, plain and simple. It is fraud to undercharge anyone that you have agreed, by contract. to charge a required rate. Charges are a way to limit utilization. If you meet your deductible in a fraudulent manner, the insurance company will then have to pay next dollar. You are in a PLAN not cash-paying. It is the same reason doctors cannot write off co-pays and deductibles.
I said no submission to the insurance at all. So the deductible is not touched. I may be in a plan, but it's not mandatory that I use the plan. I am simply asking for the plan rate, or possibly a rate lower than the plan rate (in exchange for saving the facility the trouble of billing the insurance company). The downside for me of course is if I start running up a lot of health bills and hit the deductible.

In fact, I saw a thread here from a doctor asking if patients would be willing to pay the Medicare rate out of pocket (but their plan, which is likely not Medicare, is not billed).

It's not that I intend to do this (except possibly for prescriptions), it's just a hypothetical.

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simplesimon
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Re: To the doctors on the forum

Post by simplesimon » Thu Jan 18, 2018 3:50 pm

I'm happy to have an HDHP because it really lets me see how messed up our healthcare system is and I hope more people get on an HDHP and see this too. While there isn't total transparency, it's a heck of a lot more transparent than being on a low deductible plan with $20 copays. I think I've learned more about our healthcare billing system in the year that I've been on an HDHP/HSA plan than I ever have in my life.

Here's another story to add to the list...

After an ER visit I get a bill from the hospital. It is more than what my insurance said I was supposed to pay per its explanation of benefits. I call the company that manages the ER doctor's practice payments to ask about the discrepancy. It turns out the doctor was out-of-network even though the hospital is in-network. I asked the billing rep if he expects me to go into an in-network ER and ask if the ER doctor is in- or out-of-network before trying to be seen...silence on the other end of the phone.

In the end my insurer paid the difference and I just had to pay what it would have been if it was an in-network visit. In this case the insurer is paying for it. In most other cases it's the patient that is paying for it. In a normal business industry the company (in this case the billing company or the doctors practice) would eat the cost barring a non-payment.

Healthcare costs need to be reduced at every part of the chain...universities, hospitals, pharmaceutical companies, medical device manufacturers. Insurance companies are usually pitted as the bad guys but they just want some margin...that margin doesn't change if healthcare costs and premiums go down...just look at how we shop auto, home, and life insurance.

Gus
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Re: To the doctors on the forum

Post by Gus » Thu Jan 18, 2018 3:52 pm

staythecourse wrote:
Thu Jan 18, 2018 2:36 pm
theplayer11 wrote:
Thu Jan 18, 2018 1:57 pm

kick them out for what? In his example, the dr asked him how much he wanted to pay.
The attitude of trying to get the bottom cost out of my time. My time is worth x. The patient obviously believes it is not worth x. They want it for something less. I can't stand that attitude. That is why it would be see you later. I have kicked out patients for less. No big deal either the patient can now find a doc. that fits their financial parameters. The MOST important aspect of a patient doctor relationship is trust. This seems like the patient just wants to bargain the lowest cost. It is demeaning to the provider. It is NOT a bazaar in India, but a doctor's office.
She asked how much I want to pay and I told her that I want to pay the going rate for this type of appointment. We had previously been taking our son to a psychiatrist for these medicine checks and she charged $140 for such a visit. Other psychiatrists he had seen charged $140 - $150 for a med check. The pediatrician was charging too much. If she had said that it's $325 and she won't negotiate I would have told her that we're going back to the psychiatrist. Not because I'm cheap but because she is charging more than twice the market rate.
theplayer11 wrote:
Thu Jan 18, 2018 1:57 pm
What a NORMAL patient would have asked in that situation goes something like this: "Hey doc these visits are costing us a lot is there any way we can just call you and let you know how the new drug is working and see if there is a need to come in at that point?" Not, an attempt at low balling the doctors time.
So I should ask her to work for free instead?

bltn
Posts: 148
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Re: To the doctors on the forum

Post by bltn » Thu Jan 18, 2018 4:06 pm

I first realized how convoluted our health care reimbursement system is about 8 years ago when I had to take my teenage son to a hospital ER following a family vacation to the middle east. He developed a severe parasitic colon infection. With X-rays and treatment, his ER hospital charge was about 11,000 dollars. Our insurance paid about 675.00 and we paid about 275.00. This satisfied the entire bill! An uninsured patient would have been billed 11,000.00 and the the resulting negotiation with the hospital would probably have been much higher than what the hospital received for our care.

Made me wonder if these write offs have something to do with tax deductible losses.

Interesting.

patholoraptor
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Re: To the doctors on the forum

Post by patholoraptor » Thu Jan 18, 2018 4:09 pm

Bacchus01 wrote:
Thu Jan 18, 2018 2:44 pm
The most standard response I’m seeing, if I have this right, is “not my problem”

Okay
Like most physicians, I am am employee. My employer neither seeks my opinion about nor informs me of the bill each of my patients receives for my services. [Most physicians don't own their own practices (true since 2017), and only about 25% of those under age 40 are practice owners.] Health care is almost 20% of GDP. 95% of the growth in the health care industry over the past twenty years has been in administrative staff.

The business of medicine is a train wreck. It's reductionist to the point of absurdity to lay the blame for that on the doorstep of today's physicians. I, and a sizable majority of the other doctors I know, want to take care of our patients for a fair price. If you can figure out how to make that happen, we'd appreciate it.

Image
Last edited by patholoraptor on Thu Jan 18, 2018 4:18 pm, edited 2 times in total.

MiddleOfTheRoad
Posts: 128
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Re: To the doctors on the forum

Post by MiddleOfTheRoad » Thu Jan 18, 2018 4:12 pm

simplesimon wrote:
Thu Jan 18, 2018 3:50 pm
I'm happy to have an HDHP because it really lets me see how messed up our healthcare system is and I hope more people get on an HDHP and see this too. While there isn't total transparency, it's a heck of a lot more transparent than being on a low deductible plan with $20 copays. I think I've learned more about our healthcare billing system in the year that I've been on an HDHP/HSA plan than I ever have in my life.

Here's another story to add to the list...

After an ER visit I get a bill from the hospital. It is more than what my insurance said I was supposed to pay per its explanation of benefits. I call the company that manages the ER doctor's practice payments to ask about the discrepancy. It turns out the doctor was out-of-network even though the hospital is in-network. I asked the billing rep if he expects me to go into an in-network ER and ask if the ER doctor is in- or out-of-network before trying to be seen...silence on the other end of the phone.

In the end my insurer paid the difference and I just had to pay what it would have been if it was an in-network visit. In this case the insurer is paying for it. In most other cases it's the patient that is paying for it. In a normal business industry the company (in this case the billing company or the doctors practice) would eat the cost barring a non-payment.

Healthcare costs need to be reduced at every part of the chain...universities, hospitals, pharmaceutical companies, medical device manufacturers. Insurance companies are usually pitted as the bad guys but they just want some margin...that margin doesn't change if healthcare costs and premiums go down...just look at how we shop auto, home, and life insurance.
It is good that you see more of what is going on behind the scene. But only partially.

- Doctors cannot contract with every insurance out there. Some plans even limits who gets to be in the network.

- Insurance do not want to contract fairly with everyone. They even exclude MDs and include others, using it as incentive to get a better deal.

- Insurance shoot for a 20% margin to be the middle man. You don’t see that kind of margin often.

- Doctors are made out to be the bad guys because they are the faces you see and the people saying no. Insurance say “we will look into it” and then send 10 more forms to the doctor to clarify/justify their service, then say your doctor denies it.

- most often, the doctors sell you his service and advice, , not all the tests. He does not often get incentivized, or it has to be legally disclosed.

- Doctors “eat the cost” all the time in the forms of un-insured or under insured patients. What they bill the insurance are actually all stipulated by law and in the contract. What the insurance pay or responsible for is also stipulated in the plan and contract. They will try to wiggle out of it, but if they cannot they will approve the “special one time” in your case. They will not pay if they can back it up legally.

The main issue is people don’t want to look at healthcare as a business. They get mad when their doctors don’t appear to be on their side but then give the other entities the pass.

Suman
Posts: 89
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Re: To the doctors on the forum

Post by Suman » Thu Jan 18, 2018 4:20 pm

I am a doctor. I learned medicine and I practice medicine. Healthcare finance in not my monkey and not my business. I earn my salary, take care of my family and keep my patients healthy. The day it is too burdensome to deal with all the middlemen, I will quit, and hopefully boglehead philosophy will help me reach there on time.

staythecourse
Posts: 5813
Joined: Mon Jan 03, 2011 9:40 am

Re: To the doctors on the forum

Post by staythecourse » Thu Jan 18, 2018 4:49 pm

SlowMovingInvestor wrote:
Thu Jan 18, 2018 3:50 pm
goodenyou wrote:
Thu Jan 18, 2018 3:39 pm
SlowMovingInvestor wrote:
Thu Jan 18, 2018 3:07 pm
staythecourse wrote:
Thu Jan 18, 2018 1:45 pm
Gus wrote:
Thu Jan 18, 2018 12:10 pm
Here's the conversation I had with my son's pediatrician at his last visit for a medication check (10 minutes sitting with her discussing how the medication is working and whether she wants to make any changes).

Me: These visits are very expensive.
Dr.: How much are they? I don't handle the billing so I don't know what they charge.
Me: You bill $325. The negotiated rate is $220. We're on an HDHP so we pay the full $220.
Dr. How much do you want to pay?
Me: The going rate if we took him to a specialist is $140.
Dr.: OK. You will now pay $140.

I'm now going to negotiate every visit with every doctor we see.
Umm... No. That is illegal for several reasons. The doctor has a CONTRACT with the payer that if they bill xxxxx they get paid y. They can't just decide to whatever they want. Again it is NOT up to the doctor it is what they negotiated contract states. The other reason it is illegal is what if the next patient is little Tommy who has the SAME insurance as you and now they have to pay the going rate and you didn't. That is charging 2 folks with the same insurance 2 different rates. That is insurance fraud. Your doctor is either dumb or incompetent and either is bad.


if I have an HDHP and say I'm willing to pay out of pocket. so no submission to the insurance at all, how is it insurance fraud and remotely illegal ? Is that any different from my asking a pharmacy what their cash rate for a medication would be ?
It is an inducement, plain and simple. It is fraud to undercharge anyone that you have agreed, by contract. to charge a required rate. Charges are a way to limit utilization. If you meet your deductible in a fraudulent manner, the insurance company will then have to pay next dollar. You are in a PLAN not cash-paying. It is the same reason doctors cannot write off co-pays and deductibles.
I said no submission to the insurance at all. So the deductible is not touched. I may be in a plan, but it's not mandatory that I use the plan. I am simply asking for the plan rate, or possibly a rate lower than the plan rate (in exchange for saving the facility the trouble of billing the insurance company). The downside for me of course is if I start running up a lot of health bills and hit the deductible.

In fact, I saw a thread here from a doctor asking if patients would be willing to pay the Medicare rate out of pocket (but their plan, which is likely not Medicare, is not billed).

It's not that I intend to do this (except possibly for prescriptions), it's just a hypothetical.
I am no expert, but is is surely illegal for the doctor to take the money outside of what their contract says. If they have a contract to charge x for code xxxxx then they charge x for code xxxxx. That is why it is a CONTRACT and not a suggestion. The provider has the option of just not being in network (no contract) and they can charge those patients with that insurance whatever they want, i.e. $1 or $1 million. That is why most docs like being out of network so they can just charge as much as they want.

Good luck.
"The stock market [fluctuation], therefore, is noise. A giant distraction from the business of investing.” | -Jack Bogle

staythecourse
Posts: 5813
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Re: To the doctors on the forum

Post by staythecourse » Thu Jan 18, 2018 4:53 pm

cutterinnj wrote:
Thu Jan 18, 2018 3:03 pm
theplayer11 wrote:
Thu Jan 18, 2018 2:45 pm
staythecourse wrote:
Thu Jan 18, 2018 2:36 pm
theplayer11 wrote:
Thu Jan 18, 2018 1:57 pm
staythecourse wrote:
Thu Jan 18, 2018 1:45 pm


Umm... No. That is illegal for several reasons. The doctor has a CONTRACT with the payer that if they bill xxxxx they get paid y. They can't just decide to whatever they want. Again it is NOT up to the doctor it is what they negotiated contract states. The other reason it is illegal is what if the next patient is little Tommy who has the SAME insurance as you and now they have to pay the going rate and you didn't. That is charging 2 folks with the same insurance 2 different rates. That is insurance fraud. Your doctor is either dumb or incompetent and either is bad.

My advice for every patient is the same, go to the doctor and pay x or don't go and don't pay x. Do you go to McDonalds and say well the burger at Burger King is Y so I want to pay Y? I get that you are trying to get the cheapest deal you can for the best quality, but that conversation would have let me show you the door and kicked you out of my practice.

Good luck.
kick them out for what? In his example, the dr asked him how much he wanted to pay.
The attitude of trying to get the bottom cost out of my time. My time is worth x. The patient obviously believes it is not worth x. They want it for something less. I can't stand that attitude. That is why it would be see you later. I have kicked out patients for less. No big deal either the patient can now find a doc. that fits their financial parameters. The MOST important aspect of a patient doctor relationship is trust. This seems like the patient just wants to bargain the lowest cost. It is demeaning to the provider. It is NOT a bazaar in India, but a doctor's office.

What a NORMAL patient would have asked in that situation goes something like this: "Hey doc these visits are costing us a lot is there any way we can just call you and let you know how the new drug is working and see if there is a need to come in at that point?" Not, an attempt at low balling the doctors time.

Good luck.
so taking $140 for 10 minutes isn't enough and you would rather not see them at all? Sure, you can certainly choose to do that, but blaming the patient for trying to get the best price is kind of the attitude we are talking about on this thread. Yes, I realize that legally you might not be sable to negotiate the price, but don't blame someone for trying.
It’s economics.
I’m in a high demand, low supply specialty.
If a patient doesn’t agree to my terms, then it’s probably not a great fit with my practice, and we ask that he goes elsewhere for his care.
Each person has their own emotions. Having a patient try to negotiate their charge with me is offensive for me. I would rather not see that person at all. I do just fine financially that I don't see ANYONE I don't jive with. That is the great part of owing your own business you can do WHATEVER you want as long as it is not illegal.

Everyone has their own triggers that would annoy them and this is ONE of mine.

Good luck.
"The stock market [fluctuation], therefore, is noise. A giant distraction from the business of investing.” | -Jack Bogle

afan
Posts: 3651
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Re: To the doctors on the forum

Post by afan » Thu Jan 18, 2018 5:02 pm

That was a good analogy to the McDonalds. The docs are the equivalent of the person who rings you up at the counter. They have no more say in the prices that the clerk at the fast food joint. If the clerk gives someone a discount, that money is being taken from the company that employs the clerk. Depending on who owns the franchise, THAT person might have the option of giving a discount, but I don't know whether a McDonald's franchisee is committed to follow McD's pricing structure. Docs who contract with insurance companies, or rather, companies that contract with insurance companies and then employ or contract with doctors, agree to follow the prices they establish.

Taking cash would be stealing from the employer.

It is a complicated mess.

Note that "universal health care" would not, by itself, solve these problems. All that would mean is that everyone had coverage. It would not mean we could not have dozens of different insurance plans in a market, each with its own set of negotiated rates, different copays and coinsurance, different deductibles, different rules are authorization for procedures...
We don't know how to beat the market on a risk-adjusted basis, and we don't know anyone that does know either | --Swedroe | We assume that markets are efficient, that prices are right | --Fama

jayk238
Posts: 390
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Re: To the doctors on the forum

Post by jayk238 » Thu Jan 18, 2018 5:14 pm

theplayer11 wrote:
Thu Jan 18, 2018 2:48 pm
Bacchus01 wrote:
Thu Jan 18, 2018 2:44 pm
The most standard response I’m seeing, if I have this right, is “not my problem”

Okay
seems that way..I'm a small business owner and I'm in charge of every aspect in running my business..production, marketing, billing, customer service, quality control, ect
Neither of these responses are actually what doctors are saying. Instead, as others have mentioned, they are an example of blaming doctors because we are the face of your healthcare.

The cost of running a small business and the products sold by that business are generally intimately intertwined. Whatever small business you own, your billing is directly related to the costs associated with your production, your marketing is directly associated with your expertise and knowledge of the product and aim to sell it along with quality control.

Doctor's are not saying "not my problem." and if they are its because they are frustrated with this line of questioning.
Doctors like me are saying that we have no voice at the table with the insurance. Insurance is a separate industry. It is regulated, marketed, produced much like your small business in an entirely separate industry with its own quality controls.

Your products are NOT sold through insurance. At least hardly. They may get a line of credit or a business loan or another loan but that is entirely different. Medical products, on the other hand, require insurance- a separate industry. The medical industry is different with its own endeavors including research, dissemination, education, and utilization. This is the business I am in.

To sell this business, IE to help you out, I have to utilize another industry- the insurance industry.

Because of how challenging the insurance industry is- an entirely new industry is now taking over medicine. As said elsewhere medicine is no longer run by small practices but owned by hospitals to better bargain and control costs with insurers. As a result as a physician, in my own medical industry I now work for another industry (hospital) that directly deals withe insurance industry.

This is why we dont know. We dont know because we are not in these industries for the most part.

jayk238
Posts: 390
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Re: To the doctors on the forum

Post by jayk238 » Thu Jan 18, 2018 5:15 pm

theplayer11 wrote:
Thu Jan 18, 2018 2:48 pm
Bacchus01 wrote:
Thu Jan 18, 2018 2:44 pm
The most standard response I’m seeing, if I have this right, is “not my problem”

Okay
seems that way..I'm a small business owner and I'm in charge of every aspect in running my business..production, marketing, billing, customer service, quality control, ect
As a small business owner, did you ever help a customer obtain a loan to purchase your product? If not, then what you are selling is too small to be of significance to compare to the medical industry where surgical procedures can easily cost 30k or more.

If you have helped them obtain a loan do you understand the lending industry as well as your business or do you get them in touch with a bank whose business is to lend?

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WoodSpinner
Posts: 516
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Re: To the doctors on the forum

Post by WoodSpinner » Thu Jan 18, 2018 6:14 pm

WCI,

Figuring out Universal Health Care is much easier than understanding and building on our current insane system. Sure there is work to do and limits to impose. No question about it.

There simply has to be a better way than our current system. it leaves way too many people vulnerable, exposed, and denied (or delayed) basic access to health care.

The current for profit system simply isn’t working.

I don’t have any beefs with the doctors—it’s clear this thread has touched a nerve! I do have a beef with the current way Health Care is paid for, rationed or denied.

WoodSpinner
Last edited by WoodSpinner on Thu Jan 18, 2018 6:43 pm, edited 1 time in total.

radiowave
Posts: 1737
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Re: To the doctors on the forum

Post by radiowave » Thu Jan 18, 2018 6:22 pm

simplesimon wrote:
Thu Jan 18, 2018 3:50 pm
. . .
Healthcare costs need to be reduced at every part of the chain...universities, hospitals, pharmaceutical companies, medical device manufacturers. Insurance companies are usually pitted as the bad guys but they just want some margin...that margin doesn't change if healthcare costs and premiums go down...just look at how we shop auto, home, and life insurance.
Two issues, first is what is charged/billed for a specific service and what is the "true" cost of providing that service. Much of this thread has focused on the first part, charges and deductibles, etc. But what about the actual cost of care delivery. Interesting, a majority of healthcare cost are labor (personnel costs) that include all providers caring for a patient (physicians, nurses, lab tech, PT/OT/RT, pharmacists, etc.) and non direct care personnel (administrators, accountants, housekeepers, the person at the front deck when you check into your doctors appointment, etc.). To reduce costs in healthcare as simplesimon suggests, would inevitably lead to cuts in labor costs or substitution of technology for healthcare professionals (imagine your nurse in the hospital is a robot?!) or major leaps in efficiency and effectiveness.

Not trying to be argumentative here, the problem is very complex without any clear vision how best to address this important issue.
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Bacchus01
Posts: 1747
Joined: Mon Dec 24, 2012 9:35 pm

Re: To the doctors on the forum

Post by Bacchus01 » Thu Jan 18, 2018 6:57 pm

staythecourse wrote:
Thu Jan 18, 2018 4:53 pm
cutterinnj wrote:
Thu Jan 18, 2018 3:03 pm
theplayer11 wrote:
Thu Jan 18, 2018 2:45 pm
staythecourse wrote:
Thu Jan 18, 2018 2:36 pm
theplayer11 wrote:
Thu Jan 18, 2018 1:57 pm

kick them out for what? In his example, the dr asked him how much he wanted to pay.
The attitude of trying to get the bottom cost out of my time. My time is worth x. The patient obviously believes it is not worth x. They want it for something less. I can't stand that attitude. That is why it would be see you later. I have kicked out patients for less. No big deal either the patient can now find a doc. that fits their financial parameters. The MOST important aspect of a patient doctor relationship is trust. This seems like the patient just wants to bargain the lowest cost. It is demeaning to the provider. It is NOT a bazaar in India, but a doctor's office.

What a NORMAL patient would have asked in that situation goes something like this: "Hey doc these visits are costing us a lot is there any way we can just call you and let you know how the new drug is working and see if there is a need to come in at that point?" Not, an attempt at low balling the doctors time.

Good luck.
so taking $140 for 10 minutes isn't enough and you would rather not see them at all? Sure, you can certainly choose to do that, but blaming the patient for trying to get the best price is kind of the attitude we are talking about on this thread. Yes, I realize that legally you might not be sable to negotiate the price, but don't blame someone for trying.
It’s economics.
I’m in a high demand, low supply specialty.
If a patient doesn’t agree to my terms, then it’s probably not a great fit with my practice, and we ask that he goes elsewhere for his care.
Each person has their own emotions. Having a patient try to negotiate their charge with me is offensive for me. I would rather not see that person at all. I do just fine financially that I don't see ANYONE I don't jive with. That is the great part of owing your own business you can do WHATEVER you want as long as it is not illegal.

Everyone has their own triggers that would annoy them and this is ONE of mine.

Good luck.

So, you own your business and don’t want to negotiate. Great.

Then do you have a posted price for every procedure then? Or do you only tell them two weeks later when you send them a bill?

Bacchus01
Posts: 1747
Joined: Mon Dec 24, 2012 9:35 pm

Re: To the doctors on the forum

Post by Bacchus01 » Thu Jan 18, 2018 7:00 pm

jayk238 wrote:
Thu Jan 18, 2018 5:15 pm
theplayer11 wrote:
Thu Jan 18, 2018 2:48 pm
Bacchus01 wrote:
Thu Jan 18, 2018 2:44 pm
The most standard response I’m seeing, if I have this right, is “not my problem”

Okay
seems that way..I'm a small business owner and I'm in charge of every aspect in running my business..production, marketing, billing, customer service, quality control, ect
As a small business owner, did you ever help a customer obtain a loan to purchase your product? If not, then what you are selling is too small to be of significance to compare to the medical industry where surgical procedures can easily cost 30k or more.

If you have helped them obtain a loan do you understand the lending industry as well as your business or do you get them in touch with a bank whose business is to lend?
Agreed.

Then why is the response too often “what do you care? You have insurance”

It’s not even that they don’t know, they don’t have any empathy about why you would even ask.

That’s been my general experience.

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Re: To the doctors on the forum

Post by LadyGeek » Thu Jan 18, 2018 7:02 pm

This thread has run its course and is locked (topic exhausted - devolved into a general rant, conjecture on universal health care). See: Personal Consumer Issues
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