As interesting as the post it, I found DW's comments to be particular enlightening. Yes, there's a bit of rant in there, but many good points are made along the way, like why procedures cost what they do, priorities, and the overall structure of healthcare. (Maybe later I'll go back and underline or bold the main points. I can't right now, cause my lunch is over.) DW is one of the people that works at a doctor's office, doing everything except seeing the patients.
***Edit***
I got the chance to bold and underline some of DW's main points in case you just want to skim it.
DW Yesterday 09:06 PM
Today at work, a patient balked and complained about the cost of her exam and how expensive it was. Granted, $229 is a lot of money. The flip side is that she doesn't know what hubby knows. He's the doctor. He went to school for years and years and years. The kicker is that she is my former hair stylist. A cut and a color ran $180 three years ago when I last saw her. I didn't balk at her prices. She's the professional - I am not. Doctors have been devalued to a great degree. Some patients leave us because we no longer accept their insurance. Some return after seeing how poorly they are treated elsewhere and some return because they realize they get exemplary care from hubby. Some never return, but continue to pay $180 for their hair every eight weeks. It's bizarre. No one would stand for managed hair care, would they?
Lets not even go into the outstanding student loans.
DW Yesterday 09:56 PM
Let me also add that I don't think patients CAN control the cost of healthcare and I'm not sure they would want to. We are much more costly than some physicians and much less than others. We DO get price shopped. And often there is someone willing to see a patient for a lot less. Unfortunately, one must then make their wage on quantity, not quality. Some insurance companies, like Oxford, reimburse us a pittance. Sometimes the copay is more than the insurance company deems the exam worth! Others, like Aetna, pay us roughly four times what Oxford pays. Sometimes, I don't get paid AT ALL by the insurance company and eat it. Or I wait none months and have to spend four hours tracking down claims. And then I eat it. And sometimes we just do the service gratis because the patient needs it and has no resources or is in pain or is otherwise NOT getting this treatment unless we do it gratis. As a rule, we tun no one away because that is not what medicine is about. It is a reality that the patients who can pay do pay as it helps us meet payroll and offset the services we perform gratis. We hope for reforms because this way is truly broken and I get to experience that from a provider's point of view every day.
I had a point when I started this rant...
DW Yesterday 10:02 PM
Actually, Wondering, I'm not saying that at all. I'm saying this system is fucked up. It hurts many doctors as much as it hurts patients. Insurance companies fuck us as much as they fuck patients and should be cut out, or minimized, of the equation. My point was healthcare is NOT a commodity, although it is treated as one. It should be a basic right. When it is treated as a commodity, everyone suffers, especially patients. My point with the hair care comparison was to show how doctors are devalued when it IS treated as a commodity.
DW Yesterday 10:07 PM
...and furthermore, patients are also devalued when healthcare is a commodity. All we want to do is provide and treat and serve. Instead, I get a shit pile of denied claims and insurance company BS routinely. That hurts our patient care because we spend so much damn time chasing claims and making phone calls. Insurance is the ultimate scam. That, to me, is a crying shame.
Gah. Long day at the office.
Yesterday 11:08 PM
Yeah, I'm having a bad explaining day. Sorry. I went off on a riff before I got my explanation out.
I gotta tell ya'll, we work hard. We see every emergency, every everyone who can pay or not. What galls me - GALLS ME - about the hair care comparison is that no one would allow a third party to dictate their hair care but we have our healthcare dictated to us. That is STUPID!!!!!eleventy one to infinity, squared for good measure.
It does piss me off that I would pay someone the ridiculous sum of $180 to cut and color my hair and she would turn around and complain that our service fees were too high. Um, hello? Like, almost equal. Some of the hidden costs doctors bear are rent, utilities, staff, FICA, Medicare tax, worker's comp, disability, malpractice, health insurance for our employees, equipment that allows us to practice at the standard of care, pens, paper, soap, computers, EVERYTHING. If Oxford finally pays us 6 weeks later a whopping $46.50 for an exam I'm lucky. I would love, love love, love, love to just know I was getting x dollars for every single patient that we saw even if x was lower than most of the plans we take now. Often, we don't know what testing plans will cover despite calling them before the exam. And it is pretty hard to do that when you have 6 back to back patients and the insurance company phone tree pretty much guarantees you never get a human being on the line. As a general rule, doctors are NOT business people. Nor should they be. Sign us up for a new system, please.
Thank you for giving me the space to further rant and explain. I am completely stressed out over our office situation and I'm trapped there because I work for peanuts in this family business because we couldn't afford to pay someone else to do what I do which is everything but actually see the patients.
DW Yesterday 11:24 PM
A Sniper - I can explain some of that. As a provider, I MUST bill everyone at the same rate. But each individual contract we sign with individual carriers reimburses us at a different rate. Often, there is a cap on rates for a geographic area. If I set my fees too low, I don't get reimbursed the maximum for my area which, btw, is usually substantially less than the billed amount. I am not permitted to discount based on carrier. Which puts us all in this conundrum. So all those providers bill outrageously high amounts hoping that they will capture the prevailing maximum fee which is ALWAYS less than is billed. The shitty side is that no discount is then applied to the private payor who ends up with the crazy bills. We bill every insurance company $269 for a routine exam. We accept anywhere from $45 to $195 for that service depending on the contract. Outlandish, no?
A few years ago, I saw a top thyroid specialist in NYC. He took one plan - Oxford. I didn't have Oxford. He charged me $500 out of pocket to see him. He would have billed Oxford the same $500 but accepted $125 from them for the same service. Totes not even remotely sensical.
DW Yesterday 11:27 PM
I meant @ Sniper. I'm on a roll today. I'm going to stop posting these epic comments. If anyone has a question about insurance, please ask me. Unfortunately, I know more than I'd like to know. :(
DW 32 minutes ago
@MomTFH, my point about the hair dresser was to show how docs are devalued, not to compare their services, where you have choices, to medicine, where you do not. It was also to demonstrate that as Americans, we have a skewed priority system. And patients expect that once they hand you their insurance ID card, they are abdicated of all financial responsibility. And they are not because roughly 1/3 of the time, there is a non covered service or a deductible or a coinsurance that neither we, no they, are aware of. YES, there are docs who do expensive things JUST for the reimbursement. Some are greedy and some are just tired of constantly fighting the insurance company to receive a fraction of what they bill and what they deserve to be paid. The system is inherently unfair and completely skewed towards profit for the one controlling the checkbook - not in the best interest of patients OR docs.
After being with my sister in labor and delivery twice, I know just how hard C-sections are pushed. At the convenience of the doctor, in her case. Was it necessary? I bet three different docs would give you three different answers. The next baby, she used a mid wife. It was a vaginal birth. Go figure.
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