I just found my billing information from Cigna for my DS revision with dr. K. Dr K bill the insurance company $18,000 for the revision. Cigna paid him $1,388. No wonder he doesn't take hmos that was a PPO. If a PPO is paying him that little can you imagine what an HMO would pay him? My surgery was a six and a half hour surgery because he had to do three hours worth of adhesion removal.
I see why dr charge the outrageous program fees
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Oh I understand why...I don't like it but I do understand it. My surgeon got a little less than $3,000 for the $21,000 he submitted.
wow, that's terrible 
writegirl
Work in Progress
I had no idea that the surgeons don't collect the cost they submit. I just assumed they got paid the covered amounts. WOW.
when they agree to accept insurance they agree to the rates the company sets. They cannot recoup the written off portion from the patient hence I'm sure thats why program fees were invented.
Munchkin
Full of Fairy Dust
True.... I wonder if they write it off their taxes????
Psychomom
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What the doctor billed is not everything. The hospital bills for hospital charges, the anesthesiologist bills for anesthesia administration and monitoring, and the radiologist bills for any and all x-rays and for reading them. What the doctor got paid is just a small drop in the bucket. Insurances contract with the doctors and hospitals so that they pay a lesser amount than what is actually billed. Some of that is passed on to the patient in the form of deductibles, co-insurance, and copays. Medicaid usually pays the bare minimum, with Medicare coming in second. Now, Medicare deducts a Sequestration Administration charge. Remember when Obama was making all his presidential directives? He made a rule that takes a percentage of all Medicare payments made to hospitals and doctors to force Congress to make a balanced budget. That directive has not yet been appealed, so every doctor and hospital that accepts Medicare has their payments reduced. The patient is not responsible for this amount. You can't make this stuff up. I work in billing, so I see this stuff everyday. Hospitals renegotiate contracts with insurance companies all the time. Usually it works out and the hospitals turn a profit. The Chief Financial Operator in hospitals have a clue as to what a procedure actually costs to perform and negotiate up from that amount. Sorry--this is too boring and technical. Let's just say that the allowed amount most insurances pay will more than provide for the actual costs of the procedure and that what is actually billed is usually way too much. Do they deserve what is actually billed? Of course they do. Can they make what is paid work for them? Yes.
Spiky Bugger
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While I agree with you, there are exceptions...for example:
We have a PPO.
An ortho sugeon who avoids back surgery at all costs was highly rcommended.
He has two offices.
One is five minutes from here.
The other is a good 90 minutes in L.A. traffic.
The office near us would cost Mr Sue about $10 per visit.
But that office is ONLY for the use of HMO members.
So Mr Sue drives close to three hours r/t, (it used to be 2x week, now it's once every two weeks), and pays $85 per visit.
So, in a very few rare cases, HMOs are paying the doctor enough to have him keep that office open.
But not usually.
We have a PPO.
An ortho sugeon who avoids back surgery at all costs was highly rcommended.
He has two offices.
One is five minutes from here.
The other is a good 90 minutes in L.A. traffic.
The office near us would cost Mr Sue about $10 per visit.
But that office is ONLY for the use of HMO members.
So Mr Sue drives close to three hours r/t, (it used to be 2x week, now it's once every two weeks), and pays $85 per visit.
So, in a very few rare cases, HMOs are paying the doctor enough to have him keep that office open.
But not usually.
why is healthcare so complicated and stupid? I know: profits for somebody.
Sometimes I think it is just malice by the insurance companies. Each insurance company has extensive manuals or participating requirements. I had a physician treating me who gave up private practice because of all the junk required just to see patients. He might get approval for four visits then go through the whole approval process again if more appointments were needed. I had to sign a nine page release to see my GYN. part of which was agreeing to not ask him to bill for procedures that weren't covered. i.e. some insurance companies thought OB ultrasounds were completely unnecessary. My PCP does not participate in Medicare so that again was a waiver I had to sign. It's a load of garbage for doctors and patents. Malice and money actually.
harrietvane
Well-Known Member
It was only after leaving Australia that I discovered the terrible world of insurance and pre-existing conditions. I miss my Medicare (our version of the NHS)!
K9, 8 months ago I would have argued with you: Malice? oh, no. it's greed and stupidity, is what it is.
but now I know it has become a much angrier, meaner country we live in. anything is possible, our species is capable of much worse and we seem to be speeding downhill faster every day.
but now I know it has become a much angrier, meaner country we live in. anything is possible, our species is capable of much worse and we seem to be speeding downhill faster every day.
K9, 8 months ago I would have argued with you: Malice? oh, no. it's greed and stupidity, is what it is.
but now I know it has become a much angrier, meaner country we live in. anything is possible, our species is capable of much worse and we seem to be speeding downhill faster every day.
Sadly, I must agree with you. I have come to believe that malice and greed can be closely related. Maybe not all the time, yet I do believe health care is one area where capitalism has run amok. With college loans handed over to private banks, it looks like it education is headed the way of health care. (If not there already.) I did have the GI Bill, but it wasn't quite enough for the private college I attended. I used to think those with massive debt were a bunch of whiners until I realized that their loans came with much higher interest than my government loans.
Spiky Bugger
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Yea, but...since education benefits the country, our entire society, why not have the banks just loan out the student aid money at about 1/2% over what THEY pay on savings accounts. (Because 1/2% of BILLIONS of dollars is still a chunk of change.) Those loans are guaranteed by the feds, you cannot discharge student loans in bankruptcy...so the banks are taking ZERO chances, as they are on other loans. In fact, each bank should be REQUIRED to provide a little of this service.
It is a bit ludicrous that the same places that charge folks interest rates in the 18-25% range and pay savers a whopping 1/10th of a percent for that same money they are lending out. (Ally is paying a bit more, but no B&M stores.)
You'll get no argument from me. Doesn't a better educated populace benefit all of us? Just my opinion that if it weren't for the Hill-Burton Act and EMTALA laws, the poor would get no care at all. I don't mind the Math for the Stupid state run lotteries that were supposed to set up to fund education. It's just that once governments got heir hands on the money, education got shafted. So while things were done to provide health care and education to the "financially challenged" it all went awry.
I'm not against capitalism. If a man can invent the proverbial better mouse trap, more power to him. I just don't think healthcare and education should be a part of it. If other countries can set prices for medication, surgery/doctor fees, etc., why can't we? These deals with insurance companies are not the kind of capitalism that helps us. I under stand there are regional differences to account for varying costs, but a tonsillectomy in Chicago should be billed at the same rate for every doctor and hospital there.
On I hope not too distant drift from the thread: My grandparents bought my first car for me. It wasn't a gift. The bank worked out terms that all the money I paid was at the same interest rate they would have earned had they left that money in savings. They did that so I could establish a credit history. I sent my payment in every month with a little passbook like those once be issued with savings accounts. When I bought my own car years later, the interest rate was the standard going rate and significantly higher than my first one.
I'm not against capitalism. If a man can invent the proverbial better mouse trap, more power to him. I just don't think healthcare and education should be a part of it. If other countries can set prices for medication, surgery/doctor fees, etc., why can't we? These deals with insurance companies are not the kind of capitalism that helps us. I under stand there are regional differences to account for varying costs, but a tonsillectomy in Chicago should be billed at the same rate for every doctor and hospital there.
On I hope not too distant drift from the thread: My grandparents bought my first car for me. It wasn't a gift. The bank worked out terms that all the money I paid was at the same interest rate they would have earned had they left that money in savings. They did that so I could establish a credit history. I sent my payment in every month with a little passbook like those once be issued with savings accounts. When I bought my own car years later, the interest rate was the standard going rate and significantly higher than my first one.
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