Giving Up

pattychat · 10-13-2007, 03:04 AM

Quote:

Originally Posted by laurend

Case in point, my band surgery. The hospital/surgeon billed my insurance for close to $50k. My insurance took off more than $18k off that, basically said, "no, this is what the charge is."

By the way.... Laurend. My weight and BMI are higher that what you started with, so I really needed the band. My deductable had been paid for this year and I don't think I'll be able to get surgery in this year.

anonemouse · 10-13-2007, 03:04 AM

Quote:

Originally Posted by WASaBubbleButt

But that is a contractual agreement between each and every individual doc and the insurance co. The doc knows full well what insurance will pay and what the patient will need to pay before the procedure is even done.

But wouldn't it vary, based on which insurance it was and which policy? If they knew my insurance wouldn't pay $50k, why did they send them the bill for $50k?

WASaBubbleButt · 10-13-2007, 03:14 AM

Quote:

Originally Posted by laurend

But wouldn't it vary, based on which insurance it was and which policy? If they knew my insurance wouldn't pay $50k, why did they send them the bill for $50k?

Nope, wouldn't vary. Each doc has an individual contract with each insurance company and the fees for various procedures are agreed upon before the procedure is done. Cigna might pay $8K for banding and BC might pay $10K. But it's known up front what insurance will pay and what the doc HAS to write off. They can bill a gazillion dollars, that doesn't change the contract.

Insurance co's are following Medicare about over billing. Medicare is just now coming down on docs for over billing. If Medicare agrees to pay $4K for banding and the doc bills them for $50K, they can now get in trouble. But this is new. Not all insurance co's are following Medicare guidelines yet. They will, but not yet.

Docs charge private pay patients more for office visits vs. what insurance will pay. They charge what they want, doesn't mean they'll get it.

It is known full well what insurance will pay and what the patient portion will be before the patient ever walks in the door. Some bill the insurance and have the patient pay later and some insist on payment ahead of time. Docs really are the last to be paid most of the time so many have switched to the payment up front kind of policy.

anonemouse · 10-13-2007, 03:19 AM

That still seems unethical to me, since they're billing someone that hasn't received a service yet. Now, I can understand making arrangements that detail the fees that are to be paid upon surgery, before the surgery occurs. But actually making people pay money for a surgery that hasn't happened is odd, IMO.

WASaBubbleButt · 10-13-2007, 03:26 AM

Quote:

Originally Posted by laurend

That still seems unethical to me, since they're billing someone that hasn't received a service yet. Now, I can understand making arrangements that detail the fees that are to be paid upon surgery, before the surgery occurs. But actually making people pay money for a surgery that hasn't happened is odd, IMO.

Since people are great at not paying MD bills, it is becoming standard. The alternative is having them pay before they leave the hospital. What's the difference?

Do you pay for your groceries before you eat them?

anonemouse · 10-13-2007, 03:44 AM

Quote:

Originally Posted by WASaBubbleButt

Since people are great at not paying MD bills, it is becoming standard. The alternative is having them pay before they leave the hospital. What's the difference?

Do you pay for your groceries before you eat them?

Yes, I do, but I don't pay for them before I go pick them off the shelves. I dunno, I guess it just rubs me the wrong way. Makes me think that they're just in it for the money. Hell, what am I thinking, this is the US, of course they are.

WASaBubbleButt · 10-13-2007, 03:45 AM

Well, medicine IS in it for the money. We don't go to work for the emotional feelings, we go to work for an income. Medicine is no different from groceries or the plumber.

WASaBubbleButt · 10-13-2007, 03:48 AM

Lauren, let me ask you something.

You do editing for me. When I have something I really want to be absolutely perfect it's no secret that my grammar and spelling bite a big one. You are gracious enough to edit the important stuff for me.

Let's say that editing was your career path in life. Let's say you charge for this.

Let's further say that by experience you know that over 90% of people will not pay you for your services.

Would you finally get to the point that you charge for your services in advance? This is your only source of income. And 90% of your consumer base is not paying you. Would you request money up front?

anonemouse · 10-13-2007, 03:56 AM

Quote:

Originally Posted by WASaBubbleButt

Lauren, let me ask you something.

You do editing for me. When I have something I really want to be absolutely perfect it's no secret that my grammar and spelling bite a big one. You are gracious enough to edit the important stuff for me.

Let's say that editing was your career path in life. Let's say you charge for this.

Let's further say that by experience you know that over 90% of people will not pay you for your services.

Would you finally get to the point that you charge for your services in advance? This is your only source of income. And 90% of your consumer base is not paying you. Would you request money up front?

Honestly, I don't know. I don't think I'd request the entire amount upfront. Maybe a down payment, or a portion, but not the whole thing. I don't think the two situations are entirely comparable. There is no such thing as editing insurance. I could understand a doctor requiring complete payment upfront, if there was no insurance involved. But when there is insurance, the surgeon knows he will be paid.

WASaBubbleButt · 10-13-2007, 04:00 AM

No, the surgeon knows he will be paid the contracted insurance amount. He does not know he'll be paid for the patient fees.

If it is a heart attack and someone needs emergency care... yep, I agree with you. But for an elective procedure when the VAST amount of people do not pay their fees, I don't blame the doc.

I do not agree with waiting until a week before surgery to announce a new policy, but I do understand why they request payment upfront. If they don't the odds are they will not receive payment. Statistically speaking, they will not be paid.

It really isn't different from a grocer or plumber. Pay or no service. At least with a grocer or plumber they can go and get their parts back if they aren't paid. A doc can't do the same.

anonemouse · 10-13-2007, 04:03 AM

Quote:

Originally Posted by WASaBubbleButt

No, the surgeon knows he will be paid the contracted insurance amount. He does not know he'll be paid for the patient fees.

If it is a heart attack and someone needs emergency care... yep, I agree with you. But for an elective procedure when the VAST amount of people do not pay their fees, I don't blame the doc.

I do not agree with waiting until a week before surgery to announce a new policy, but I do understand why they request payment upfront. If they don't the odds are they will not receive payment. Statistically speaking, they will not be paid.

It really isn't different from a grocer or plumber. Pay or no service. At least with a grocer or plumber they can go and get their parts back if they aren't paid. A doc can't do the same.

I guess. Honestly, I'm too tired to think right now. I need to go to bed, it's past 3 AM here. I might be back tomorrow, if not, probably Sunday night or Monday. Night, all!

WASaBubbleButt · 10-13-2007, 04:04 AM

Quote:

Originally Posted by laurend

I guess. Honestly, I'm too tired to think right now. I need to go to bed, it's past 3 AM here. I might be back tomorrow, if not, probably Sunday night or Monday. Night, all!

NONONO!!! Don't go away! You are one of the few that understand me.

You MUST post! ;)

Have fun with the poochies!

anonemouse · 10-13-2007, 04:09 AM

Quote:

Originally Posted by WASaBubbleButt

NONONO!!! Don't go away! You are one of the few that understand me.

You MUST post! ;)

Have fun with the poochies!

Eh, prefer the kitties, honestly. But I get to see my cat! He's been living at my parents' clinic since I've been in grad school (nasty apt manager doesn't allow pets). He's got lots of friends, though. My folks are soft touches when it comes to pets, so he's got a couple of roommates that I'll have to take along with him when I get a new place.

One last reply...
I can understand why they do it, it just rubs me wrong, though. It's kinda tacky. But, much less tacky than the folks who run out on their bills. I guess it's going to be the coming trend, though, to not trust anyone to actually live up to their responsibilities.

pattychat · 10-13-2007, 10:22 PM

Wasa, I've read your posts defending upfront payment.

the Docs really are the last to be paid most of the time so many have switched to the payment up front kind of policy.

I want to say again, I have no problem with an upfront payment. What I had a problem with was jumping through all the hoops (8 months worth) only to be told 7 days prior to my surgery I had to pay or no surgery. I just want to make sure you are not missing that point. Do you feel that part was fair?

pattychat · 10-13-2007, 10:28 PM

Sorry Wasa, I looked back and you have already acknowledged that you disagreed with the 7 day notice. My bad. I just didn't want for that point to get lost. My gripe is the 7 day notice... not the upfront payment.