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>the Medicare/Medicaid market is huge and they tend to pay their share on time and without hassle. Companies put up with the pricing nonsense because they net o

>the Medicare/Medicaid market is huge and they tend to pay their share on time and without hassle. Companies put up with the pricing nonsense because they net out on top This is certainly not true for providers (ie, hospitals and doctors). Medicare is notoriously painful with billing and reimbursements. In addition, they don't come out ahead. In fact, Medicare reimburses about 7% less than COGS, which means providers are already losing money per patient before they have to think about covering their overhead. The reason they accept Medicare is because it's very difficult, legally, not to. Despite this, Medicare has gotten so costly for them that many hospitals have recently started talking about finding a proper legal path to dropping Medicare altogether.

koolba 10y ago
> The reason they accept Medicare is because it's very difficult, legally, not to. Source? I'd find it hard to believe that doctor's are forced to accept patients with Medicare or Medicaid.
- chimeracoder 10y ago
  > I'd find it hard to believe that doctor's are forced to accept patients with Medicare or Medicaid. It's easier in private practice, but private practices are a dying breed - most doctors these days are employed. But hospitals are hard-pressed to do the same. For an example, if you're a hospital and you have an an emergency room, you cannot refuse emergency care for a patient. That emergency care may or may not also result in an admission to the hospital, and that's a decision you can't make preferentially based on the insurance status of a patient (by law). You can refuse to accept Medicare, in which case Medicare won't reimburse you, but that means that you're providing emergency care to 40% of the population for free[0]. So refusing service to Medicare patients means, among other things, not running an emergency room. (Incidentally, some hospitals have done exactly this - either shutting down their emergency rooms entirely, or switching to freestanding ERs, which are (ironically) prohibited by law from accepting Medicare). [0] Technically they bill the patients for this, but from a hospital's perspective, this is "for free" - they don't expect to collect on most bills they issue to self-paying patients for emergency services, which is why they're so quick to negotiate them down if you ask. They know self-paying patients are very unlikely to actually pay the full bill, so they'd rather discount it up-front than write it down.
  - FireBeyond 10y ago
    "they don't expect to collect on most bills they issue to self-paying patients for emergency services, which is why they're so quick to negotiate them down if you ask. They know self-paying patients are very unlikely to actually pay the full bill, so they'd rather discount it up-front than write it down." ... or send it to Collections, charge it off, pick up the check for what might likely have been the negotiated amount anyway, take the difference in a tax write off, and debtor gets chased for the full Chargemaster rate...

koolba 10y ago

> The reason they accept Medicare is because it's very difficult, legally, not to. Source? I'd find it hard to believe that doctor's are forced to accept patients with Medicare or Medicaid.

chimeracoder 10y ago
> I'd find it hard to believe that doctor's are forced to accept patients with Medicare or Medicaid. It's easier in private practice, but private practices are a dying breed - most doctors these days are employed. But hospitals are hard-pressed to do the same. For an example, if you're a hospital and you have an an emergency room, you cannot refuse emergency care for a patient. That emergency care may or may not also result in an admission to the hospital, and that's a decision you can't make preferentially based on the insurance status of a patient (by law). You can refuse to accept Medicare, in which case Medicare won't reimburse you, but that means that you're providing emergency care to 40% of the population for free[0]. So refusing service to Medicare patients means, among other things, not running an emergency room. (Incidentally, some hospitals have done exactly this - either shutting down their emergency rooms entirely, or switching to freestanding ERs, which are (ironically) prohibited by law from accepting Medicare). [0] Technically they bill the patients for this, but from a hospital's perspective, this is "for free" - they don't expect to collect on most bills they issue to self-paying patients for emergency services, which is why they're so quick to negotiate them down if you ask. They know self-paying patients are very unlikely to actually pay the full bill, so they'd rather discount it up-front than write it down.
- FireBeyond 10y ago
  "they don't expect to collect on most bills they issue to self-paying patients for emergency services, which is why they're so quick to negotiate them down if you ask. They know self-paying patients are very unlikely to actually pay the full bill, so they'd rather discount it up-front than write it down." ... or send it to Collections, charge it off, pick up the check for what might likely have been the negotiated amount anyway, take the difference in a tax write off, and debtor gets chased for the full Chargemaster rate...