4 ms·

I'm actually not sure that they know (2), as I've read a number of articles and posts which say that almost no healthcare organization uses cost accounting.

by nickff 10y ago

WalterBright 10y ago
If they can send you a bill with a figure on it, they can produce a quote.
- DollaWilliam 10y ago
  That's not true, due to price discrimination. They can't precisely tell how much they can get paid for something until they submit invoices to insurers.
  - WalterBright 10y ago
    If you opt to submit the claim to your insurance company yourself, this is not an issue.
richardw 10y ago
I think you guys are getting screwed. 1) unless this is the first time they've done it, they'll at least have a range and an explanation for the difference. 2) They're motivated to not tell you. By staying quiet, they prevent you from shopping around. They maintain the ability to decide charges rather than having to negotiate. Telling you only once you owe them is something other businesses would love. Is there a doc in the house who can give us their perspective? What's up with this pricing?
- DollaWilliam 10y ago
  Not a doctor, but I have spent ~10 years working with data on the reimbursement side of a large hospital. Please see my comment above.
DollaWilliam 10y ago
I can confirm that, at least for an N of 1. Contracts with individual insurers are typically negotiated to be set to a percentage of (known) Medicare reimbursement for a given procedure. As it is with any negotiations, more powerful insurers get better rates. The costs are usually monitored at a macro accounting level, since what really matters is staying in the black. As an aside, in addition to other confounding factors, cost accounting would likely affect physician compensation since it would shine a light on their actual effort. Expect that to Just Not Happen in an organization with more than one provider. They enjoy their compensation, and they will fight to keep it. Edit: perhaps the physician compensation scheme I am familiar with is wildly atypical. Hence the N=1 disclaimer.
- chimeracoder 10y ago
  > Contracts with individual insurers are typically negotiated to be set to a percentage of (known) Medicare reimbursement for a given procedure It's usually pegged at multiples of what Medicare reimburses (ie, "300% of Medicare rates") > Expect that to Just Not Happen in an organization with more than one provider. They enjoy their compensation, and they will fight to keep it. It has nothing to do with physician compensation, because most are salaried now anyway, and they make a lot less than people think. The problem is that they literally do not know what the reimbursement rates are.
  - coredog64 10y ago
    By law, nobody can be charged less than Medicare.
  - FireBeyond 10y ago
    Given that the median salary for a physician (not specialist) is $180K, I'm not sure what you think people think they make if they think it's a "lot more" than that.

I'm actually not sure that they know (2), as I've read a number of articles and posts which say that almost no healthcare organization uses cost accounting.

by nickff 10y ago

I'm actually not sure that they know (2), as I've read a number of articles and posts which say that almost no healthcare organization uses cost accounting.

WalterBright 10y ago

If they can send you a bill with a figure on it, they can produce a quote.

DollaWilliam 10y ago
That's not true, due to price discrimination. They can't precisely tell how much they can get paid for something until they submit invoices to insurers.
- WalterBright 10y ago
  If you opt to submit the claim to your insurance company yourself, this is not an issue.

richardw 10y ago

I think you guys are getting screwed. 1) unless this is the first time they've done it, they'll at least have a range and an explanation for the difference. 2) They're motivated to not tell you. By staying quiet, they prevent you from shopping around. They maintain the ability to decide charges rather than having to negotiate. Telling you only once you owe them is something other businesses would love. Is there a doc in the house who can give us their perspective? What's up with this pricing?

DollaWilliam 10y ago
Not a doctor, but I have spent ~10 years working with data on the reimbursement side of a large hospital. Please see my comment above.

DollaWilliam 10y ago

I can confirm that, at least for an N of 1. Contracts with individual insurers are typically negotiated to be set to a percentage of (known) Medicare reimbursement for a given procedure. As it is with any negotiations, more powerful insurers get better rates. The costs are usually monitored at a macro accounting level, since what really matters is staying in the black. As an aside, in addition to other confounding factors, cost accounting would likely affect physician compensation since it would shine a light on their actual effort. Expect that to Just Not Happen in an organization with more than one provider. They enjoy their compensation, and they will fight to keep it. Edit: perhaps the physician compensation scheme I am familiar with is wildly atypical. Hence the N=1 disclaimer.

chimeracoder 10y ago
> Contracts with individual insurers are typically negotiated to be set to a percentage of (known) Medicare reimbursement for a given procedure It's usually pegged at multiples of what Medicare reimburses (ie, "300% of Medicare rates") > Expect that to Just Not Happen in an organization with more than one provider. They enjoy their compensation, and they will fight to keep it. It has nothing to do with physician compensation, because most are salaried now anyway, and they make a lot less than people think. The problem is that they literally do not know what the reimbursement rates are.
- coredog64 10y ago
  By law, nobody can be charged less than Medicare.
- FireBeyond 10y ago
  Given that the median salary for a physician (not specialist) is $180K, I'm not sure what you think people think they make if they think it's a "lot more" than that.