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Doctors who don't run their own practices usually don't know how much their services will cost, because those prices are determined by private negotiations betw

Doctors who don't run their own practices usually don't know how much their services will cost, because those prices are determined by private negotiations between practices/hospitals and health insurance companies. The rates vary depending on location, provider, insurance carrier and other factors. Health insurance companies pay their executive staff huge salaries while working as hard as they can to deny medical claims to patients. And the ACA mandating the minimum medical loss ratio for insurance companies had the unintended side effect of incentivizing health insurance companies to pay more expensive medical bills, because they can only pay their exec staff a fixed % of what they spend on health claims. The more they spend on claims, the more they can pay their executive staff. Doctors can be corrupt in many ways, but not being transparent about what they'll bill isn't an important one.

lotsofpulp 6y ago
>Doctors who don't run their own practices usually don't know how much their services will cost, because those prices are determined by private negotiations between practices/hospitals and health insurance companies. It's other doctors who own the practices and companies. As far as I can see, the golden years for doctors were 80s to 00s, but now they are having to band together as it's big insurance company vs big doctor group vs big hospital group, and if you're not big, you get crushed. Sucks for the younger doctors, but the decision makers are many times still older doctors. >And the ACA mandating the minimum medical loss ratio for insurance companies had the unintended side effect of incentivizing health insurance companies to pay more expensive medical bills, because they can only pay their exec staff a fixed % of what they spend on health claims. The more they spend on claims, the more they can pay their executive staff. Yet the rate of increase in healthcare costs went down after ACA went into effect. https://www.statista.com/statistics/720767/medical-cost-trend-in-us/ https://www.statista.com/statistics/720767/medical-cost-tren... >Doctors can be corrupt in many ways, but not being transparent about what they'll bill isn't an important one. That is an incredible claim to me. Literally, the only time someone asks me to hand over an infinite amount of money is when I purchase healthcare, and if one can't see the moral hazard there, then I don't know what to say. We're not talking about a person in the ER with unknown ailments and required work, we're talking about completely routine procedures that healthcare providers are refusing to give information about. They could provide me the codes so that I can ask my insurance company what it will cost. They could take those codes and look up what they negotiated with my insurance company. But they do neither. Because why not get a blank check from everyone.
- stevebmark 6y ago
  There's no guarantee a doctor will know what their procedures will get coded as. Doctors who join hospital networks are also often surprised when their learn what their patients get billed. You can literally get a degree in medical coding, and practices employ medical coders to extract as much money from medicare and insurance as possible by exploiting the system. The salaries of these coders might appear on your hospital bills. Consulting groups, CMOs and billing departments might change codes depending on what insurance or medicare will accept. Like trying to bill one surgery as three separate codes. There's corrupt back room work that doctors may never see depending on the practice. There are some corrupt doctors who work in specialist networks to suggest how to code the most profitably for procedures, but I consider that different than doctors who do regular day to day practice for a larger entity and know less about how their work gets billed (and might not have a direct say in it either unless they're on the board).

lotsofpulp 6y ago

>Doctors who don't run their own practices usually don't know how much their services will cost, because those prices are determined by private negotiations between practices/hospitals and health insurance companies. It's other doctors who own the practices and companies. As far as I can see, the golden years for doctors were 80s to 00s, but now they are having to band together as it's big insurance company vs big doctor group vs big hospital group, and if you're not big, you get crushed. Sucks for the younger doctors, but the decision makers are many times still older doctors. >And the ACA mandating the minimum medical loss ratio for insurance companies had the unintended side effect of incentivizing health insurance companies to pay more expensive medical bills, because they can only pay their exec staff a fixed % of what they spend on health claims. The more they spend on claims, the more they can pay their executive staff. Yet the rate of increase in healthcare costs went down after ACA went into effect. https://www.statista.com/statistics/720767/medical-cost-trend-in-us/ https://www.statista.com/statistics/720767/medical-cost-tren... >Doctors can be corrupt in many ways, but not being transparent about what they'll bill isn't an important one. That is an incredible claim to me. Literally, the only time someone asks me to hand over an infinite amount of money is when I purchase healthcare, and if one can't see the moral hazard there, then I don't know what to say. We're not talking about a person in the ER with unknown ailments and required work, we're talking about completely routine procedures that healthcare providers are refusing to give information about. They could provide me the codes so that I can ask my insurance company what it will cost. They could take those codes and look up what they negotiated with my insurance company. But they do neither. Because why not get a blank check from everyone.

stevebmark 6y ago
There's no guarantee a doctor will know what their procedures will get coded as. Doctors who join hospital networks are also often surprised when their learn what their patients get billed. You can literally get a degree in medical coding, and practices employ medical coders to extract as much money from medicare and insurance as possible by exploiting the system. The salaries of these coders might appear on your hospital bills. Consulting groups, CMOs and billing departments might change codes depending on what insurance or medicare will accept. Like trying to bill one surgery as three separate codes. There's corrupt back room work that doctors may never see depending on the practice. There are some corrupt doctors who work in specialist networks to suggest how to code the most profitably for procedures, but I consider that different than doctors who do regular day to day practice for a larger entity and know less about how their work gets billed (and might not have a direct say in it either unless they're on the board).