3 ms·

> Worse, I need to confirm the doctor kept in mind _all_ of this in my treatment plan, because I've had awful reactions when they haven't. I'm not disabled but

> Worse, I need to confirm the doctor kept in mind _all_ of this in my treatment plan, because I've had awful reactions when they haven't. I'm not disabled but do have some chronic stuff. A couple decades ago I started carrying my medical record (well...the synopsis) to the doctors office for this reason. Especially when you end up in a clinic rather than a real private practice you're often not guaranteed to even see the same doctor twice. > This is terrible for the doctor. I'm making them go over time, be late to the rest of their appointments for the day, and asking them for extra energy and brain cycles for treatment, for no extra money. Though I'd not worry about this. My insurance EOB stated for a simple visit and bloodwork the doctor charged well over $1300. I saw the doctor for exactly 10 minutes. Make them work a little for their money.

arkades 4y ago
That’s not what the doc gets paid. That’s the pretend amount that the insurer and doc have agreed upon, before their agreed upon discount. Source: doctor.
- User23 4y ago
  You as the doctor actually explicitly signed off on the real price? Not some administrator somewhere? Did you have any real input, or is your relationship to the insurer more like a driver’s relationship to Uber?
  - arkades 4y ago
    When working for a hospital, it’s an admin somewhere. When in private practice, the insurer generally has geographic monopoly, so I sign off on whatever they shove in my face if I intend to accept their patients. The only time I have a real say in price is in private practice for uninsured patients, which is where I set aside a piece of my time for charity care.
- lotsofpulp 4y ago
  My EOBs have always stated what the healthcare provider is owed per the insurance price. It shows what was billed (the fantasy number), then the insurance price (or the discount), and patient responsibility (dependent upon an individual’s deductible/copay/oop max). Is that not true?
  - johannbok 4y ago
    That's right, only there is no normal physician visit that bills $1300. The absolute highest reimbursement you're gonna get for an outpatient visit - a level 5 evaluation and management first-time patient visit plus double-coding an 'prolonged visit for high complexity care' (some handful of insurers allow triple-coding a G2212) - (a 99205 + G2212 x 2) is 244.99 + something like $30 (I don't recall the G2212 reimbursement off the top of my head, but it's in that ballpark), for a total of about $275. +/- some adjustment for geography. That's not what patients pay - that's the total allowable reimbursement to the doc via medicare. I use medicare numbers here because almost all private insurers negotiate as %medicare. If I'm a hot specialty people are willing to pick an insurance plan over (say, cardiology) and there's a shortage of my folks in the area, I might negotiate up to something like 110-120% of medicare. Most of the time I'll be happy to get 105% medicare, and some folks will end up getting something like 95% of medicare. To hit $1300 there'd have to be: -A procedure, likely an inpatient or facility service, such as a small outpatient surgery, or an infusion. - Your doc has an in-house blood work lab and your insurer doesn't cover it, and the bill is actually a lab work bill That latter bit is a gray area - it's actually barred under the Stark Law, as clinical lab work is considered a Designated Health Service that's barred from self-referral, if it's a third-party lab that they own or co-own. If it's their own actual in-clinic lab, though, I'm unsure of how that works out (I don't run my own lab, so I just know of this second-hand). If you have a private-information-redacted copy of a 'normal' bill for $1300, I'd be happy to eyeball it - either to let you know something is off and worth appealing, or to learn something new for my self.
    - lotsofpulp 4y ago
      I did not intend to claim that the doctor got paid $1,300 for a consultation (that person wrote they received lab work too). I was clarifying what arkades claimed, which I interpreted as the EOB does not state the true remuneration for the healthcare provider.

arkades 4y ago

That’s not what the doc gets paid. That’s the pretend amount that the insurer and doc have agreed upon, before their agreed upon discount. Source: doctor.

User23 4y ago
You as the doctor actually explicitly signed off on the real price? Not some administrator somewhere? Did you have any real input, or is your relationship to the insurer more like a driver’s relationship to Uber?
- arkades 4y ago
  When working for a hospital, it’s an admin somewhere. When in private practice, the insurer generally has geographic monopoly, so I sign off on whatever they shove in my face if I intend to accept their patients. The only time I have a real say in price is in private practice for uninsured patients, which is where I set aside a piece of my time for charity care.
lotsofpulp 4y ago
My EOBs have always stated what the healthcare provider is owed per the insurance price. It shows what was billed (the fantasy number), then the insurance price (or the discount), and patient responsibility (dependent upon an individual’s deductible/copay/oop max). Is that not true?
- johannbok 4y ago
  That's right, only there is no normal physician visit that bills $1300. The absolute highest reimbursement you're gonna get for an outpatient visit - a level 5 evaluation and management first-time patient visit plus double-coding an 'prolonged visit for high complexity care' (some handful of insurers allow triple-coding a G2212) - (a 99205 + G2212 x 2) is 244.99 + something like $30 (I don't recall the G2212 reimbursement off the top of my head, but it's in that ballpark), for a total of about $275. +/- some adjustment for geography. That's not what patients pay - that's the total allowable reimbursement to the doc via medicare. I use medicare numbers here because almost all private insurers negotiate as %medicare. If I'm a hot specialty people are willing to pick an insurance plan over (say, cardiology) and there's a shortage of my folks in the area, I might negotiate up to something like 110-120% of medicare. Most of the time I'll be happy to get 105% medicare, and some folks will end up getting something like 95% of medicare. To hit $1300 there'd have to be: -A procedure, likely an inpatient or facility service, such as a small outpatient surgery, or an infusion. - Your doc has an in-house blood work lab and your insurer doesn't cover it, and the bill is actually a lab work bill That latter bit is a gray area - it's actually barred under the Stark Law, as clinical lab work is considered a Designated Health Service that's barred from self-referral, if it's a third-party lab that they own or co-own. If it's their own actual in-clinic lab, though, I'm unsure of how that works out (I don't run my own lab, so I just know of this second-hand). If you have a private-information-redacted copy of a 'normal' bill for $1300, I'd be happy to eyeball it - either to let you know something is off and worth appealing, or to learn something new for my self.
  - lotsofpulp 4y ago
    I did not intend to claim that the doctor got paid $1,300 for a consultation (that person wrote they received lab work too). I was clarifying what arkades claimed, which I interpreted as the EOB does not state the true remuneration for the healthcare provider.