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I would point out that the attending surgeon, the anaesthesiologist, and the hospital all bill the patient separately here for a surgery, in Ontario, Canada. (
by retrac 3y ago
I would point out that the attending surgeon, the anaesthesiologist, and the hospital all bill the patient separately here for a surgery, in Ontario, Canada. (Most people will never see these bills and it's covered by the public insurance.)
The reason is that the service - the contract - is organized in that way. Between the patient and the anaesthesiologist, between the patient and the surgeon, and between the patient and the hospital. So three separate bills. The doctor and hospital will have their own contract. Legally, and in an important way when it comes to decide who to sue for malpractice, the hospital is not the provider or performer of the surgery. They just provide the venue and equipment; the doctors do the surgery.
- AlecSchueler 3y agoBut why is done that way? Lots of freelance chefs move between restaurants but the bill is always between the restaurant and the people who dine there.
- beaeglebeached 3y agoServer is better analogy. The wage you pay/owe the waiter is direct and (mostly) separate from meal, albeit informal with only shame as a deterrent for default.
- AlecSchueler 3y agoI'm not based in the US, so my servers are paid a wage directly by the restaurant.
- beaeglebeached 3y agoThat makes sense, but the ah ah ah this isn't the US card comes unexpected on an analogy developed specifically alongside a US based topic.
- AlecSchueler 3y agoI'm sorry? I was only asking a question about another culture.
- John23832 3y agoBecause the legalities of chef/restaurant malpractice are orders of magnitude less important than those of doctor/anesthesiologist/hospital.
- devilbunny 3y agoBecause historically doctors were in private practices. I still am, as an anesthesiologist. Many of the surgeons I work with are also private. So, since neither of us is employed by the hospital, we do our own billing. If we were hospital employees, we could indeed do unified billing. That's a better analogy; your chefs are expecting to be paid by the restaurant, so it collects the bill. I am not paid by the hospital except a stipend for taking call for them - not for any specific services I provide to patients. It's frustrating for patients and families, it's annoying for us, but it's the price of legal independence for us. If my hospital collapsed overnight (and they sometimes do), my group could go out and start working other sources of income right away, because we already have the business setup to do our own billing.
- petre 3y agoIt's still better than billing to the hospital and the hospital billing to the patient, piling up taxes and comissions. The patient is also getting more cost transparency instead of a bundled bill one can never make sense of.
- ddoolin 3y agoI don't agree with the last point and I think this thread is evidence of that. We cannot make sense of the myriad of bills we get from all the different providers, particularly since many or all of them are also being dealt with by our insurance and may have already been negotiated by the time we get the bills in the mail. To that point, I went to the ER a few months ago and I've probably received ten or so mailings for unpaid bills, only one of which I actually ended up owing, but my insurance didn't make the claims visible until they were settled which was months after the fact. To make matters worse, I can still log in and pay bills which were settled by my insurance. And I've received bills in the mail -- late I assume -- after they were paid by me or settled by insurance, confounding matters further.
- Aloisius 3y agoTransparency would be far more useful if it came before the service being rendered. Obviously there are some practical limits in exceptional cases, but I can't think of another industry that has high-price services where providing estimates isn't standard.
- taeric 3y agoThis doesn't endear me to the situation. :(
- plagiarist 3y agoNot seeing these bills would be incredible. Having them all covered in the same way would be fantastic. Instead, for us, states need to enact surprise billing laws since each provider can mysteriously be out-of-network despite working within a hospital that is in-network. The in-network concept is complete bullshit to start with, but then you have to have complete documentation of every person involved in whatever care you are getting.
- plants 3y agoThis is what infuriates me the most about healthcare in the US. I give someone my card, they enter the numbers with no indication of whether or not everything will be covered by insurance (they assume you just know). Then, a month later, I receive a bill indicating a routine procedure that I assumed out of ignorance was covered by insurance (since they took my card and entered the numbers without saying anything to the contrary) for $500 (or, god forbid, more). If I knew a salad at a restaurant were $200, I probably wouldn’t order it. There is no basic transparency in medical billing, and that needs to change.
- lazide 3y agoIt’s actually even worse. If you (or the Dr’s) could reliably tell how it was even going to be coded (aka categorized/identified) in the system in advance, it would already be a huge step up. Then you’d only have a handful of different prices you might have to pay.
- jimmygrapes 3y agoSounds like the way hair salons and strip clubs are run in the U.S.