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If someone invoices me, and I don’t pay the full amount in a timely manner, what do you think will happen? Late fees, reports to credit bureaus, collections age
by Apreche 1y ago
If someone invoices me, and I don’t pay the full amount in a timely manner, what do you think will happen? Late fees, reports to credit bureaus, collections agencies hounding me, maybe even lawsuits?
If insurance companies underpay, doctors should treat that no differently. Don’t appeal through the insurance company itself. Imagine I go to a store and pay less than the full amount at the register, and then the grocery store appeals to ME to decide whether I actually should have paid the correct amount. It’s absurd.
Doctors should treat the insurance companies like anyone else who owes them money and isn’t paying in full on time.
- hn_go_brrrrr 1y agoI was thinking the same thing. Would it be permissible to bring each underpayment to small claims court as a separate case? If enough doctors did this, it would very quickly be a legal DDoS attack, like we've seen happen with mandatory arbitration.
- nradov 1y agoWhen providers join payer networks they generally waive their right to sue over issues like this.
- postflopclarity 1y agogood luck suing when lawyers cost the doctor 2k/hour and the insurance companies have armies of in house counsel.
- gwbas1c 1y agoDoctors have extensive contracts with insurance companies, and often have employees dedicated to billing. I wouldn't make assumptions here, other than "downcoding" is probably just subtle enough to not be worth it to fight.
- some_random 1y agoSo what should happen when Docs lie about what procedures they did? Because it happens quite frequently and for some reason is always left out of these discussions.
- Pet_Ant 1y agoMan, it's almost like healthcare and human lives shouldn't be for profit...
- pastor_williams 1y ago"It is not from the benevolence of the butcher, the brewer, or the baker, that we expect our dinner, but from their regard to their own interest."
- jasonlotito 1y agoExactly. Glad you agree it shouldn't be for profit, either.
- pastor_williams 1y agoI have no problem with it being for profit. The issue is the alignment of interests and the thumb on the scales by government and vested interests. If health insurance worked like car insurance I think we'd be in a better state.
- kbelder 1y agoI wish health care worked like veterinary care. Except, now, veterinary care is becoming more like human health care, and it sucks.
- nocoiner 1y agoVets are really the most amazing doctors and I hate to see what is happening to their industry. Hopefully in exchange for dealing with the bullshit of human health care, at least maybe the money is getting a little better for them (a lot of them are just criminally underpaid).
- jasonlotito 1y ago
- lesuorac 1y agoSure but imagine you hire a landscaper and they send you a $40 invoice for $20 of law cutting and $20 of leaf cleanup. You go look outside and see a ton of leafs so you just send them $20. That's the insurance companies' stance. The work you performed is this and so our agreed upon rate is this.
- bshep 1y agobut the landscaper has a photo of the clean yard after they finished. They send it to you but you ( as the insurance company) say they need to call a specific time and speak to your 12y/o who is the yard representative of the house. The 12 y/o say ‘no you stink’ and hangs up. Then you send the landscaper a letter saying ‘sorry your peer to peer was denied’ ( I know this is exaggerating a bit and made to sound funny but it mostly works like that in healthcare )
- kstrauser 1y agoBut in reality, the landscaper bills you for $100, you say you’re only going to pay $90, and then you write them a check for $31.50. (That’s because you’re a major, well-known insurer and pay an industry high 35%. The guy who mows the Medicare yard might pay 40 cents on the dollar. The person mowing the Medicaid yard has to file 87 forms to get paid his $6.) Source: I’ve co-owned doctors offices.
- pragmatic 1y agoInsurers (payers in the industry lingo) simply don’t pay or underpay. Proving this sucks bc smaller practices have horrible staff turnover, the EMRs are dog shit and the contracts are who knows where and in what format. Recovery is beyond the scope of most small practices. Its a nightmare where providers are often shorted millions of dollars and that ends up coming out of the patient’s pocket. Everyone yammering about upcoding on this thread is blissfully clueless.
- kamarg 1y ago> Recovery is beyond the scope of most small practices. Seems like a business opportunity. Could probably work very similar to other collections agencies where they either buy the debt for pennies on the dollar or take a percentage of the collected amount.
- datadrivenangel 1y agoSending your patient's 'debt' to collections promptly is very unpopular with the patients, and the insurance companies will 100% insist that the patient is responsible.
- brewdad 1y agoIt's much easier to treat it like identity theft where the business's problem becomes the customer's problem to solve. In this case, insurance didn't pay what was required so the patient does. There's already a potential collections agency involved if the patient doesn't pay. Who do you think is easier to squeeze the money from? A mega-insurance corporation or your sick grandma?
- toast0 1y agoYeah, there's an industry of companies that insert themselves between the medical record and the insurance company to upcode claims and get better payments. This article is about the reverse process, where the insurance company looks at the claims and downcodes them to send worse payments. IMHO, in office care should be more of a time and materials billing than billing based on procedures done. Of course, then the doctors' billing office would aggressively measure time the doctor spent, and the insurance company would suggest the doctor took too long for whatever.
- spiffytech 1y agoInsurance companies hold tremendous leverage over care providers, up to and including the power to effectively put them out of business on a whim. Care providers don't like picking fights with insurance companies.
- tptacek 1y agoCare providers make massively, massively more money than insurance providers.
- aspenmayer 1y agoCare providers also likely spend much more time and labor on making that money than the insurance providers spend making their end, though I only have anecdotal evidence of this through my involvement in healthcare providers’ practices as an MSP.
- tptacek 1y agoIt's $2.5Tn vs $0.3Tn. It's more than 8x more.
- aspenmayer 1y agoThat’s one half of the proportion. What is the time/labor spent?
- zaptheimpaler 1y agoYou can look up Dr. Elizabeth Potter on Youtube who publicly details what its like dealing with insurance, and all the ways insurance screws her and her patients. United Health actively threatened and retaliated against her business when she started getting publicity. The total industry wide profit numbers aren't relevant at all if you're running a small clinic going up against an insurance provider. Heck even if a single clinic made more money than an insurance provider, it would barely matter - the insurance providers have the power to stop covering your practice and kill it, a clinic does not have any such power over insurance providers.
- bena 1y agoIt's truly fucked up. Most insurances won't publish their fee schedules. So doctors don't know what they will pay. So what they do is bill insanely high knowing the insurance will come back with "Nah, we only cover $X". They'll collect $X, then write off the remainder. Because the fear is not getting the maximum money possible. If the doctor would bill $100 and the insurance pays up to $200, then the doctor "lost" $100. Regardless of how much it actually cost the doctor to provide the service. It's also why the "cash price" is usually much cheaper, because it's closer to what it costs the doctor to provide the service.
- hibikir 1y agoAh, but this has also lead to many private practices getting bought by hospital groups, at which point they have superior pricing power. The doctor makes more money, and the insurance company pays more, as it's harder to strongarm a company that owns 8 hospitals than a 3 doctor practice. Either way, the price goes up.
- nradov 1y agoHealth plans are legally required to publish their rates and they all comply with this now. You can literally just go to any payer web site and download the MRF. There are occasional data errors but overall the numbers are generally accurate. https://www.cms.gov/priorities/healthplan-price-transparency/health-plan-price-transparency https://www.cms.gov/priorities/healthplan-price-transparency... https://github.com/CMSgov/price-transparency-guide https://github.com/CMSgov/price-transparency-guide
- bena 1y agoAs of 2022, that explains it. It’s been a bit since I’ve worked in the field. It’s good that it’s changed
- anigbrowl 1y agoI'm 90% certain that submitting claims to an insurer subjects doctors to resolving any disputes via an appeal followed by an arbitration process, and that the right to sue or handle the debt in the regular way is severely attenuated.