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@scottalanmiller said:
Why send a bill of $250, then? What's that bill for? If Medicare says an X-Ray is worth $50, and even that is very high, why bill them an amount they won't pay unless it is for creating a "standard" to charge to uninsured people?
Ding.
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@scottalanmiller said:
@Dashrender said:
Medicare pays us something like $50 or so per xray. Sure we send them a bill for $250, but we only see $50...
Why send a bill of $250, then? What's that bill for? If Medicare says an X-Ray is worth $50, and even that is very high, why bill them an amount they won't pay unless it is for creating a "standard" to charge to uninsured people?
that's exactly why.
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@Dashrender said:
@scottalanmiller said:
@Dashrender said:
Medicare pays us something like $50 or so per xray. Sure we send them a bill for $250, but we only see $50...
Why send a bill of $250, then? What's that bill for? If Medicare says an X-Ray is worth $50, and even that is very high, why bill them an amount they won't pay unless it is for creating a "standard" to charge to uninsured people?
that's exactly why.
That's the most evil thing ever. Fake high prices that they know aren't what things are worth just to hurt the poorest people. It's honestly one of the most evil things that can be done without breaking the law. This is why I don't respect doctors as professionals but not as members of the human race and truly wish they could be jailed for life for things like that. I know of few criminals more vicious and evil. These are acts that would make me uncomfortable being around them and not feel safe letting those people around my family - and those are the people we have to trust to take care of us. They don't even meet a minimum level of ethics and humanity to be considered decent human beings.
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@scottalanmiller said:
This is why I don't respect doctors as professionals but not as members of the human race and truly wish they could be jailed for life for things like that.
A wise man once said "don't hate the players hate the game"
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@MattSpeller said:
A wise man once said "don't hate the players hate the game"
That's like saying "don't hate terrorists, hate the state."
Every doctor who does this makes a personal choice to violate their oaths and their morality and to become the pieces of sh1t that they are. No doctor is forced to be inhuman, it's something they choose because they don't feel it violated their personal beliefs and they can rape humanity for their own gain.
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You also have to take into account liability insurance in the millions that have to be paid by doctors.
If you tell Medicare that the X-Ray is only $50, they're only going to give you $5.
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@johnhooks said:
If you tell Medicare that the X-Ray is only $50, they're only going to give you $5.
I don't believe that that is true, they have set prices for these things AFAIK.
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@scottalanmiller said:
@Dashrender said:
@scottalanmiller said:
@Dashrender said:
Medicare pays us something like $50 or so per xray. Sure we send them a bill for $250, but we only see $50...
Why send a bill of $250, then? What's that bill for? If Medicare says an X-Ray is worth $50, and even that is very high, why bill them an amount they won't pay unless it is for creating a "standard" to charge to uninsured people?
that's exactly why.
That's the most evil thing ever. Fake high prices that they know aren't what things are worth just to hurt the poorest people. It's honestly one of the most evil things that can be done without breaking the law. This is why I don't respect doctors as professionals but not as members of the human race and truly wish they could be jailed for life for things like that. I know of few criminals more vicious and evil. These are acts that would make me uncomfortable being around them and not feel safe letting those people around my family - and those are the people we have to trust to take care of us. They don't even meet a minimum level of ethics and humanity to be considered decent human beings.
the argument that I hear is that we lose money at the $50 per study we get paid by Medicare. So we have to get more money from the other side to cover the losses by Medicare.
We have drugs that we are now refusing to offer to patients because our costs are $600, but the medicare re-reimbursement is only $200, and we can't get the rest of the difference made up by the patient. So instead we simply refuse to sell it.
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@Dashrender That's some of the most depressing shit I've heard in a while
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@Dashrender said:
the argument that I hear is that we lose money at the $50 per study we get paid by Medicare. So we have to get more money from the other side to cover the losses by Medicare.
Isn't that yet another degree of worse? The rich people with their insurance manage to get the doctors to give them services at a loss so the poor who can't afford insurance have to not only pay for themselves, and pay for the doctor's Ferrari, but then pay for the rich people with some level of insurance on top of it all! It's like mocking those most vulnerable for being so vulnerable.
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@scottalanmiller said:
@johnhooks said:
If you tell Medicare that the X-Ray is only $50, they're only going to give you $5.
I don't believe that that is true, they have set prices for these things AFAIK.
If that's the case then their base prices are ridiculous. There is no way it can only cost $50 for an X-Ray. First they have to cover the cost of the machine, which of course over time is less, but that's assuming you have patients that are going to use it. Second is the time to pay a nurse to give the X-Ray and a doctor to go over it. There is no way that is only worth $50.
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@Dashrender said:
We have drugs that we are now refusing to offer to patients because our costs are $600, but the medicare re-reimbursement is only $200, and we can't get the rest of the difference made up by the patient. So instead we simply refuse to sell it.
That part is, more or less, as it should be from the doctor's side. The same should go for the X-Rays. If the insurance doesn't cover it, punish those with insurance and let them sue the insurer, don't punish the poorest for someone else's inability to pay.
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@scottalanmiller said:
@johnhooks said:
If you tell Medicare that the X-Ray is only $50, they're only going to give you $5.
I don't believe that that is true, they have set prices for these things AFAIK.
While Scott is correct that Medicare does set it's own prices, they don't care what we charge (as long as it's the same or more than they are willing to pay).
The higher price is also based up the agreed contracts set with other insurance carriers. BCBS for example might pay $75 for an X-ray instead of $50...
These numbers are just sample numbers, FYI. But it's very common for private practices to be squeezed like this, where hospitals with much more power backing them are able to get more from the Medicare system, etc. The hospitals are trying to squeeze out the private practices... and sadly they are winning. Today there are fewer and fewer private practices, and instead you just see doctors working for mega health systems.
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@johnhooks said:
If that's the case then their base prices are ridiculous. There is no way it can only cost $50 for an X-Ray. First they have to cover the cost of the machine, which of course over time is less, but that's assuming you have patients that are going to use it. Second is the time to pay a nurse to give the X-Ray and a doctor to go over it. There is no way that is only worth $50.
I guarantee outside of the US it is a fraction of that cost. We are getting an sonogram on Monday full price, paying in cash, so will let you know what it costs here. That should provide a decent baseline idea since we get a level of care I've seen no doctor in the US provide. And these are ER prices, not clinic prices. So no sugarcoating.
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@scottalanmiller said:
@johnhooks said:
If that's the case then their base prices are ridiculous. There is no way it can only cost $50 for an X-Ray. First they have to cover the cost of the machine, which of course over time is less, but that's assuming you have patients that are going to use it. Second is the time to pay a nurse to give the X-Ray and a doctor to go over it. There is no way that is only worth $50.
I guarantee outside of the US it is a fraction of that cost. We are getting an sonogram on Monday full price, paying in cash, so will let you know what it costs here. That should provide a decent baseline idea since we get a level of care I've seen no doctor in the US provide. And these are ER prices, not clinic prices. So no sugarcoating.
That may be what it is outside of the US. But, you're not taking into account insurance liabilities, wage restrictions, unions, etc. All things that cost a lot of money that are outside of the doctors office's ability to control
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@scottalanmiller said:
@Dashrender said:
the argument that I hear is that we lose money at the $50 per study we get paid by Medicare. So we have to get more money from the other side to cover the losses by Medicare.
Isn't that yet another degree of worse? The rich people with their insurance manage to get the doctors to give them services at a loss so the poor who can't afford insurance have to not only pay for themselves, and pay for the doctor's Ferrari, but then pay for the rich people with some level of insurance on top of it all! It's like mocking those most vulnerable for being so vulnerable.
The reality is, at least in my clinic, that we make agreements with the uninsured and give them medicare rate, and often just dismiss the dept altogether.
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@Dashrender said:
These numbers are just sample numbers, FYI. But it's very common for private practices to be squeezed like this, where hospitals with much more power backing them are able to get more from the Medicare system, etc. The hospitals are trying to squeeze out the private practices... and sadly they are winning. Today there are fewer and fewer private practices, and instead you just see doctors working for mega health systems.
If the doctors are using that as an excuse to squeeze the patients, though, I feel no pity. If the cost of services are non-viable, then we'd see doctors poor, but we don't. We still see private practices throwing money away like it grows on trees and doctors with competence levels that we'd never hire in IT running those practices. So I have a hard time believing that they are being squeezed that much. There is such unbelievable margin in many shops to save money and so often doctors don't care - that's not someone being squeezed, it's someone making excuses.
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@Dashrender said:
@scottalanmiller said:
@Dashrender said:
the argument that I hear is that we lose money at the $50 per study we get paid by Medicare. So we have to get more money from the other side to cover the losses by Medicare.
Isn't that yet another degree of worse? The rich people with their insurance manage to get the doctors to give them services at a loss so the poor who can't afford insurance have to not only pay for themselves, and pay for the doctor's Ferrari, but then pay for the rich people with some level of insurance on top of it all! It's like mocking those most vulnerable for being so vulnerable.
The reality is, at least in my clinic, that we make agreements with the uninsured and give them medicare rate, and often just dismiss the dept altogether.
The local hospital here will give you reductions based on your income. I think a lot of places do this.
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@scottalanmiller said:
@johnhooks said:
If that's the case then their base prices are ridiculous. There is no way it can only cost $50 for an X-Ray. First they have to cover the cost of the machine, which of course over time is less, but that's assuming you have patients that are going to use it. Second is the time to pay a nurse to give the X-Ray and a doctor to go over it. There is no way that is only worth $50.
I guarantee outside of the US it is a fraction of that cost. We are getting an sonogram on Monday full price, paying in cash, so will let you know what it costs here. That should provide a decent baseline idea since we get a level of care I've seen no doctor in the US provide. And these are ER prices, not clinic prices. So no sugarcoating.
There's probably no robbing Peter to pay Paul there either - so everything can exist at it's actual cost.
I agree it's a huge shit bag here in the US.
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@johnhooks said:
That may be what it is outside of the US. But, you're not taking into account insurance liabilities, wage restrictions, unions, etc. All things that cost a lot of money that are outside of the doctors office's ability to control
If you are in a union, your costs are your own fault and should never be passed to the customer. If your staff had to join a union because you sucked that much and it raised their income, same thing. Doctor's offices control a lot of that stuff. Not insurance problems, but those often are caused by doctors screwing up. Not always, I understand, and often it was other doctors. But that became an issue not completely because America is a litigious society.
