"Provider Discounts" are a joke

[Horse with no Name]

I pay about $7500 a year in health insurance.
Everytime I go to the doctor I pay $20 for the regular doc and $30 for a specialist.

I've been in a cash-only position before and paid through the nose for office visits and procedures.

I have had some health problems lately and I am going through my EOB's and I am finding HUGE writeoffs for the insurance companies, yet if I was billed for the same procedure...I might get 10% discount for cash up front...but geez louise, if I paid these prices, I could almost get by without insurance.
Examples:

I had radiology and medical services. The Doctor billed the insurance company for $440. The DISCOUNT given was $280.99, I paid $20 and the insurance company paid $139.01.

For my pap smear, exam and labs...my doctors office billed $310.00. I paid $20 and my insurance company paid a whopping $29.41.

This should be criminal...at the very least, the providers should be forced to provide the same prices to uninsured folks for the price.
I mean...how many uninsured women out there forego these necessary screenings because of the $300 price tag...but would jump at the chance to pay $30?

:mad:

[fasttense]

1. I believe the Doctors are determined to become wealthy off the backs

of the sick and suffering. Otherwise they would charge reasonable amounts for visits and office procedures, especially to the uninsured.

[Horse with no Name]

3. But they have to charge them to make up the difference in what the insurance companies will NOT pay

Very few doctors I know these days are getting rich. I don't begrudge them...but it isn't FAIR that I pay all that money for insurance only to have them pay prices that I could afford if I did NOT have insurance.:mad:
Local story...apparently some of the local hospitals and Docs outside of the Dallas area have BCBS (which is what I have). Their contracts have gotten so low and what they pay the docs is so minuscule, that they are starting to refuse BCBS. None of us who are insured have the choice of who our employer contracts with...so it really is NOT my choice to have BCBS...it was the only thing offered.
Yet my rates have doubled over the past few years...they pay the docs less and less to the point of docs refusing it...where is the money going?

[MuseRider]

11. Our largest medical group

in our city just said yesterday that they are refusing to take any more Medicare patients because they are losing so much money. I am not a Dr fan. I was an RN, my husband was a Dr and I always thought the Docs made way too much money off the backs of patients but that began to change with Reagan and now the Docs still do OK but the insurance companies are making a killing off of both the Docs and the patients. It really is criminal.

[Horse with no Name]

12. We live in a SEVERELY economically disadvantaged area

95% of all babies delivered are paid by Medicaid.
Apparently Medicaid allows the docs to accept a certain number of Medicaid cases in order to get the funding, but our Docs have never heeded that. They went over those numbers.
I heard last week that they are going to start limiting their Medicaid patients to those numbers.
That leaves a very LARGE client base without obstetricians. The nearest hospital is 60 miles and they ALSO limit their numbers.
I wonder where these women will seek their prenatal care because IF they show up at a hospital...they HAVE to be delivered.
Indeed...there will be MANY without prenatals. That isn't good for anyone.

[MuseRider]

13. It is disgusting.

Our country has fallen apart, totally. Human services will all be gone soon as we spend more and more enforcing Democracy elsewhere. I see no changes for the better in the future. An entire generation is growing up and this is normal for them.

Watching the FISA vote and posting on this thread has made me angrier and sadder than I have ever been.

[jakem]

2. ironically...

1) providers feel they HAVE to charge high in order to get the reduced % they get from insurance
2) it is illegal to charge ins differently than those paying out of pocket

a lose-lose for the consumer.

[Horse with no Name]

8. Capitalism at it's finest

I remember as little as ten years ago when I hit my annual out of pocket fee...that I didn't pay another copay for prescriptions, medical or hospital fees. What I paid before they deemed I reached my deductible was sent back in a check payable to ME. I purchased my very first computer with that $3k.
Nowadays, I am really not sure what meeting your out of pocket MAXIMUM is. I still have to pay copays.:shrug:

[flashl]

4. IMHO, the patient is just an incidental

on the investor-legal-insurance-medical battleground of the dollar.

[Horse with no Name]

7. I think the REAL definition of being insured

is being given the privilege of paying the actual costs--through copays, coinsurance, and non-covered items.

[NC_Nurse]

5. Yep. It's a shell game, that's for sure. In any other business, you would see

the rates for services published. Ever ask anybody what a procedure costs at a hospital? You're lucky if they'll give you a ballpark figure.

[Horse with no Name]

6. Yeah for my recent surgery

They called me and told me my part would be around $4k and they needed it up front cash or credit card please. Whew.
Of course that was until I informed them I had already expended my annual out-of-pocket fee and the insurance company would be responsible for 100% of the charges. They didn't like that nearly as well as me paying $4k out of pocket.:rofl:

[NC_Nurse]

10. I bet they didn't...

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[Vinca]

9. It's like rats on a treadmill. The insurance companies agree

to pay a certain percentage, so in order to make the same amount of money, the provider ups the price. Every so often the insurance companies review the policy, agree to a new percentage, and the provider ups the price again. It's not fair to the millions of us trapped paying the full price because we can't afford insurance. It's not fair to honest providers, either. My own doctor gave up his practice because the insurance companies were screwing him on 2 fronts. He was fighting lymphoma and had all kinds of uncovered expenses on one hand. On the other, he was receiving only a fraction of what he should have been for treating his patients.