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If the consulting physician is doing it for my benefit and to ensure a quality diagnosis, I'll pay. But, if the attending is doing it because they aren't that bright or they want to cover their rear for something, they pay. There's a difference between a consult for me and a consult to minimize malpractice payouts.
As for good insurance, yes there still are many good health insurance plans available. Unfortunately they cost money and most Americans have reduced their health care to as cheap as possible. I have decided I don't want to deal with the nonsense so I buy the plan that provides what I want without the game playing. It also helps that I have no problem with other taxpayers providing me with free healthcare even though I can afford to self insure. If the loophole exist, I'll use it.
So you're willing to agree not to sue if your doctor agrees to not practice defensive medicine?
When my hubs was in the hospital after a stroke, the attending physician told him, "Save money, don't take your own meds that you brought from home." Yeah right. When we got the bill, pharmacy cost was one third of the total bill. They charge through the nose for every pill they give you. Of course you CAN'T save money by using your own pills either - every pill you take has to be verified by the hospital pharmacy. And they charge for that.
Or are you referring to consults between colleagues in the same specialty where one physician is just trying to get a second opinion on their own treatment plan?
I'm fortunate that the business makes enough to buy the best suited plan for my employees. Once benefit of this plan is their cost containment which has a health dose of auditing. Employees are encouraged to review their bill and send any concerns to the insurance company for action. From my understanding (they can't disclose specifics) as much as 25% of billed charges in 2015 were found to be bogus. I know from one employee that they had a hospital consulting physician charge removed because the insurance company deemed it as not medical in nature but administrative and educational. Even my own private doctor has me bring in any of my bills to look over because, as he calls it with a wink, "mistakes" often do happen in a hospital setting.
As you mention, there are definitely problems that have to be addressed. Being in a hospital makes you something of a captive audience. Services provided by practitioners you have little or no say in choosing (ER, Radiologists, Pathologists etc), not to mention the potential for services not even performed. Seems like there needs to be more transparency for patients to understand and expect charges, while still balancing the needs to pay physicians and facilities for legitimate services.
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