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Old 09-21-2008, 04:55 PM
 
Location: San Antonio
10 posts, read 24,188 times
Reputation: 10

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Our podiatrist gave my daughter an athletic brace to wear after coming out of a walking cast for a fractured ankle. I have "full boat" insurance paying a high premium w/ low deductable and insurance paid for everything but the small co-pay up through the walking cast. I check out and the charge for the brace is $300 which I thought was crazy high-I cut a check on the spot. 6 months later on the web I find numerous sites selling the exact same brace for $89 to a max of $129. That was retail on the web. On a recent check up for a scheduled x-ray to check on the injury I asked the podiatrist what a typical margin is for DME and he claims they will charge "what the market will bare". I also find out that insurance was charged $189 in addition to my $300. That's almost 5 times more than what I could have purchased it for on the web.

This seems not only un-ethical but criminal.

Am I way off here ?
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Old 09-21-2008, 05:35 PM
 
896 posts, read 2,565,466 times
Reputation: 593
We had a similar situation where the podiatrist charged $500 for an ingrown toenail. I had to pay then or else no relief for my kid's toe. I did the same as you did, paid the bill. When your kid is in pain, you do what's necessary. My husband had a giant cow and checked with the insurance and found out that something was indeed wrong.
As it turns out, the office had the wrong code -- they charged us for outpatient surgery, when the ingrown toenail was supposed to be coded something else. After several go arounds with the office, they filed the insurance themselves and once the insurance paid them, they paid us back. Took over 3 months, too. Needless to say, hubby was really angry that they could hold our $$ for so long, but we had to pay inorder to get the toenail fixed. Bottom line - check with the insurance co and see if there's more to the story.
We also had to get an athletic brace for my daughter when she sprained her ankle. I know it wasn't as complicated as the brace yours needed for the fractured ankle, but it was no where even near $300 for the brace, office visit and xray. We went to TX Med Clinic -- they have orthopaedics doctors at the one off of 410 and Nacogdoches/Broadway area.

I'd definitely check into it.
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Old 09-21-2008, 06:16 PM
 
Location: San Antonio
1,532 posts, read 3,279,732 times
Reputation: 644
Unfortunately, docs are having to "charge a lot" because they want to get reimbursed by the insurance companies. The insurance companies don't pay docs what they should, they only pay them a portion of what they charge. Therefore, the docs are having to charge more so that they can get what they deserve from the insurance companies. At least, this is how it was explained to me by someone in the medical field. If you want to be angry, be angry at the insurance companies for being so greedy.
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Old 09-21-2008, 07:12 PM
 
124 posts, read 223,610 times
Reputation: 55
Quote:
Originally Posted by mojokitty View Post
Unfortunately, docs are having to "charge a lot" because they want to get reimbursed by the insurance companies. The insurance companies don't pay docs what they should, they only pay them a portion of what they charge. Therefore, the docs are having to charge more so that they can get what they deserve from the insurance companies. At least, this is how it was explained to me by someone in the medical field. If you want to be angry, be angry at the insurance companies for being so greedy.

I think that may NOT be the case -- that is really an old chestnut put out by the docs lobby to explain their exorbitant charges. The reality is that everyone involved in the medical 'business' is price gouging -- from the docs to the hospitals to the insurance companies.

Docs (with the exception of the primary care docs) make exhorbitant salaries - I know this from first-hand experience - one doc I know makes over 400K per year and works 4 days a week. Also I went to visit a specalist last week and he had italian tiles and a 'water fountain' in his waiting area - This is absurd - over half the population is uninsured, health care costs forcing people into bankrupcty and we have italian water fountains in waiting rooms!

Docs should be well paid - but not where they have lost the plot and think that their medical offices should be bathed in italian tile.

This system is going to go belly up - just like Wall Street - and we are going to have to place price controls and regulations on this medical business - not an outcome I desire - but as inevitable as night follows day.
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Old 09-21-2008, 07:38 PM
 
Location: San Antonio
1,532 posts, read 3,279,732 times
Reputation: 644
I have to disagree with you. Docs deserve what they get, why? They have hours that no one else wants to put up with. They have to work holidays, weekends, miss outings with their families, be on call, get woken in the middle of the night, constantly keep up with the newest procedures, medicines, and information. They are responsible for people's lives and god forbid they make a mistake, they can be sued for millions of dollars. Not only does that mess with their reputation, but also their salaries and insurance. I don't know too many jobs that are like that, so therefore, I think if they get 400k a year, good for them. If they choose to spend it on fountains and Italian tiles so their patients can enjoy a relaxing atmosphere, so be it. They work hard for that huge salary. I know I wouldn't want to be in their shoes and have all of that responsibility! Not to mention, all of the facts and figures that they have to keep in their heads. This is my opinion on the matter at least. Let's start looking at these insurance companies which I have to say, their higher ups in the companies are making much more than docs!!! Look it up!

PS, not all docs make 400K a year, so let's not put that out on the table.
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Old 09-21-2008, 07:52 PM
 
Location: Alexandria, VA
10,711 posts, read 19,040,812 times
Reputation: 14653
Well, I have an issue w/drs. hrs. - a couple on each day of the week, yet the charges are higher and higher - this isn't a family doctor, an Endo. but obviously he/they must be making some good money in order to be able to only open the office for specific hrs. on 4 days a week

On one hand I understand the insurance issues (we don't want me to get started there), but there has to be a point where people get what they pay for, doctors get what they deliver, etc. - I used to feel bad when I got a statement showing what was paid as opposed to what was charged, but then I think about it: a very few minutes spent and the doc. can apparently cut his hrs. - must not be hurting him too much.
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Old 09-21-2008, 08:16 PM
 
10 posts, read 26,184 times
Reputation: 12
Quote:
Originally Posted by slonga View Post
I think that may NOT be the case -- that is really an old chestnut put out by the docs lobby to explain their exorbitant charges. The reality is that everyone involved in the medical 'business' is price gouging -- from the docs to the hospitals to the insurance companies.
Uh, no, this is absolutely accurate. Not only is this true but the high prices for DME also factor in the loss due to the joe that came in an hour before and will not be paying his bill at all. Like the previous poster stated the insurance carriers have contracts with providers where the provider only receives a percentage of billed charges, AND receives it only after waiting for months to get paid, AND after fighting with the insurance carrier for every claim submitted, ANDre-filing several times due to every excuse the insurance carrier can cook up, AND after lost revenue due to missed filing deadlines. Also don't forget the conveinence and service factors, i.e. a gallon of milk at a conveinece store cost more than at the grocery store and the brace was likely personally fitted and the patient was likely provided instructions on use, care and provided the opportunity to ask questions. Try that when you buy from the internet. Don't forget that you also have a person to call and go to when you have difficulties because the patient doesn't bother to wear it the way they were instructed. The cost also factors in the high overhead for things like malpractice insurance because every Tom, Dick or Harry that walks into the office beleives that they should sue the provider because he/she couldn't cure their cold. Sorry, touched a nerve. Mopst people just don't have a clue to the internal operations of a doctors office and seem to just complain about high the costs are. Just as in other businesses, costs are passed on.
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Old 09-21-2008, 08:23 PM
 
Location: San Antonio
10 posts, read 24,188 times
Reputation: 10
If the docs are getting taken advantage of by the insurance industry then they need to do what everyone else does and get organized and change things. I know some docs that don't take insurance at all and save on the extra staff required for the billing, accounting, etc.

The fact that they feel they need to "get even" with the insurance company should not have innocent casualties. The insurance company in my situation overpaid for the item as well.

I don't have a problem paying for the docs expertise but they should be up front and not try to hide it in quadrupling the cost of a simple ankle brace.

Docs should be compensated on the level of complication of the expertise or procedure. The endless amount of information on the internet is going to make their opinions on simple issues much less valuable. Same thing that is happening with attorneys- you can now get good corporate documents online for a fraction of the cost of an hourly attorney that spits the same doc out twenty times but charges as if its from scratch.

Many minor medical conditions can be diagnosed and treated just by going to Web Md or other sites. There may be some casualties due to this but there are thousands of casualties from quacks out for a quick buck as well.
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Old 09-21-2008, 08:29 PM
 
124 posts, read 223,610 times
Reputation: 55
Quote:
Originally Posted by mojokitty View Post
I have to disagree with you. Docs deserve what they get, why? They have hours that no one else wants to put up with. They have to work holidays, weekends, miss outings with their families, be on call, get woken in the middle of the night,
Most do not - ever tried to get a Doctor at 1 am?

Quote:
Originally Posted by mojokitty View Post
constantly keep up with the newest procedures, medicines, and information.
Like most carreer professionals that I know of!

Quote:
Originally Posted by mojokitty View Post
They are responsible for people's lives and god forbid they make a mistake, they can be sued for millions of dollars. Not only does that mess with their reputation, but also their salaries and insurance.
The 400K is after after all of these expenses.

Quote:
Originally Posted by mojokitty View Post
I don't know too many jobs that are like that, so therefore, I think if they get 400k a year, good for them.
Every career that I know of is like this - every one! - except the 400K

Quote:
Originally Posted by mojokitty View Post
If they choose to spend it on fountains and Italian tiles so their patients can enjoy a relaxing atmosphere, so be it. They work hard for that huge salary.
However I know many many other careers that work just as hard - really!

Quote:
Originally Posted by mojokitty View Post
Not to mention, all of the facts and figures that they have to keep in their heads.
Most careers require a similar aquaintance with facts and figures.

Quote:
Originally Posted by mojokitty View Post
PS, not all docs make 400K a year, so let's not put that out on the table.
I agree that not all docs make 400K per year -- I think I said that - but many I know do and even more... and it is disgusting to litter a medical practice with Italian tiles when the charges from these doctors are forcing many many families into penury.

It you believe that all of the problems in the medical system are due to the 'insurance companies and their execs' then we will simply have to agree to disagree and live on different planets. The execs at the insurance companies make up a tiny part of the medical system costs. However their are not blameless - they are part of a system - doctors, hospitals and insurance companies - that are literally destroying families with exccessive greed.

Look up recent articles in the Wall Street Journal that highlighed a not-for-profit hospital in Roanake that has that town in a form of medical slavery,

Nonprofit Hospitals Flex Pricing Power - WSJ.com

Also Doctors are notorious for similar dubious practices - that has been the subject of many Department of Justice investigations. I know that I have been subject to numerous needless 'procedures' and guess what? the Doc just happens to have the expensive scanner in his office to perform said procedure all for a $1000 bill to the insurance company. When I question this their response is why do I care I am not paying for it?

My response is I am - we all are.

I do not want to seem to be unduly negative about Docs - they have a lot of pressures - but we have monetarily incentized them in all the wrong ways.

We will have to agree to disagree - my vision is a medical system that will be affordable to all - and not a system that is only available to a select few with italian marble in the waiting rooms.
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Old 09-21-2008, 08:36 PM
 
124 posts, read 223,610 times
Reputation: 55
Quote:
Originally Posted by jlivelyjr View Post
Uh, no, this is absolutely accurate. Not only is this true but the high prices for DME also factor in the loss due to the joe that came in an hour before and will not be paying his bill at all. Like the previous poster stated the insurance carriers have contracts with providers where the provider only receives a percentage of billed charges, AND receives it only after waiting for months to get paid, AND after fighting with the insurance carrier for every claim submitted, ANDre-filing several times due to every excuse the insurance carrier can cook up, AND after lost revenue due to missed filing deadlines. Also don't forget the conveinence and service factors, i.e. a gallon of milk at a conveinece store cost more than at the grocery store and the brace was likely personally fitted and the patient was likely provided instructions on use, care and provided the opportunity to ask questions. Try that when you buy from the internet. Don't forget that you also have a person to call and go to when you have difficulties because the patient doesn't bother to wear it the way they were instructed. The cost also factors in the high overhead for things like malpractice insurance because every Tom, Dick or Harry that walks into the office beleives that they should sue the provider because he/she couldn't cure their cold. Sorry, touched a nerve. Mopst people just don't have a clue to the internal operations of a doctors office and seem to just complain about high the costs are. Just as in other businesses, costs are passed on.
Agree 100% -- the amount of hassle that a Doc has to deal with re the Insurance companies is insane. I have enough correspondence from my Insurance Company to fill a library - and I have minor medical problems -- must be miserable to have to deal with this every day.

However I take it if we get rid of the insurace companies shenannigans then the Docs will pass the saving on to us....

Hmm I'm not convinced.
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