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At issue is that most patients are uninformed consumers, and little has been done by the industry to educate them as to possible costs. Joe Blow, who has spent his life digging ditches or driving a truck is not a medical healthcare professional. Ask him about the nuances of trucking or the differences in various backhoes and he will be able to hold his own. Ask him about how a medical procedure is billed and he isn't likely to have a clue OR even know which questions to ask to buy a clue. It wasn't a big deal if the amounts were the small amounts charged back when health care was on a cash basis.
If your group does not want to accept certain insurances, fine. That is a free market decision. However, if your group goes in on a surgery where a patient has had the procedure pre-approved by an insurance company and been quoted a cost, and you know that your services are not going to be covered, there is deception. You can blame it on the patient (wrongly), you can blame it on the insurance company, but when it is your group that is demanding the money, I have to think that a majority of responsibility falls on its shoulders.
Again, I have no issue with your being paid what you have as your set rates of payment. What I do have issue with is non-informed "consent" and billing after the fact with amounts that are unexpected. Or, we could all work the way that you seem to find acceptable. Joe Blow can do work digging up your septic, which would be covered by your homeowner policy, except he can hire me to come in as a separate contractor to level the new drainage field and I get to charge you directly for my work, which is NOT covered by your homeowner insurance. Or he can quote you a job of moving your belongings, to be covered by your employer, and I can come in as a separate contractor to unpack your belongings and dust them and place them in position, and that is billable directly to you, even though Joe never mentioned that it was not part of his fee.
The concept I am going after here is "reasonable, fair, and respectful." If you are going to charge hundreds of dollars, the cost of ONE phone call in advance, informing the patient of the cost seems reasonable, fair, and respectful. Even Guido the local loan shark generally makes a call in advance to let you know of his overdue bill before coming out to break your legs.
Quote:
Originally Posted by writerwife
I'd rep ya Harry, but I have to spread it around. You said what I was thinking. Most of us of the great unwashed don't have surgery every day and don't have all of those answers or the proper questions. HazelGreeCitizen was given the cost, supposedly the total cost. Had no idea the anesthesiologist cost was separate as she asked the doc for the entire out of pocket cost. She might have shopped around for an anesthesiologist that she wanted if she knew that was a separate cost.
Way back, when you got the bill from the hospital, it was all inclusive. Somewhere along the line the separated it all up. That came as an unpleasant shock to me when we first discovered that. Oh.. and by the way.. I don't get paid until a job is done. Neither does my mechanic.
I'm sure you don't get paid 3-6 months after the fact, and in some cases, for less than you bill, but that is another story. Very often, I have patients ask me ahead of time if I accept their insurance, so the great unwashed may not be as unwashed as you think. If your surgeon is telling you one price, and leaving out the anesthesia portion of the bill, is that the anesthesiologist's fault or the surgeon's. After all, we don't usually see you until right before the surgery, while the surgeon has direct contact with you throughout the preoperative period. We are just doing a job and expecting payment for it, just like everybody else in the world. The bill you get from the hospital can be misleading. It may list the surgeon, the anesthesiologist, the pathologist, the radiologist, etc, but 9 times out of 10, each doctor billed separately and the hospital is itemizing the separate bills for you so that you can see how much everything costs. The other 1 time out of 10 is when the hospital employs the doctors. This usually happens in poor areas where the hospital gets a lot of state aid because the patient population is mostly medicaid. Since doctors can't make a living on medicaid, the hospital has to pay them with state funds just to attract them to those hospitals. In my specialty, medicaid does not even cover expenses, so we lose money on every medicaid patient, but since we are not in a poor area, we get no state aid and just chalk up the loss as pro bono.
There is nothing I would like more than to be able to accept all insurance companies, and then we wouldn't run into these problems. But here is the thing, we have learned from experience that this just lowers the fees the good insurance companies pay.
For example, if insurance company A, B, and C all pay $450-$500 for a procedure, but insurance company D only pays $250, it doesn't take long before insurance company C comes along and says "You are accepting $250 from insurance company C, so that is what we want to pay you." Next comes insurance company B with the same argument, and then company A comes along and says "Why are we paying more than everyone else?" Now, the new fee for the procedure is $250. But it doesn't stop there. When the new contract comes around, cr@ppy insurance company D comes along and says "Everyone is paying $250, but we are only willing to pay you $150." And it all starts over again. The only tool we have against this, is to not accept insurance company D right from the start.
And if you think that savings is going to get passed onto the consumer (you), you are mistaken. Your rates are still going to go up while at the same time, covering less. That "saved" money is going to the insurance company's shareholders and the CEO's $50M bonus. So now you have a whole bunch of people that have ZERO involvement in your care, being payed more rather than the people who are actually treating you.
Last edited by AnesthesiaMD; 04-21-2015 at 12:59 PM..
After all, we don't usually see you until right before the surgery, while the surgeon has direct contact with you throughout the preoperative period.
How would I even know to contact you ahead of time? In all of the surgeries I and my family have been through, I've never been informed who the anesthesiologist would be until just before the procedure and have never been given a choice...
Harry you are a wise and eloquent person. You have well described the real world that we must deal with, especially in the medical care area.
How anyone can argue with your position is unthinkable, it is purely reasonable and logical. (the opposing point of view is deceitful and possibly purposeful)
I too can't rep you in the forum, but in my imagination you get 1,000,000 points from me today.
LOL! I also reserve the right to be an opinionated, wordy, and pain in the tukkus curmudgeon who doesn't care who gets upset. Sometimes the words hit right, sometimes they miss the mark and are wild shots. My wisdom in this is little more than stating what 95% of people see as obvious but haven't been in a position to state.
Being an anesthesiologist is a job that I doubt I could do properly even with training. The fine line between keeping a patient safely "out" and not subject to extended brain fog and loss of intellect is an extreme skill and an art. The same goes for many medical skills and I applaud the dedication required to perform regularly, consistently, and properly - often under extreme pressure and with less than optimal sleep. That doesn't mean that I'm unwilling to raise heck when there is a part of the business that acts like a horse's backside and expects to be kissed.
How would I even know to contact you ahead of time? In all of the surgeries I and my family have been through, I've never been informed who the anesthesiologist would be until just before the procedure and have never been given a choice...
Usually the patient's just ask me when I come to interview them before the surgery. You always have the power to cancel the surgery right up until the time you go to sleep. But the really savvy patients ask the surgeon well before the day of the operation. Even if he/she isn't sure, they most certainly have the contact information for the anesthesia group he will be working with. You can always call them directly, and even if they don't accept your insurance, you can often work out a reduced rate and/or payment plan. At the very least, it gives you the option to go somewhere else.
I'm sure you don't get paid 3-6 months after the fact, and in some cases, for less than you bill, but that is another story. Very often, I have patients ask me ahead of time if I accept their insurance, so the great unwashed may not be as unwashed as you think. If your surgeon is telling you one price, and leaving out the anesthesia portion of the bill, is that the anesthesiologist's fault or the surgeon's. After all, we don't usually see you until right before the surgery, while the surgeon has direct contact with you throughout the preoperative period. We are just doing a job and expecting payment for it, just like everybody else in the world. The bill you get from the hospital can be misleading. It may list the surgeon, the anesthesiologist, the pathologist, the radiologist, etc, but 9 times out of 10, each doctor billed separately and the hospital is itemizing the separate bills for you so that you can see how much everything costs. The other 1 time out of 10 is when the hospital employs the doctors. This usually happens in poor areas where the hospital gets a lot of state aid because the patient population is mostly medicaid. Since doctors can't make a living on medicaid, the hospital has to pay them with state funds just to attract them to those hospitals. In my specialty, medicaid does not even cover expenses, so we lose money on every medicaid patient, but since we are not in a poor area, we get no state aid and just chalk up the loss as pro bono.
There is nothing I would like more than to be able to accept all insurance companies, and then we wouldn't run into these problems. But here is the thing, we have learned from experience that this just lowers the fees the good insurance companies pay.
For example, if insurance company A, B, and C all pay $450-$500 for a procedure, but insurance company D only pays $250, it doesn't take long before insurance company C comes along and says "You are accepting $250 from insurance company C, so that is what we want to pay you." Next comes insurance company B with the same argument, and then company A comes along and says "Why are we paying more than everyone else?" Now, the new fee for the procedure is $250. But it doesn't stop there. When the new contract comes around, cr@ppy insurance company D comes along and says "Everyone is paying $250, but we are only willing to pay you $150." And it all starts over again. The only tool we have against this, is to not accept insurance company D right from the start.
And if you think that savings is going to get passed onto the consumer (you), you are mistaken. Your rates are still going to go up while at the same time, covering less. That "saved" money is going to the insurance company's shareholders and the CEO's $50M bonus. So now you have a whole bunch of people that have ZERO involvement in your care, being payed more rather than the people who are actually treating you.
"I'm sure you don't get paid 3-6 months after the fact, and in some cases, for less than you bill, but that is another story. "
Actually, I've had that happen, as well as have customers skip or go bankrupt. One of them almost put me out of business from the loss. But as you say, that is a different story.
"The bill you get from the hospital can be misleading. It may list the surgeon, the anesthesiologist, the pathologist, the radiologist, etc, but 9 times out of 10, each doctor billed separately and the hospital is itemizing the separate bills for you so that you can see how much everything costs. "
This is more in line with what the Humana rep explained to me. The hospital gathers all costs and even though the practitioners bill individually, the insurance company sees one provider code.
Your last two paragraphs sound all too familiar, and I agree with you 100% What you DIDN'T add is that when faced with insurances demanding a discount, the RETAIL cash price is often ballooned to unreasonable levels, placing the burden of lost revenue on the backs of those least able to pay.
Usually the patient's just ask me when I come to interview them before the surgery. You always have the power to cancel the surgery right up until the time you go to sleep. But the really savvy patients ask the surgeon well before the day of the operation. Even if he/she isn't sure, they most certainly have the contact information for the anesthesia group he will be working with. You can always call them directly, and even if they don't accept your insurance, you can often work out a reduced rate and/or payment plan. At the very least, it gives you the option to go somewhere else.
Did you actually manage to write that out and not understand how messed up and ridiculous that is?
You know what insurance I have even before your pre-op visit. Why aren't you informing me that I am not covered, preferably before the day of surgery?
Did you actually manage to write that out and not understand how messed up and ridiculous that is?
You know what insurance I have even before your pre-op visit. Why aren't you informing me that I am not covered, preferably before the day of surgery?
I actually don't. The only time I do is when you have serious medical conditions that require you to come in and get examined by me in the weeks leading up to the surgery. Otherwise, I only find out when I open your chart on the day of surgery.
But again, this is rarely a problem, as I accept most insurance companies. It is only a problem with a few outliers.
Last edited by AnesthesiaMD; 04-21-2015 at 01:54 PM..
"I'm sure you don't get paid 3-6 months after the fact, and in some cases, for less than you bill, but that is another story. "
Actually, I've had that happen, as well as have customers skip or go bankrupt. One of them almost put me out of business from the loss. But as you say, that is a different story.
"The bill you get from the hospital can be misleading. It may list the surgeon, the anesthesiologist, the pathologist, the radiologist, etc, but 9 times out of 10, each doctor billed separately and the hospital is itemizing the separate bills for you so that you can see how much everything costs. "
This is more in line with what the Humana rep explained to me. The hospital gathers all costs and even though the practitioners bill individually, the insurance company sees one provider code.
Your last two paragraphs sound all too familiar, and I agree with you 100% What you DIDN'T add is that when faced with insurances demanding a discount, the RETAIL cash price is often ballooned to unreasonable levels, placing the burden of lost revenue on the backs of those least able to pay.
I submit my own provider number when I bill, as do the other doctors.
Also, the "retail cash price" is not ballooned. It is the actual price. The insurance companies negotiate a discounted rate. Doctors would LOVE to take the out-of-network fee, and the NOT balance bill the patients. It is not legal. The insurance lobby made sure of that. It would be good for the doctors, and good for the patients, but bad for the insurance companies. They know if the patient's are unhappy with the out of network costs, fewer patients will use out of network doctors.
I actually don't. The only time I do is when you have serious medical conditions that require you to come in and get examined by me in the weeks leading up to the surgery. Otherwise, I only find out when I open your chart on the day of surgery.
Someone in your office does. Every doctor I have ever seen (rather, their staff) asks for my insurance card. Without exception. So does the hospital.
Someone in your office does. Every doctor I have ever seen (rather, their staff) asks for my insurance card. Without exception. So does the hospital.
Nobody in my office does. The hospital surely does, but in most cases the anesthesiologists office is a completely separate entity. For all intents and purposes, we are independent contractors, just like the surgeons, obgyns, etc. Most groups cover several hospitals with a centrally located office in a medical building or office complex. In my case we cover 9 hospitals and a handful of surgery centers.
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