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I am on Medicare and have been for the past 5 years. I don't see my doctors that much. Once to see my GP and twice to a specialist (every 6 months) re an on-going infection (which is very much under control) last year.
Anyway, I get a copy of every bill as well as the amount paid by Medicare. I have to tell you that total (along with the supplemental) pays far, far more to my doctors than you imply. In fact, its much more than 1/2 of what the doctors billed.
Perhaps its their specialty. Maybe its the location.
In any event, my experience (looking at the amount billed vs paid on my last statement) is vastly different than what you post. And if I were to multiply that amount paid by 4 or 5 the results would be beyond preposterous and far above the billed amount. NO insurance company would even remotely pay that multiplied amount. Not ever.
We have an inherently flawed system and ACA has only pulled a blanket over the problems.
WHY is it that if I am uninsured and break my arm it's going to cost me $25K to fix but if I am insured it's <10K ?
WHY is it that if I am uninsured and sick with flu or an infection I go to the doctor and pay 2X the insured rate and my prescriptions are extra and often just as expensive as the doctor visit ?
Sure I can ask for discounts but this requires being pre-informed about my condition as well as calling several physicians which take time and is a huge pain. Most doctors deal with increasing insurance oversight by seeing many more patients - like an assembly line - killing any doctor patient relationship. Doctors push procedures they know will be paid by insurance or compensated by Medicare/caid in order to maximize their revenue. Drug and Equipment companies push commercials 24X7 advocating consumers to ask their doctor for their products. Insurance and Drug companies are making record profits under Obamacare.
I have lived in several countries and they were all superior to the US in basic medical care (probably not in specialty care but I wouldn't know). I can go see a doctor in China, Europe, UAE, Singapore, etc for < $100 for examination + meds. This is not necessarily socialized medicine as often can and do pay out-of-pocket.
We have too many special interests here in the USA trying to protect their turf and profit - Physicians want barriers to entry and high salaries, insurance companies want high profits and ability to minimize their chronic patients, drug companies want high profits.
Who is advocating for affordable care for the consumer ? Personally I think the only way to fix these problems are through increased regulation.
Your experience may reflect the current differences between a specialist surgeon, and a more general medical practice as mine is. Or high cost city vs a cheaper more rural practice setting.
We have 10 docs, overheads about twice yours, and make fine money with Medicare patients.
Ours is a bare bones and low COL area practice so we can easily accommodate most all patients. Medicaid is actually not so much a numbers crunch as a patient hassle factor with the preponderance of drug abuse and such.
The powers that be have in fact been steering improved payments towards us in primary care since around 2012, when my office numbers started looking quite slim.
What is your patient split between commercial and traditional Medicare... Not Medicare advantage as those rates are contracted higher than the traditional Medicare fee schedule.
And yes, each states Medicaid administration and reimbursement is a nightmare.
We have an inherently flawed system and ACA has only pulled a blanket over the problems.
WHY is it that if I am uninsured and break my arm it's going to cost me $25K to fix but if I am insured it's <10K ?
WHY is it that if I am uninsured and sick with flu or an infection I go to the doctor and pay 2X the insured rate and my prescriptions are extra and often just as expensive as the doctor visit ?
Sure I can ask for discounts but this requires being pre-informed about my condition as well as calling several physicians which take time and is a huge pain. Most doctors deal with increasing insurance oversight by seeing many more patients - like an assembly line - killing any doctor patient relationship. Doctors push procedures they know will be paid by insurance or compensated by Medicare/caid in order to maximize their revenue. Drug and Equipment companies push commercials 24X7 advocating consumers to ask their doctor for their products. Insurance and Drug companies are making record profits under Obamacare.
I have lived in several countries and they were all superior to the US in basic medical care (probably not in specialty care but I wouldn't know). I can go see a doctor in China, Europe, UAE, Singapore, etc for < $100 for examination + meds. This is not necessarily socialized medicine as often can and do pay out-of-pocket.
We have too many special interests here in the USA trying to protect their turf and profit - Physicians want barriers to entry and high salaries, insurance companies want high profits and ability to minimize their chronic patients, drug companies want high profits.
Who is advocating for affordable care for the consumer ? Personally I think the only way to fix these problems are through increased regulation.
The 'regulation' is what has over complicated the industry in the first place.
What you are referring to is known as the billed, allowed, and paid amount - copay, co insurance, deductible. Everyone that sees a provider gets what you do as its the law... It's called an 835 transaction it eob to you (explanation of benefits), eor to the provider (explanation of remittance). The 'write-off' is called overhead.
This has also been explained before. Docs contract above the med fee schedule with group insurance to make up the deficit of Medicare and Medicaid.
An office visit, 99201 as an example reimburses like...
Medicare = 50
Medicaid = 35
Group = 70
There is also something called the wage index based off either the msa (med service area) or cbsa (core based service area) determined by rural or metropolitan area. Same thing for institutional (hospitals) that are paid by a 'pps' prospective payment system. Same principle. In short, most providers have to contract at a higher rate than Medicare reimbursements to even be able to operate, or they will be paying their own money to keep their doors open.
And, again, the AMA sets the rvu (relative value unit) of each procedure (overhead, etc...) but... They make their money from cmms. That is what dr participation in that organization is so low (less than 20% last I checked), why practicing physicians and surgeons are not keen on it. Most that work for the AMA are no longer practicing physiciabs. Their income comes from cmms, so it's in their interest, the org, to look out for, not those in practice (that's also why many new techniques will be covered privately but take a few years with Medicare. That's a coding aspect)
A lot of patients think medicine is expensive because the docs charge too much. The reality is that most docs have to take as payment whatever the plan pays. And as I said the big corporations are buying medical practices left and right because they know the docs are TIRED of the INSURANCE bureaucracy and red tape. They rather work for a salary even if they make less money.
The BIG expense has to to with overutilization and the price of medications. A patient may see the doc once a year and still be saddled with $500.00 a month in pricey medication.
It is also well known that private plans generally would want to pay the same fees medicare pays. New techniques are often studied by medicare to see if they will pay for them or not. For example the new brain imaging test for Alzheimer's is not covered because there is no effective TREATMENT for Alzheimer, so why bother with one more test.
And yet, I see no role for private insurance. They do a service that could be done cheaply by a fee rather than billions of dollars in profit every quarter.
How about modifying Tricare to cover the young? Most folks I know that use Tricare have no problems with it.
Last edited by Julian658; 02-06-2016 at 08:59 AM..
Only those that collect. Not if you die before 65 or are part of a pension plan (since Medicare is called payor of last resort... Dual eligibles. Had to correct cmms files all the time with those. Lol)
A lot of patients think medicine is expensive the docs charge too much. The reality is that most docs have to take as payment whatever the plan pays. And as I said the big corporations are buying medical practices left and right because they know the docs are TIRED of the INSURANCE bureaucracy and red tape. They rather work for a salary even if they make less money.
The BIG expense has to to with overutilization and the price of medications. A patient may see the doc once a year and still be saddled with $500.00 a month in pricey medication.
It is also well known that private plans generally would want to pay the same fees medicare pays. New techniques are often studied by medicare to see if they will pay for them or not. For example the new brain imaging test for Alzheimer's is not covered because there is no effective TREATMENT for Alzheimer, so why bother with one more test.
And yet, I see no role for private insurance. They do a service that could be done cheaply by a fee rather than billions of dollars in profit every quarter.
How about modifying Tricare to cover the young? Most folks I know that use Tricare have no problems with it.
Tricare is military only and is administered by those companies you detest.
I am glad you admitted utilization, it's what some have been stressing as the main contributor to overall cost and that is each citizens 'role' in the equation
What is your patient split between commercial and traditional Medicare... Not Medicare advantage as those rates are contracted higher than the traditional Medicare fee schedule.
And yes, each states Medicaid administration and reimbursement is a nightmare.
Maybe 2/3 fee for service. Medicaid for me has been no nightmare. The largest hassle has been dealing with the psyche of the typical patient, at that has started to end for me as of last week.
I am not advocating short life spans... When those numbers were set up, 65 was reasonable. Now, well if it's changed, those +- 15 or so years of me (42) get screwed... But regardless, we all are in a way.
I would like to opt out of ss and FICA, voluntarily give up most to date contributions, and I'll still contribute .5% and not be allowed to collect ss or Medicare if I get to keep the rest of that tax money
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