My gynecologist of many years did that recently. I don’t have a problem with it. He bills my insurance company as a courtesy and applies any payments to my account, but I’m responsible. The other day he avoided doing a test to save me money, because he felt it wasn’t necessary. Would he have done it if Blue Cross was paying? Not sure…

I totally agree with these article. As I was begining my practice as a doctor here in the Philippines I have worked with a HMO which pays me by the hour to see patients. I also get paid for procedures that I do on the patient. But to be honest I get paid for services after a month and payment is only aorund 30-40% of what I would charge if I did the procedures in my own clinic. A lot of doctors here have gone none par which is much better thing to do since doctors who do co-pay are given the silent disaffiliation treatment. silent disaffiliation means that doctors who charge extra are not referred any patients but are still considered as affiliates of the HMO. I agree that doctors are really bad business people primarily because we were not trained to be business people. I dont mind seeing 100 people a day but if 20-25 of them were paying and the rest were either “gratis” or insurance were would that leave me. I would most likely just be breakeven at the end of the month.
In order to make insurance pay more i think that the various medical societies should work as a team in demanding fair and adequate payment. This is currently being done in the Philippines when the Society of neurologist requested all fellows not to accept referrrals from HMO’s until a reasonable agreement regarding payments can be achieved. Sanctions of course were given to fellows who did not follow the societies request. At present both the society and the HMO are sitting down and discussing agreeable payment schemes for both parties. Most of the neurologist now are making good money (i guess) since most of their patient are paying patients and they get the payments on time.

In Delaware County, PA where I was an intern, the insurance companies were ruthless in trying to play one doctor against another to cut reimbursements. The hardest hit were surgical specialties, like orthopedics. They would tell Doctor A that Doctor B down the street was willing to accept less for a procedure, and demand they lower their rates as well. Then they would go to Doctor C and say that Doctor A and B just approved a cut in their reimbursement, therefore Doctor C could either accept the new rate, or be kicked out of the plan.

To fight back, all the orthopedic surgeons in the county joined together as one huge “group practice” with multiple satellites (i.e. their individual offices) Now if any patient in the county needed a procedure done, it had to be done by that group, since they were the only game in town. The insurance companies suddenly realized how much leverage the large group had, and magically reimbursement for procedures went back up again. It’s sad that this is what physicians have to do just to make a living. I can’t really blame my colleagues for going non-par when this is the kind of treatment they get for being a provider.

While I agree providers are going non par because of low reimbursements, I do not agree this is best for the patient. I’m on the fence because I work for an insurance company. Insurance companies are mostly large corporations that are for profit. Besides employee salary, the highest cost that impacts what a provider is paid and what a patient is charged for a plan is fraud and regulatory compliance. This is fraud committed by patients and providers. These are regulations that protect patient and provider rights. It almost seems like a circular argument. Patients don’t have enough money to pay for insurance and providers are not paid enough from the insurance company. Government intervention won’t help. It would be like going to the DMV for treatment. While I cannot offer any words of wisdom, I can say that every provider that calls me for assistance especially related to claim payment problems gets my 5 star treatment and help.

Some… only see patients who… can pay the difference of what insurance does not cover. For example, if their surgery costs $4,000 and the insurance can only pay $2,000, the doctor asks that the patient pay the $2,000 difference.

I’m not quite sure how they get away with this. Every provider agreement I’ve ever seen requires that the provider accept the insurance payment plus co-pay or co-insurance as payment in full. And they were expressly prohibited from billing the pt. for the “contractual discount”, which is the difference between the billed amount and what the insurance actually pays (plus pt responsiblity/co-pay/co-insurance).

Patients need to be very careful to read their “Explanation of Benefits” or EOB for every claim and compare the “pt responsibility” with any billing statement they may receive. You should also keep it for at least a year (I recommend 3 yrs), as dr’s offices have been known to bill pt’s a year or more later with the excuse that they did an audit and found that you had an amt due that had been “overlooked.” Yeah, right….. If you have your EOB you can prove that they got paid appropriately.

I know that providers are getting paid less and less, but if docs keep pulling out of insurance contracts, then a lot pf pts will have no alternative than to go to ER with things that they can’t find treatment for any other way. That would be bad…