Posted on 09/22/2014 12:10:28 PM PDT by Lorianne
But in an emergency, of course, they can involve who/what they see fit.
"I think this is a bogus article. I am a physician and know of NO procedure that cost that much NONE ,ZIPPA ,NOT””” The article is misleading PERIOD."
Well . . . I've spent a long career in healthcare and can tell you that this does happen. It is fairly infrequent to happen at this extreme level, but it does happen. There is a relatively small subset of physicians who cover Emergency/Trauma services who have built a business model around this approach. They provide services to a smaller number of patients, in general, because they do not have insurance contracts and can only see patients who come in for emergent or traumatic injuries. The patient has no choice. Those physicians bill out at rates that I have seen be as high as 800% or 900% of Medicare rates (obviously higher from the article). Key specialties that sometimes do this: Neurosurgery (trauma neurosurgeons), Trauma orthopedists, and hand surgeons who only treat emergency room patients.
For Medicare and Medicaid patients, they only get paid the government fee schedule. But, for commercial insurance, they can often collect their billed charges. If the insurer pays something less than full billed charges, the provider will send a bill to the patient for the balance. It is up to the billing physician to decide how hard he wants to pursue the balance in collection. Some just send the bill and don't follow up; others get more aggressive and submit the paper to collection agencies.
It is only a matter of time before this practice is ended ...
There are those who abuse it, for sure. However, the other side of the coin is that providers need to maintain some leverage to negotiate fair/reasonable rates with insurance companies, and some state's attempts to deal with the problem of abuse end up making it impossible for fair-minded physicians to still have any negotiating power against large health insurance companies.
As a side note, this issue goes way back; it is not related to the Affordable Care Act, aka ObamaCare.
One final note: I have also seen the above specialists further abuse the system by having a partner participate as an Assistant Surgeon and bill/collect something like 60% of what the primary surgeon billed/collected. Just looks like an extreme/egregious example of what can sometimes be a very real problem, especially when the physician(s) aggressively balance-bills the patient. I am aware of surgical cases in which the primary neurosurgeon and his assistant neurosurgeon have collected (in total) well over $200k for a surgery. Gulp!
oh i hear you, i have been in healthcare sense 1974, seen all kinds of stuff both good and bad, the good by far out weights the bad
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