# Fictionalized medical bills and provider proliferation **URL:** \ **Category:** The BBQ Pit\ **Created:** [June 10, 2013, 4:41pm UTC](https://boards.straightdope.com/t/fictionalized-medical-bills-and-provider-proliferation/660633 "2013-06-10T16:41:50Z")\ **Posts on this page:** 12\ **Page:** 3
**Author:** ![Kelevra](https://avatars.discourse-cdn.com/v4/letter/k/97f17d/32.png) [@Kelevra](https://boards.straightdope.com/u/Kelevra)\ **Post date:** [June 11, 2013, 6:04pm UTC](https://boards.straightdope.com/t/fictionalized-medical-bills-and-provider-proliferation/660633/41 "2013-06-11T18:04:21Z")
Some doctors are [opting out of insurance](http://money.cnn.com/2013/06/11/news/economy/cash-only-doctors/index.html?source=cnn_bin)and going cash only. > [@](#): > > The office has negotiated deals for services outside the office. By cutting out the middleman, Nunamaker said he can get a cholesterol test done for $3, versus the $90 the lab company he works with once billed to insurance carriers. An MRI can be had for $400, compared to a typical billed rate of $2,000 or more. This brings me to a soapbox issue of mine. If all the smart people who want to be rich become doctors then my health care will improve. If they all work for insurance companies all I will get is less medical coverage for more money. So it isn’t in my interest for insurance companies to make any more money than bare survival rates. ---
**Author:** ![Folacin](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/folacin/32/3195_2.png) [@Folacin](https://boards.straightdope.com/u/Folacin)\ **Post date:** [June 11, 2013, 6:27pm UTC](https://boards.straightdope.com/t/fictionalized-medical-bills-and-provider-proliferation/660633/42 "2013-06-11T18:27:47Z")
> [@The Great Sun Jester](#): > > Or you could just charge $80 and balance bill the patient for the portion not covered byinsurance. No? > > Or is it part of your agreement with the insurance companies to not do that? > > And if it is part of your agreement, then once again the good doctors have the power to correct the issue by collectively refusing to accept certain insurance. If no doctor will accept my insurance plan, I as a patient will find another they WILL accept. Unless my insurance is through my employer. At which point I can bitch to HR about there not being any doctors that take the insurance, but the doesn’t have to care about that (although most likely would). ---
**Author:** ![artemis](https://avatars.discourse-cdn.com/v4/letter/a/91b2a8/32.png) [@artemis](https://boards.straightdope.com/u/artemis)\ **Post date:** [June 11, 2013, 6:38pm UTC](https://boards.straightdope.com/t/fictionalized-medical-bills-and-provider-proliferation/660633/43 "2013-06-11T18:38:49Z")
> [@Folacin](#): > > Unless my insurance is through my employer. At which point I can bitch to HR about there not being any doctors that take the insurance, but the doesn’t have to care about that (although most likely would). That’s another big problem: the people buying the insurance aren’t necessarily the ones who will be using the insurance. Most people are at the mercy of their employer, and some employers don’t car much about anything other than the bottom line. ---
**Author:** ![Inigo\_Montoya](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/inigo_montoya/32/124_2.png) [@Inigo\_Montoya](https://boards.straightdope.com/u/Inigo_Montoya)\ **Post date:** [June 11, 2013, 6:49pm UTC](https://boards.straightdope.com/t/fictionalized-medical-bills-and-provider-proliferation/660633/44 "2013-06-11T18:49:32Z")
> [@Folacin](#): > > Unless my insurance is through my employer. Agreed. The tradition of employer-sponsored healthcare adds a whole 'nother layer of complexity to things. ---
**Author:** ![Damuri\_Ajashi](https://avatars.discourse-cdn.com/v4/letter/d/898d66/32.png) [@Damuri\_Ajashi](https://boards.straightdope.com/u/Damuri_Ajashi)\ **Post date:** [June 11, 2013, 8:46pm UTC](https://boards.straightdope.com/t/fictionalized-medical-bills-and-provider-proliferation/660633/45 "2013-06-11T20:46:27Z")
> [@artemis](#): > > Bingo! And it makes for a very frustrating situation for everybody. Unless we go single-payer, though, I don’t see an easy way out, unfortunately. Some form of transparency might help. There would be sites out there doing all the comaprison for you. Hell, someone would probably create an Angie’s list or Zagat’s for doctors and hospitals. > [@psychobunny](#): > > As a physician, here’s the problem. You are not allowed to discuss rates with other physicians (for antitrust reasons?). Every insurance plan pays a different rate. It is almost impossible to figure out what each insurance is paying given different copays and deductible for different versions of different plans (I participate with 13 or 14 insureres but there are hundreds of different plans). The insurance pays you the lesser of their agreed fee or what you charge. Therefore, in order to get full payment you have to make sure that you are charging more than the allowable cost of the best-paying plan. My buddy uses a billing service that takes 10% off the top. After years of dealing with insurance companies, he thinks its a bargain. > [@](#): > > The other alternative is to just charge everybody $150 and hope that this is higher than my best payor. It sounds like you would be in favor of a single payor model as long as single payor doesn’t mean medicare level reimbursements for everyone. > [@minor7flat5](#): > > The hospital attempted to charge our insurance company $45,000 for this overnight stay with 5 minutes of a very special specialist’s time. > > The insurance company allowed about $3,000 (more in line with what I expected) > > We paid a couple of hundred dollars. > > My problem with this is that I don’t see where _anyone_ would pay the $45,000 for such a procedure. If we were uninsured, we would certainly settle for a lower amount. > > I do not see this charge as being in good faith: the hospital is planning on profiting from insurance companies that don’t question bills, people who don’t review their bills closely, and making the poor uninsured person happily pay $10,000 for the procedure, gladly accepting the huge discount over the original 45K. I’d like to hear the hospital’s side of this but this sort of thing seems like fraud. > [@septimus](#): > > The “free market” concept is based on sellers trying to maximize price while buyers try to minimize price. But the American healthcare system doesn’t work that way. Buyers _are insurance companies_ **and want to maximize prices**. Oh sure, they’ll seek to minimize in the short-term but, in the long-term their revenue will be proportional to total costs; the higher the total paid for health care the more total profit for the health insurance industry. > > Despite this, you Americans have _The Best Healthcare In The World_™ and the rest of us are envious. I have the worst of worlds where I live: Socialized medicine for which I, a foreigner, am ineligible. I’ve had to pay $8 for an EKG and $40 for a CAT scan _all totally out of my own pocket_: I don’t have insurance. So you are saying that if medical costs were managable, there would be a much lower demand for insurance. I entirely agree. But your solution to getting managable medical costs seems to be socialized medicine. :smack: > [@Irishman](#): > > Scott Adams calls these kinds of systems “Confusopolies”. Another example is phone service, where none of the plans are the same and none of the features are the same. Anything where you cannot easily do a one to one comparison to tell what the costs are for the same features. It’s not that the companies are in collusion (monopoly) to set prices, they just have such a scramble of options that you cannot make sense of what a fair cost is. Or mattress companies. Mattress companies do everything they can to make it hard to compare apples to apples when you buy a Serta at Macy’s versus a Serta at Mattress Discounters. I recently had a warranty claim on my mattress and they had to replace it and it became very clear that the confusion is intentional. > [@The Great Sun Jester](#): > > I dearly love doctors and the work they do, and I have the deepest respect for their knowledge, but when so many don’t even know what they charge for a service they really deserve a good portion of blame for runaway healthcare costs. During the healthc are debate it started to become clear how we could drastically reduce health care costs without sacrificing health care results. 1. Single payer (or at least a public option) was one important element. 2. Having medical boards create best practices to prevent unnecessary defensive medicine and shielding doctors from medical liability if best practices were followed. 3. Controlling end of life health care costs. We did NONE of these things. ---
**Author:** ![Inigo\_Montoya](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/inigo_montoya/32/124_2.png) [@Inigo\_Montoya](https://boards.straightdope.com/u/Inigo_Montoya)\ **Post date:** [June 11, 2013, 10:00pm UTC](https://boards.straightdope.com/t/fictionalized-medical-bills-and-provider-proliferation/660633/46 "2013-06-11T22:00:28Z")
> [@Damuri\_Ajashi](#): > > Some form of transparency might help. There would be sites out there doing all the comaprison for you. Hell, someone would probably create an Angie’s list or Zagat’s for doctors and hospitals. Something like [this](http://www.cohealthdata.org/#/home)? It’s a work in progress but when finished should provide very telling information indeed. ---
**Author:** ![artemis](https://avatars.discourse-cdn.com/v4/letter/a/91b2a8/32.png) [@artemis](https://boards.straightdope.com/u/artemis)\ **Post date:** [June 11, 2013, 10:14pm UTC](https://boards.straightdope.com/t/fictionalized-medical-bills-and-provider-proliferation/660633/47 "2013-06-11T22:14:44Z")
> [@Damuri\_Ajashi](#): > > Some form of transparency might help. There would be sites out there doing all the comaprison for you. Hell, someone would probably create an Angie’s list or Zagat’s for doctors and hospitals. What metrics are they going to compare, though? The devil’s in the details. Even contractors can’t always give an accurate estimate for what a job’s going to cost until they get started and see what (if any) hidden problems are there; any such list is more likely to be measuring differences in bedside manner than actual quality of the care given to the patient. (Not that bedside manner isn’t important!) > [@](#): > > My buddy uses a billing service that takes 10% off the top. After years of dealing with insurance companies, he thinks its a bargain. Pretty much every physician practice uses a specialized billing service these days: billing’s just too complicated to manage without one (which is telling). ---
**Author:** ![Eva\_Luna](https://avatars.discourse-cdn.com/v4/letter/e/e495f1/32.png) [@Eva\_Luna](https://boards.straightdope.com/u/Eva_Luna)\ **Post date:** [June 11, 2013, 10:22pm UTC](https://boards.straightdope.com/t/fictionalized-medical-bills-and-provider-proliferation/660633/48 "2013-06-11T22:22:12Z")
> [@pbbth](#): > > I called and asked why they never billed our insurance and their response was, “Oh, nevermind that then. We will go ahead and bill your insurance.” Are they incompetent? Are they trying to scam us into paying and then billing our insurance too? I guess we will never know. I’d put my money on incompetent. In 1996 I busted my leg in a really big way, 2 days before insurance kicked in at my new job. I was quite clear about that fact. And yet the hospital billed an insurance company that hadn’t covered me in years, because it was the last insurance info they had on record. Eventually they had to rebill everything (for surgery & 2 weeks total in the hospital) to the right insurance company (by the time I made it back to my home state, etc. my insurance had kicked in - long story). It was a paperwork nightmare. ---
**Author:** ![alphaboi867](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/alphaboi867/32/3898_2.png) [@alphaboi867](https://boards.straightdope.com/u/alphaboi867)\ **Post date:** [June 11, 2013, 11:12pm UTC](https://boards.straightdope.com/t/fictionalized-medical-bills-and-provider-proliferation/660633/49 "2013-06-11T23:12:56Z")
> [@joebuck20](#): > > …But, I’ve found in many cases the doctors themselves won’t even know how much the services cost, let alone how much the patient has to pay out of pocket. I hated that when I had to go to the ER without insurance. Nobody had the slightest clue what anything would cost. All asking got me was a WTF look, and patronizing assurance that I could get everything taken care of later with a social worker. ---
**Author:** ![psychobunny](https://avatars.discourse-cdn.com/v4/letter/p/54ee81/32.png) [@psychobunny](https://boards.straightdope.com/u/psychobunny)\ **Post date:** [June 12, 2013, 6:49pm UTC](https://boards.straightdope.com/t/fictionalized-medical-bills-and-provider-proliferation/660633/50 "2013-06-12T18:49:23Z")
You can’t balance bill-that’s part of your agreement. In fact, for Medicare it’s fraud. Sure you can refuse to take Medicare. Let me show you how that works with another example. Let’s make it easy-let’s say the doctor wants to charge $120 for a visit but Medicare allows $100. -Doctor #1 participates with Medicare. He gets 80% or $80 from Medicare and 20% copay or $20 from the patient for $100 total. -Doctor #2 is non-participating with Medicare meaning he bills the patients who then collect from Medicare. By law, he can only bill 110% of Medicare so he bills $110. Medicare pays about 65% or roughly $70 and he can bill the patient the remaining $40 for a total of $110. -Doctor #3 wants to opt out of Medicare entirely. He must sign a 2 year contract that restricts him from taking any Medicare money from any patient for 2 years total. He can bill the patient a full $120 but the patient cannot then collect any money from Medicare and is responsible for the entire bill. If you practice in a wealthy area where people have money to throw around you can opt out of Medicare but if you have to do any procedures or admit the patient they will be responsible for the full bill which can be thousands of dollars so most will not do it. So, let’s say Doctor #1 or Doctor #2 wants to bill the patient for the rest of the fee. As noted above, this is Medicare fraud and is charged at triple damages plus $10,000 per incident (not per patient, per incident which means per charge. So, how does the government keep tabs on this? They have hired independent contractors to review billing for fraud and pay them 30% of all money collected. Oh, and don’t forget that underbilling is also Medicare fraud. If you only bill $75 for that visit that Medicare says should cost $100 or if you waive the copay, you can still be charged the $10,000 per incident and remember, these companies are paid at a percentage of what the government collects. (And yes, I am in favor of single-payor, even at Medicare rates. Even with all of the above I see rampant Medicare fraud, particularly in the DME industry). Also, remember that there really is no free market[cite](http://www.benefitspro.com/2012/12/11/top-10-states-with-the-least-competitive-health-in). In many states one dominant insurer has most of the market. Also most people cannot afford insurance outside of their work which may offer little to no choice of plans. ---
**Author:** ![psychobunny](https://avatars.discourse-cdn.com/v4/letter/p/54ee81/32.png) [@psychobunny](https://boards.straightdope.com/u/psychobunny)\ **Post date:** [June 12, 2013, 7:02pm UTC](https://boards.straightdope.com/t/fictionalized-medical-bills-and-provider-proliferation/660633/51 "2013-06-12T19:02:11Z")
One last thing-I can’t remember the term from Economics but medical care is not the kind of good that operates on a strict demand and supply curve. People assume that the mst inexpensive care is the worst care so if two providers charge different amounts, they will often choose the more expensive one since they assume that somebody who charges more must be better. This also encourages providers to jack up fees since it can lead to increased patients. ---
**Author:** ![Carepilot](https://avatars.discourse-cdn.com/v4/letter/c/76d3ee/32.png) [@Carepilot](https://boards.straightdope.com/u/Carepilot)\ **Post date:** [July 22, 2013, 5:17pm UTC](https://boards.straightdope.com/t/fictionalized-medical-bills-and-provider-proliferation/660633/52 "2013-07-22T17:17:47Z")
When you break it down like this, yes its clear indeed that there’s ample room for reform in the industry. That’s why its great this debate is now happening and shifts are being made…in the right direction. It won’t be fixed over night, but we’re inching closer day by day. [Previous page](https://boards.straightdope.com/t/fictionalized-medical-bills-and-provider-proliferation/660633.md?page=2)