Doctor getting kickbacks? - Page 3

 

JohnDoe@BadISP.org wrote:


The contract with the MD and insurance company is not for coverage; it
is only for payment rates.  The MD is not the customer of the insurance
company, and the insurance company certainly is not the customer of the
doctor.  There have been many times at our office when the insurance
company reneged, and the doctor has absolutely NO recourse because the
insurance company holds all the cards.

I suppose the simplest solution for the doctor would be to say, "I will
not take patients who want me to assign their insurance benefits to me.
  I will only take patients who will pay me directly and then collect
their insurance benefit themselves."  This is how practically every
other business operates.


Well, if you are saying that the doctor should own everything so he can
control costs, then what about the people who don't want to go to a
facility owned by the doctor because they are convinced that he/she will
be getting kickbacks?

I have Kaiser Permanente insurance.  Everybody in Kaiser is an employee,
not an independent contractor.  They control costs well because they
have their hand on everything, and patients generally don't get
surprised by bills that the insurance company sticks them with.  I agree
that this is a very efficient model.  On the other hand, I fear for one
entity owning all the health-care insurance in this country because I
have seen lots of bad situations where a patient's health care was
controlled by one gatekeeper, and I don't want to see that happen.  I
had a friend who suffered from specific medical problem for years
because she had one gatekeeper for her health care who would only
consider one treatment for the problem that was an unacceptable solution
to her and refused to consider other equally-valid and equally-respected
treatments well known to the medical community at large.  So I would
oppose a gatekeeper-type approach to health care.

 


I doubt it.  There are at least three sets of prices:
1.  The amount the doctor bills the insurance company.  This cost is pretty
much irrelevant to the insured.  It could hurt the uninsured a lot.

2.  The contract amount for the procedure.  An in-network doctor can't
charge more than this amount.  This amount gets paid by the insurance
company and the patient, divided somehow.

3.  The amount paid by the patient.  This can be affected by things like
how much deductible he hasn't used yet.

*ALL THREE* of those prices are highly variable depending on your insurance
company.  


I expect government health care to do just this sort of thing,
and I expect that it's already being done in some situations, like
not giving a 93-year-old man a heart transplant.


Would you care to define "health insurance", "medical insurance", and
state the difference between the two?


Some medical services work exactly like that:  for example, flu
shots.  You pay for the flu shot, and they give you a receipt and
YOU file a claim with your insurance company.  I've also seen the
same thing happen with more expensive procedures like a non-routine
root canal requiring a specialist.  These guys *can* give you a (large)
price and stick to it.  You can talk to your insurance company to see
how much they will pay.


Some medical services decidedly do *NOT* work that way.  The doctor
doesn't communicate with the insurance company.


Yes, it would be a tangled mess, with the patient having to pass messages
between the insurance company and the doctor.

 

Gordon Burditt wrote:


visits and procedures.


Its true anyway.


And you forgot the most important one in that particular situation.


4. The amount of cash he will accept for a particular office visit
and proceedure when he has no involvement what so ever with any
insurance company at all, because he is paid in cash by the patient.


company.

And FOUR involves no insurance company whatever as far as the doctor is
concerned.


It doesnt, most obviously when you end up with
a serious infection as a result of the surgery etc
or when its discovered that you have cancer when
they open you up and it makes sense to remove
the cancer when it has been discovered etc.


Yes, when there are no unexpected complications.


That happens with the insurance system too when there
are no suitable donor hearts available and that individual
is well down the queue and gets to die without getting one.

The cost of the medical services that they need before
they end up dead tho cannot be predicted in advance.

No govt operation just decides that an individual is too old to ever
end up with a transplant and so they just yawn and dont provide
any further treatment because the individual will die sometime.


Even those dont work like that if you end up with a bad result from the flu shot.


But that still doesnt cover the situation where you end up with a serious
infection.

 

On 4/18/2010 12:20 AM, Gordon Burditt wrote:

That's a generous age estimate.  Around my area, you won't be considered
for a heart transplant if you're over 65, unless you're somebody famous.

Marsha

 

Gordon Burditt wrote:

But that's not what a cash-pay price is.  A cash-pay price is what the
doctor will charge if he doesn't have to get involved with any insurance
company.  So your response had nothing to do with what you were
responding to.


Sorry -- I meant "why auto insurance is so different than medical
insurance."


That is when the patient has not assigned their insurance benefits to
the doctor.  That is more difficult for the patient to manage, but it
worked for years.


Well, when the patient has assigned their insurance benefits to the
doctor, that is exactly how it works.  If the patient has not assigned
their insurance benefits to the insurance company, then it doesn't.  And
for the record, I have never been to a dentist who has allowed me to
assign my insurance benefits to them.


That's how it all used to work 30 or 40 years ago or so.  So what you
are saying is that the tangled mess needs to be transferred from the
patient to the doctor, I guess.  There is no reason why a patient who
takes their itemized medical bill and presents it to their insurance
company for payment should have to pass messages between the insurance
company and the doctor.