JohnDoe@BadISP.org wrote
>> JohnDoe@BadISP.org wrote
>>> You're probably correct and this is one of the things the recent
>>> health care reform should have corrected but probably didn't. It's
>>> disgraceful and really not understandable why the courts won't
>>> intervene and stop these practices. If you ask for your car to be
>>> repaired and the garage gives you a quote that's the maximum
>>> they can collect. Why should the human/doctor be any different?
>> Essentially because its nowhere near as easy to predict
>> what total services the individual needs with a serious
>> medical problem, like for example when the individual
>> ends up with a very serious infection that costs a hell
>> of a lot to fix. You dont get anything like that with cars.
> Yes you do.
No you dont.
> In your case the infection could have been caused by
> the intervention (e.g. the problem of MRSA) where it's
> analogous to the mechanic, after making repairs to the
> engine, testing your car without putting oil in the engine.
Nope, nothing like. Thats just an incompetant repair, the equivalent
to the doctor leaving as swab or an instrument in the individual etc.
The doctor isnt legally responsible for the MRSA infection.
The mechanic is legally responsible for not putting oil in the engine.
> The engine seizes up and usually the mechanic is liable for the damage he
caused.
They always are.
> Alternatively if he can show it wasn't his fault
Not even possible if he failed to put any oil in the engine after the repair.
> he can escape the cost of the new engine and
> ask the owner what he (the owner) wants to do.
Only if he lies about what happened.
> In any event, if the patient (how I hate that demeaning word)
I hate the even sillier alternatives like customer or client even more.
> is able to make a decision on his own (he's conscious and of sound mind)
> the MD asks him and as part of the asking he tells the patient exactly
> how much it is going to cost. How much will be paid by the insurance,
The doctor cant tell you that with the stupid american system.
> how much by the patient, how much by the malpractice lawsuit.
He cant tell you that either.
> Except for the cost aspect he has to do this anyway under the doctrine of
informed consent.
But its never going to be possible to accurately quantify the risk of
an infection, or the risk that the individual may have a very unusual
physiologogy or an unusual lack of response to medication etc etc etc.
> If the patient is non-compos-mentis, and the surgery is elective,
> the patient should have appointed a person to act on his behalf
> (same informed consent doctrine). All that has to be done is to
> extend that to "How much, buddy."
And its never feasible to cover all possibilitys on that cost question,
particularly with infection or when the doctor discovers that the
individual has some other condition as well that affects the outcome.
> Only for emergency surgery would there be any excuse for
> not providing a quote in advance and the options to decline etc.
All the quote can ever do is provide an estimate of what the bulk of
those proceedures cost, assuming no unusual infection or physiology
or drug response etc etc etc. And so that quote cannot be legally
binding on the doctor in the sense that they arent allowed to charge
any more even if the shit does hit the fan during the proceedure etc.
Hardly anyone would be happy with the doctor just yawning when
the individual gets a serious infection as a result of the surgery and
says that since that wasnt included in the quote, you get to die etc.
>>> The MD should provide a quote in writing after asking the insurance
>>> company. If later on they renege (or so he says) he (the MD) eats it!
>> It cant work like that with major surgery. There is always the
>> possibility of a very serious infection or even once the individual
>> is opened up, the surgeon discovers that the individual has a much
>> more complicated physiology than was expected or even an early
>> cancer etc.
> You keep going on about this serious infection etc,
Because its the most common reason that it isnt feasible
to provide a quote that will never be exceeded.
You dont even get that with a car, there are always some
situations where you are given a quote for an engine repair and
when it turns out that the engine is much worse than it appeared
to be, you get a choice of abandoning repair, and paying for the
work already done, or paying more for a new engine etc.
> but in these cases in elective surgery the patient
> should have made his decisions in advance.
Not even possible to anticipate all that might happen, including
the surgeon having a heart attack while doing the surgery etc.
> In any event I'd settle for a quote for uneventful
> surgery until the MD's are whipped into line.
They cant ever be whipped into line, because its never
going to be possible to anticipate all complications.
>>> BTW that's how it works for my dentist.
>> No it doesnt. If you do develop a serious infection as the
>> result of say a crown, he does not fix that entirely at his cost.
> Huh? On about this serious infection again.
Because that is the most common cause of unexpected costs.
> If you develop some infection as a result of his setting of
> the crown the dentist should> be worried about lawsuits,
Only in the stupid american system. The individual may itself
have been where the MRSA infection came from and it is most
likely that the individual's compromised immune system is the
reason they ended up with an infection. Neither is something
that the dentist is legally responsible for in any viable legal system.
> not the minor cost of antibiotics.
The cost can be a hell of a lot more than minor with an antibiotic resistant
infection.
>>> He says (say) he's got to put
>>> in a crown at [tooth number]; he sends all the paperwork and x-rays
>>> to the insurance company and they approve in advance in writing
>>> telling him how much he has to collect from me (the customer). He
>>> says he's never had a problem with the insurance company not paying
>>> later on and if they didn't he would consider that between him and
>>> them, nothing he could recharge to the customer.
>> But likely did have a problem when a patient got an infection etc.
> Oh, get off the infection kick.
Demand denied. That is the most common cause of unexpected costs.
> Only in abnormal circumstances would the dentist not know this in advance
> (e.g. an abscess) and treat it separately before putting in a crown.
Wrong.
> The insurance would also pay separately.
You havent established that there is any insurance.
> "addressofdaday <nospam@Use-Author-Supplied-
Address.invalid>" wrote:
>>
>> The fact that a doctor will not disclose costs is
sufficient
>> in my opinion to deny him a license to practice medicine.
>> These are people, not Gods, they are not allowed to play
>> under a different set of rules than the rest of us. Not
>> disclosing costs is dishonest, plain and simple.
>
> Well, as someone who has worked in the medical field for 18
years, how
> much it costs truly depends on what insurance the patient
has, assuming
> that the patient wants to know how much it will cost
him/her. And even
> if the insurance company gives you an estimate of the costs
up-front,
> that doesn't mean that even if they approve the surgery
they won't come
> back after the fact when you submit the claim for it and
say, "Sorry,
> we're not paying for that," and there is not a whole bunch
the doc can
> do except appeal the claim denial and see if he can
convince the
> insurance company to pay for it -- which, if they won't,
will mean that
> the patient now will have to pay a lot more to cover what
the insurance
> company reneged on.
>
Ok point taken. However, if a doctor does thousands of the
same procedure, same codes at the same facility and then
CLAIMS he has no idea of the costs, something is very fishy.
Also using the same insurance companies. Look at all these
people that are made poor by hidden medical costs. I have
noticed many physicians are not adverse to padding the bills
to Medicare with very high claims for procedures that pay
alot less when billed under an HMO or private party.
Clean up medicine. Make it more honest. Doctors should take
some leadership in this and that does not mean these jerks
that try to get patients to pay several thousand dollars in
advance and refuse all insurance.
ok wrote:
>
> Ok point taken. However, if a doctor does thousands of the
> same procedure, same codes at the same facility and then
> CLAIMS he has no idea of the costs, something is very fishy.
> Also using the same insurance companies.
They may be the same insurance companies, but insurance companies have
multiple plans, so it's not like everybody with Blue Cross has exactly
the same coverage. Every employer can have different options. As I
said, the doc knows EXACTLY what his cash-pay price is and he quotes
cash-pay prices to patients all the time, but for those with insurance,
he refers them back to their insurance company to get the scoop, because
the insurance company will not tell us.
> Look at all these
> people that are made poor by hidden medical costs. I have
> noticed many physicians are not adverse to padding the bills
> to Medicare with very high claims for procedures that pay
> alot less when billed under an HMO or private party.
That's ridiculous, because Medicare has fixed amounts that they will pay
regardless of what the physician charges -- and many insurance companies
base their payments on a certain percentage of Medicare (typically 90%
of Medicare at our office)
> Clean up medicine. Make it more honest. Doctors should take
> some leadership in this and that does not mean these jerks
> that try to get patients to pay several thousand dollars in
> advance and refuse all insurance.
Unfortunately, the insurance companies are holding all the cards.
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>>> You're probably correct and this is one of the things the recent
>>> health care reform should have corrected but probably didn't. It's
>>> disgraceful and really not understandable why the courts won't
>>> intervene and stop these practices. If you ask for your car to be
>>> repaired and the garage gives you a quote that's the maximum
>>> they can collect. Why should the human/doctor be any different?
>> Essentially because its nowhere near as easy to predict
>> what total services the individual needs with a serious
>> medical problem, like for example when the individual
>> ends up with a very serious infection that costs a hell
>> of a lot to fix. You dont get anything like that with cars.
> Yes you do.