Want governemnt health care? Ask a veteran that has to go to the VA. Walter Reed anyone? Let's look at the wonderful job government has done with publix schools.

Forget it.

 

I understand what you are saying but for the record, Walter Reed is not the VA - they should not be confused with one another or lumped into the same pot.

 

Since we are talking about insurance and heathcare I'll give some insight into how things happen between the provider and insurance. Let me say we are in an ugly cycle.
At first to cut healthcare costs insurance companies sat down with medical councils and determined a guideline to follow for bills and values for services rendered. MRI $475, EKG $250, office visit $125 etc.. Once a fee schedule is determined and agreed to the medical providers are now paid a certain amount for all medical services. Where is the profit in that right?
So medical providers started developing and adding new bill codes or as we say upcode the bills for "extra" services so as to hopefully get the full value of the procedure origionally billed. They would add code to minor services like Dr prep time or chart adjustments, handling fees etc. This would increase the bills overall value and some insurance companies wouldn't catch the erronious codes and just reduce the bill to acceped fee schedules fer services rendered but now on more codes, thus giving the medical provider more money. It wasn't even their goal to have this "work" everytime but if it did 1-5% they could make a nice profit.
This then led to things like utilization review. Now the insurance company can go back and look at what was done and then use our own Dr's to second guess the treating physician to determine if that procedure was ever needed in the first place. If not they will get very low if any payment. Think about that, your Dr. directs you to have an MRI for a sore back and then you return for an office visit where he gives you an epidural injection. After the bills are sent in they go to peer review and another Dr. looks over the diagnosis and he finds that the treating Dr. shouldn't have set up an costly injection based on the MRI findings, maybe physical therapy was a better choice. The insurance co. then denies the charges to the injection and then the fight begins. Now an injection is paid at fee schedule for about $700 each. The medical providers sometimes charge up to $3000. They will take $700 but if the insurance co. denies the bill they turn around to the patient and demand $3000 not the $700 they should be paid for if authorized. If that doesn't work they will try to deal the bill for less or sell it to an collections agency for pennies on the dollar. They might get paid $150 from the collections agency and then let them try to fight with the insurance co. to get their money back and a profit if possible.

So when people talk about medical costs being out of control whats really happening is there are lots or new drugs, methods of treatment or medical devices. And it costs lots of money to develop the medication or diagnostic testing machine or surgical technique. And once its done Dr. wants to use that med or device because their is a need and if it works could save money in the long run. So insurance co's cut corners where they can but usually its not possible. For a drug developed today there may not be a genaric version for 8 more years and by then something better will come along and the game starts all over.

 

Part of that is because insurance limits what a physician can charge for a service to their customers. Self pay rates are typically higher than the numbers that are 'negotiated' with the insurance companies (ie what the insurance company tells the doc they will pay for each service).

 

Yea its all part of keeping to costs down on standard procedures. And not all Dr's offices agree to take fee schedule. But if they want to stay in business its worth negotiating fees with the insurance companies. If not the costs would spiral out of control. Some may say they already have.

 

They may indeed. The faculty I am working with does not take insurance. Instead you pay him and then he gives you a receipt which you can turn into your insurance for a reimbursement (which is probably in the neighborhood of 60%). But it does save about $30,000 a year on his part in overhead

 

And this is another issue. Many of the good physicians have had it with the billing and insurance game and have done things like your office. So that leaves the lesser experienced M.D's or clinics that are in need of patients to take the insurance prices. This in turn usually means they schedule more apt's in order to turn a profit and it leaves the patients with 5 minutes of Dr. time. That leads to a higher percentage of misdiagnosis that could cost more overall and I'm not even talking about the potential health risks associated with that. Lots of issues in the healthcare world.

So I see your in UTMB. Which program?

 

I am a 3rd year med student.

 

Good for you! Your almost ready for residency, then the fun begins or so I hear. I'm looking to start Med school next year. I got a few Bio and Chem lab classes left.