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Patients Pay Before Seeing Doctor as Deductibles Spread

A lot of doctors already require payment at the time of service and have been doing so for awhile. An ER likely will not turn you away even if they do hound you throughout your visit. They are pretty pathetic about it. That said, you cannot repossess a service and medical bills are unsecured debt. I used to do collections work when I first started out. I mostly did consumer finance loans but also did some work for some doctors/dentists. The Hospital and I got to share a special assigned time on the docket every other week because the two of us would be there for a couple hours together every time just churning out stacks of judgments. I very seldom will work for someone without payment in advance unless they are known and reliable or are a business or government entity. Despite the stereotype otherwise, rich people are just as bad if not worse than poor people about not paying their bills.
 
Summerwind said:
Except for Medicare/Medicaid refusing to pay over a certain amount for procedures. Please don't just talk out of your ass, tell me where medical price regulations through the gov't exist. I await.
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Actually, I have Tricare Prime insurance, through the military. My husband is retired 20 years, a disabled vet, and we have good insurance. Thing is, though, some doctors won't accept Tricare prime. Reason being - Tricare cuts a swath across the country and finds out that the average doctor room visit is, say - $100. That's average. So Tricare tells any doctor that wants to accept their insurance that they will not pay more than 15% of that average amount. The doctor can accept the amount (no more than $115) or they can refuse to take Tricare patients. That's why Tricare patients cannot be charged significantly more than Tricare is willing to pay. The doctor can't say, "I charge $200 per office visit, and Tricare is only paying $115, so you have to pay the rest." Doesn't work that way with Tricare.

Now I don't know a lot about insurance, granted. I'm pretty healthy, and always just took the insurance my company was offering until I married my husband and went on Tricare. Maybe all insurance companies act this way - I don't know. I just know how Tricare works.
 
Superfly said:
Actually, I have Tricare Prime insurance, through the military. My husband is retired 20 years, a disabled vet, and we have good insurance. Thing is, though, some doctors won't accept Tricare prime. Reason being - Tricare cuts a swath across the country and finds out that the average doctor room visit is, say - $100. That's average. So Tricare tells any doctor that wants to accept their insurance that they will not pay more than 15% of that average amount. The doctor can accept the amount (no more than $115) or they can refuse to take Tricare patients. That's why Tricare patients cannot be charged significantly more than Tricare is willing to pay. The doctor can't say, "I charge $200 per office visit, and Tricare is only paying $115, so you have to pay the rest." Doesn't work that way with Tricare.

Now I don't know a lot about insurance, granted. I'm pretty healthy, and always just took the insurance my company was offering until I married my husband and went on Tricare. Maybe all insurance companies act this way - I don't know. I just know how Tricare works.
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Yes, you're correct. Medicare, medicaid, and VA or military insurance all keep prices down. So that's supports the idea that free market doesn't, gov't does keep costs down. If every one is under the same restrictions on pricing, pricing would have to come down. So by opening up markets as they have done wherein costs are more controlled, we get closer to "all" and put the choices of physicians back in the hands of consumers. Between now and then, some physicians will be greedy. Sooner or later, they'll just not have enough high paying patients to go around and will have to accept in order to stay open.

Don't know if that will pan out, but that's the idea, as I understand it.
 
Superfly said:
Actually, I have Tricare Prime insurance, through the military. My husband is retired 20 years, a disabled vet, and we have good insurance. Thing is, though, some doctors won't accept Tricare prime. Reason being - Tricare cuts a swath across the country and finds out that the average doctor room visit is, say - $100. That's average. So Tricare tells any doctor that wants to accept their insurance that they will not pay more than 15% of that average amount. The doctor can accept the amount (no more than $115) or they can refuse to take Tricare patients. That's why Tricare patients cannot be charged significantly more than Tricare is willing to pay. The doctor can't say, "I charge $200 per office visit, and Tricare is only paying $115, so you have to pay the rest." Doesn't work that way with Tricare.

Now I don't know a lot about insurance, granted. I'm pretty healthy, and always just took the insurance my company was offering until I married my husband and went on Tricare. Maybe all insurance companies act this way - I don't know. I just know how Tricare works.
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No, most insurance companies don't work like Tricare. Tricare acts very similarly to Medicare, right down to that 115%

For every patient that the hospital/doctor's accepts from Tricare/Medicare, the doctors have to charge other insurance companies more to pick up the slack. For example someone who's 50, on disability and has medicare will pay a $147 deductible. Someone not on medicare will pay a 5k deductible.
 
reinoe said:
No, most insurance companies don't work like Tricare. Tricare acts very similarly to Medicare, right down to that 115%

For every patient that the hospital/doctor's accepts from Tricare/Medicare, the doctors have to charge other insurance companies more to pick up the slack. For example someone who's 50, on disability and has medicare will pay a $147 deductible. Someone not on medicare will pay a 5k deductible.
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That's the greedy ass doctor's fault. If he can take one patient for $115, he can take 20 patients at $115.
 
Summerwind said:
Yes, you're correct. Medicare, medicaid, and VA or military insurance all keep prices down. So that's supports the idea that free market doesn't, gov't does keep costs down. If every one is under the same restrictions on pricing, pricing would have to come down. So by opening up markets as they have done wherein costs are more controlled, we get closer to "all" and put the choices of physicians back in the hands of consumers. Between now and then, some physicians will be greedy. Sooner or later, they'll just not have enough high paying patients to go around and will have to accept in order to stay open.

Don't know if that will pan out, but that's the idea, as I understand it.
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The story goes that prior to Medicare, doctors drove Buicks. After Medicare, doctors drove Mercedes.
 
Superfly said:
That's the greedy ass doctor's fault. If he can take one patient for $115, he can take 20 patients at $115.
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Well it's a tough position. It would be nice if health costs were cheaper, but if doctors have razor thin margins then you'll see an exodus from the field. A delicate balancing act and I don't fault the doctors who simply refuse to take medicare patients. I know they have 12+years of education plus loans that have to be paid off. I wouldn't call them greedy.
 
Gimmesometruth said:
The story goes that prior to Medicare, doctors drove Buicks. After Medicare, doctors drove Mercedes.
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Well more people at less price. Seems there's lots of companies that think this is a good idea, why wouldn't it be for doctors. Of course, some will fight it, but hopefully........
 
reinoe said:
Well it's a tough position. It would be nice if health costs were cheaper, but if doctors have razor thin margins then you'll see an exodus from the field. A delicate balancing act and I don't fault the doctors who simply refuse to take medicare patients. I know they have 12+years of education plus loans that have to be paid off. I wouldn't call them greedy.
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Yeah, right... like they're all just one step away from razor thin margins. Hype much?
 
Summerwind said:
Yeah, right... like they're all just one step away from razor thin margins. Hype much?
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A doctor who accepts medicare assignment and by Superfly's implications, charges all patients at the medicare rates is operating at razor thin margins.
 
reinoe said:
A doctor who accepts medicare assignment and by Superfly's implications, charges all patients at the medicare rates is operating at razor thin margins.
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Pfft.
 
Gimmesometruth said:
The story goes that prior to Medicare, doctors drove Buicks. After Medicare, doctors drove Mercedes.
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Doesn't surprise me. Not enough oversight, and too easy to bilk agencies like Medicare and Medicaid. There's honestly not enough oversight in the medical industry at all. I'm sorry, but do people really think it costs $800 for an aspirin? That is ridiculous. Reasons like that are why we are having to go to a universal health care system. Because the bastards have priced medical care out of the common person's hands. It's priced out of middle class hands, so of course it's going to be priced out of lower class.

You shouldn't have to be worried about losing your house just to have your appendix taken out.
 
reinoe said:
A doctor who accepts medicare assignment and by Superfly's implications, charges all patients at the medicare rates is operating at razor thin margins.
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I don't buy it. Sorry. Let's use this as an example. My primary doctor sees a patient every 15 minutes, for 8 hours a day. That's 32 patients a day. If she only saw Medicaid/Medicare/Tricare patients, at $115 a visit, she'd make $3,680 a day, or $110,400 a month, or $1.2 million a year. That's just for Medicaid/Medicare/Tricare. I'm certain she charges tiered rates for different insurances, cash pays, etc. Now I don't know what her office visit is, but my doctor before her charged $220 a visit in a tiny little hick town. I live in a coastal community where everything costs more, so who knows what she charges. But let's use my original amount. That's over a million dollars a year. Depending on what state you live in, your average medical malpractice rates are going to run you anywhere from $10,000 to $50,000 a year (unless you live in a really high cost state). She's still going to clear over $1.1 million a year. That's hardly a razor thin margin.
 
Superfly said:
I don't buy it. Sorry. Let's use this as an example. My primary doctor sees a patient every 15 minutes, for 8 hours a day. That's 32 patients a day. If she only saw Medicaid/Medicare/Tricare patients, at $115 a visit, she'd make $3,680 a day, or $110,400 a month, or $1.2 million a year. That's just for Medicaid/Medicare/Tricare. I'm certain she charges tiered rates for different insurances, cash pays, etc. Now I don't know what her office visit is, but my doctor before her charged $220 a visit in a tiny little hick town. I live in a coastal community where everything costs more, so who knows what she charges. But let's use my original amount. That's over a million dollars a year. Depending on what state you live in, your average medical malpractice rates are going to run you anywhere from $10,000 to $50,000 a year (unless you live in a really high cost state). She's still going to clear over $1.1 million a year. That's hardly a razor thin margin.
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I think you're wrong there. I'm looking at one of my mom's Medicare Summaries. Her last visit with her primary care doctor? The doctor billed Medicare $129.00. This for a standard, established patient office visit. Medicare adjusted that amount down to $53.96 and paid $42.31. (Her supplement will pick up the difference of $11 and change.)
 
MaggieD said:
I think you're wrong there. I'm looking at one of my mom's Medicare Summaries. Her last visit with her primary care doctor? The doctor billed Medicare $129.00. This for a standard, established patient office visit. Medicare adjusted that amount down to $53.96 and paid $42.31. (Her supplement will pick up the difference of $11 and change.)
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Well that's still a lot of money, though. That's basically half the cost of the doctor bill that I talked about so that's still $600,000 a year. That's if they only charge $54 a visit, and that's not a lot. Like I said, my old family doctor in Alabama charged $220 a visit, but I don't know if that's regular insurance, cash price or government price.
 
Superfly said:
Doesn't surprise me. Not enough oversight, and too easy to bilk agencies like Medicare and Medicaid. There's honestly not enough oversight in the medical industry at all. I'm sorry, but do people really think it costs $800 for an aspirin? That is ridiculous. Reasons like that are why we are having to go to a universal health care system. Because the bastards have priced medical care out of the common person's hands. It's priced out of middle class hands, so of course it's going to be priced out of lower class.

You shouldn't have to be worried about losing your house just to have your appendix taken out.
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Um, you are conflating what hospitals charge with what doctors charge. The point of my comment was to emphasize that doctors complaints about not being paid enough when accepting Medicare/Medicaid payments is historically unfounded.
 
Summerwind said:
He didn't say there were plans to change, he said his mom was forced to change. That statement is impossible to have anything to do with ACA. It's more drama hype from drama queens. Just pointing it out.
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It's pretty funny isn't it? This whole thread is about blaming every fault of our entire HC system on Obamacare and it hasn't even taken effect yet.
 
Superfly said:
Well that's still a lot of money, though. That's basically half the cost of the doctor bill that I talked about so that's still $600,000 a year. That's if they only charge $54 a visit, and that's not a lot. Like I said, my old family doctor in Alabama charged $220 a visit, but I don't know if that's regular insurance, cash price or government price.
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That could be what he billed to the insurance company. The way the game works is this: If the visit actually cost $54, then you bill four times what you expect to get, and then settle for a 25% payment. If you only bill $54, expecting to get the whole thing, then you'll only get $13 and change and go out of business. That's why health care providers need people who specialize in prying money out of the government and insurance companies.
 
Gimmesometruth said:
Um, you are conflating what hospitals charge with what doctors charge. The point of my comment was to emphasize that doctors complaints about not being paid enough when accepting Medicare/Medicaid payments is historically unfounded.
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I am agreeing with you. They make a lot of money off of Medicare/Medicaid. I just mentioned the $800 aspirin because the whole process is messed up. That's why the ACA was even needed. The whole system is broken.
 
Superfly said:
I don't buy it. Sorry. Let's use this as an example. My primary doctor sees a patient every 15 minutes, for 8 hours a day. That's 32 patients a day. If she only saw Medicaid/Medicare/Tricare patients, at $115 a visit, she'd make $3,680 a day, or $110,400 a month, or $1.2 million a year. That's just for Medicaid/Medicare/Tricare. I'm certain she charges tiered rates for different insurances, cash pays, etc. Now I don't know what her office visit is, but my doctor before her charged $220 a visit in a tiny little hick town. I live in a coastal community where everything costs more, so who knows what she charges. But let's use my original amount. That's over a million dollars a year. Depending on what state you live in, your average medical malpractice rates are going to run you anywhere from $10,000 to $50,000 a year (unless you live in a really high cost state). She's still going to clear over $1.1 million a year. That's hardly a razor thin margin.
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Staff, lease, Equipment. As for the number of patients, I'd cut that in half. It takes longer than 15 minutes a patient, they may have to run minor tests, and for ****s sake they'll need breaks just to get away from bad customers. And again, these doctors have school loans that need to be paid off and some of them may even have families by the time they see their first patient.

I don't know why you're doing your best to justify this fabulous wealthy doctor meme. That may have been a real thing in the 80's before medicare started cutting payments, but it's not a real thing now. The wealthy healthcare provider that you're looking for is the Pharmacist, not the Physician/General Practitioner.

EDIT: BTW where are you getting this nonsense about $800 aspirin? Are you just making up crap?
 
Dittohead not! said:
That could be what he billed to the insurance company. The way the game works is this: If the visit actually cost $54, then you bill four times what you expect to get, and then settle for a 25% payment. If you only bill $54, expecting to get the whole thing, then you'll only get $13 and change and go out of business. That's why health care providers need people who specialize in prying money out of the government and insurance companies.
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That's not what Maggie said. She said that Medicare billed $129 and settled for $43 and the supplemental picked up the rest. So the doctor didn't get paid $13. They got paid $54. If her doctor sees patients like my doctor does (1 every 15 minutes), than that's still $600,000 year. Ain't nobody going broke making that kind of money.
 
reinoe said:
Staff, lease, Equipment. As for the number of patients, I'd cut that in half. It takes longer than 15 minutes a patient, they may have to run minor tests, and for ****s sake they'll need breaks just to get away from bad customers. And again, these doctors have school loans that need to be paid off and some of them may even have families by the time they see their first patient.

I don't know why you're doing your best to justify this fabulous wealthy doctor meme. That may have been a real thing in the 80's before medicare started cutting payments, but it's not a real thing now. The wealthy healthcare provider that you're looking for is the Pharmacist, not the Physician/General Practitioner.
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GP's on average make @ $180K, which puts that household in the top US quintile. If they own their own practice, they make much more.
 
reinoe said:
Staff, lease, Equipment. As for the number of patients, I'd cut that in half. It takes longer than 15 minutes a patient, they may have to run minor tests, and for ****s sake they'll need breaks just to get away from bad customers. And again, these doctors have school loans that need to be paid off and some of them may even have families by the time they see their first patient.

I don't know why you're doing your best to justify this fabulous wealthy doctor meme. That may have been a real thing in the 80's before medicare started cutting payments, but it's not a real thing now. The wealthy healthcare provider that you're looking for is the Pharmacist, not the Physician/General Practitioner.

EDIT: BTW where are you getting this nonsense about $800 aspirin? Are you just making up crap?
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Excuse me while I don't grab a Kleenex, crying over the poor doctors who are going broke. :lol:

As far as the $800 aspirin, I was stretching a bit, but my uncle did get charged $50 for an aspirin when he went into the hospital. Are you going to justify a $50 aspirin? A $25 aspirin? A $5 aspirin? Medical costs are out of control. That is no surprise. A bottle of aspirin costs like $3 for 50 aspirin.

You live in Nevada - maybe you are justifying the doctors making so much money because they have to in Nevada. Nevada is one of the highest states out there for medical malpractice. Where a place like Minnesota might pay only $4,000 a year for malpractice insurance, Nevada could pay upwards of $200,000.

Why is that?
 
Superfly said:
Excuse me while I don't grab a Kleenex, crying over the poor doctors who are going broke. :lol:

As far as the $800 aspirin, I was stretching a bit, but my uncle did get charged $50 for an aspirin when he went into the hospital. Are you going to justify a $50 aspirin? A $25 aspirin? A $5 aspirin? Medical costs are out of control. That is no surprise. A bottle of aspirin costs like $3 for 50 aspirin.

You live in Nevada - maybe you are justifying the doctors making so much money because they have to in Nevada. Nevada is one of the highest states out there for medical malpractice. Where a place like Minnesota might pay only $4,000 a year for malpractice insurance, Nevada could pay upwards of $200,000.

Why is that?
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Because the trial lawyers in Nevada paid for the privilege. ;)

Thanks, Superfly. I learned something. I was shocked to see your $4,000 estimate for Minnesota; but further investigation shows you're correct. Wow.
 
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