Quote:
Originally Posted by Wolferz
Now, the medical pros still get their exorbitant cash flow and we foot the bill for 20% of the costs (until the deductible is reached) (which rarely happens) plus paying premiums to the insurance companies to boot. Even Medicare collects a premium from the sick, lame and lazy retirees and the disabled.  |
While I'm sure there some medical pros who are raking in big bucks, the reality I see for the average physician or group of docs in private practice who actually treat illnesses (as opposed to providing elective, cosmetic, or otherwise non-covered services for which their patients pay 100% up front) is that the only thing they rake in is what the insurance companies decide they're allowed to receive and collect. In our practice, that's usually only 50-60% of what we actually charge for our services. In the case of Medicare and most Medicaid plans, it's more like 20-25% of what we charge. What it costs us to provide those services and keep our doors open goes up with every passing year, but most insurance plans are paying us the same or LESS than what they did when I started this job 20+ years ago, and Medicare is the worst offender in that category.
Unfortunately, if providers don't agree to accept that, the insurance companies and government payers exclude them from their networks of "participating" doctors and they risk losing the majority of their patients, who understandably don't want to pay even more out of pocket to see a non-participating doc when another practice down the street has a contract with their plan that may reduce their OOP expenses. Doctors and small groups of docs in private practice simply do not have the bargaining power to negotiate anything with these big insurers - they have us all over a barrel and they know it.
Reimbursement here is so bad in some specialties that docs in those specialties either change specialties completely, retire early, move away, or never set up shop here in the first place... which results in people not being able to get the care they want and need even if their insurance WILL cover it, because there simply aren't enough docs to go around. Want to see a dermatologist in Greater Cinci? Be prepared to wait a while, and in the meantime just keep praying that mole on your arm isn't a melanoma.
After working on the provider of service side of this sad arrangement for over 20 years, what I see is this: every year the insurance companies collect higher and higher premiums, while paying out less in benefits due to higher dectuctibles and copays and increased authorization requirements and preferred formularies and other restrictions on coverage. They are collecting more and paying out less, and their members pay a bigger portion of what is covered out of their own pockets in addition to the higher premiums, while the overall reimbursement to the docs remains the same or actually goes down.
You don't need a PhD in math to figure out who is profiting from this arrangement, lol. Somebody is raking it in, and it most definitely ain't us.
And don't even get me started on the fact that with higher deductibles and copays, we are left getting less and less of what little we're allowed to collect from the insurance companies, and have to try and collect it from the patients, many of whom simply cannot do anything but make small monthly payments for a year or more, after which time we have usually spent so much on billing and collection expenses that any profit we might have seen from providing them with care is long gone. It ends up costing US money to have treated them in the first place.
Other patients could pay, but would rather save their precious HSA funds for providers who are not as lenient about it as we are.
And then you have a good portion who have no intention of paying, and never did. This last category costs us tens of thousands of dollars a year in accounts that are simply written off the books - and that's AFTER we've adjusted them down to what the insurance says we're allowed to collect, so double or triple that and it's a good estimate of just how much we are losing by not being the kind of practice that turns people away if they don't have cash up front for everything.