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Old 03-13-2005, 09:06 PM   #35 (permalink)
sob
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Quote:
Originally Posted by flstf
I do have insurance because you can't afford to go without it and risk loosing everything. However it has a high deductible so I am very interested in shopping for resonable medical costs. I am finding this is almost impossible to do with the way the system is set up today. I have asked many friends and family members and have yet to find anyone who compared pricing for doctor services. Maybe the medical field is just too complicated to function competitively in our capitalist system.
Almost everyone with medical insurance these days (at least around here) is part of a "preferred provider network" to some degree. That means that the doctor has agreed to limit his fees to what the insurance company says, in return for large numbers of patients who have this insurance.

Especially in places like Detroit (high percentage of people with a specific insurance), this puts the doctors at the mercy of the insurance companies.

Additionally, doctors can now be REQUIRED to see both patients on indigent care plans and Medicare. Indigent care plans often don't even pretend their fees are realistic (True example: paying $180 for a service that costs $250 to provide). Sometimes they make up a bullshit reason not to pay. Other times, state regulations dictate that if the program is out of money, all claims must be written off by the doctor.

For Medicare, the government's favorite trick is to cut payment for the most common procedures. It's happening right now with cataract surgery. Something that costs six or seven hundred dollars in overhead to provide is reimbursed at $400. Not to mention the risk of being sued that the doctor undertakes.

We are also looking at consecutive years of decreased payments to physicians. When they get paid less, and their suppliers, insurance companies, and staff are demanding more money, doctors retire or move. I see it all the time.

Believe me, I could post a LOT more on this subject.

P.S. One phone call to your insurance company should result in your being told the UCR (usual, customary, and reasonable) charge for whatever procedure you're contemplating. Of course, the insurance companies try to keep these fees two or three years behind the times.
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