New York State is challenging the practice of reimbursement by insurers based on “usual and customary” fees. (Via WSJ) The probe, led by attorney general Andrew Cuomo, targets United Healthcare.
The move takes aim at a common practice among health insurers that can result in higher medical-bill payments for many consumers. While insurers typically pay in-network hospitals and physicians a negotiated fee for medical claims, out-of-network providers are reimbursed “usual and customary” or “reasonable” charges. These charges are set according to what insurers have determined is the going rate for a given procedure or service in a specific area.
In their defense, here’s what United said –
“It’s unfortunate that today’s media event ignored these facts and failed to address the appropriateness of charging out-of-network patients $200 for ‘simple doctor visits’ lasting ’15 minutes’ — which equates to a billing rate of at least $800 an hour,” said Karen Ignagni, president of America’s Health Insurance Plans, the main health-insurance industry lobby.
Well, Karen, you’ve got it backwards. The reason the visit only lasts 15 minutes (and by the way, it’s usually 10) is because all you pay is $50! Do you really think docs like giving healthcare in 10-15 minute increments? If you were really to pay $200 a visit, we could all slow down and give the kind of healthcare patients want and we love to give.
And by the way, for every 15 minutes with a patient in the office, there’s another 10 minutes or more of unreimbursed work such as reviewing labs, calling the patients, playing phone tag, talking to referring physcians, renewing prescriptions, getting authorizations, etc, etc.
But you know that already, don’t you? It’s just that your job depends on you paying as little as possible for it.
Very well said!!!
Still missing the point, until we move to a culture of wellness and make better decisions this will be about finding a scapegoat. Read ‘You Have an Ugly Baby'(available at Amazon) if you can handle the truth!
enlightened CFO
You have hit on the usually missed point. Phone calls, paperwork, and lab review eat up my time. Patients don’t understand and insurance companies pretend they don’t understand that handling something over the phone is the equivalent of free care. All of these things cost, and take time from doctor-patient interactions.
Insurance companies may be sitting pretty right now, but their reckoning is coming. They have no friends (doctors, patients, and medical institutions all hate them) except among politicians. When the creek starts to rise, this will cost them dearly.
Doc Mchebert – “When the creek starts to rise” – COming from a man who lived throught the storm surges, that is a very prescient phrase.
Excellent post!
The independent urologist has some good recent posts about this and discusses his local and wife’s OBGYNS)
I left you a long comment on how to get pregnant. great post! 🙂
Hey don’t feel bad. Aa a “physican extender” (:::hurl:::) they’re paying me like $19.
Insurance and big Pharma = EVIL.
My last visit to my US doctor (GYN) was after I moved and no longer had US insurance. The charge for my 15 minute visit was $325.00. When I commented on the outrageous charge, and asked why it was so much more than the insured remibursment, (I was in medical claims payment in a prior life) I was told that the doctors always charged much more for uninsured or cash patients.
Needless to say it was my last visit to her. The next year I found a French doctor who did a more thorough exam, lasting 30 minutes. I was also not ‘in the system’. Total charge? $28.00.