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Originally Posted by greglepore
What kills me is the variance in what they'll accept.
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Understood. But what each entity will accept depends exactly upon that--what each entity will accept. Each entity--the hospital, the ortho, the anesthesiologist, the radiologist, the lab--is a separate business.
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Ortho-stupid and unreasonable. Offered to pay them immediately at Ins reimbursement rate. "No, we can't disclose that or do that, but we will take 50 bucks a month on the total INTEREST FREE until its paid off"-what does that tell you about the complete and utter unreasonableness of the quoted rate?? Pissed me off, paying them the 50/month. OUghta be a law requiring them to accept present value or something.
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Well, it's their policy to be helpful or not. But at the same time, how much they get reiumbursed by an insurance company depends. Depends on the contract they have with that specific insurer. So it's not a simple answer to give you. There is a law, though, that they have to charge everyone the same amount (insurance companies/Medicare/Medicaid excepted). So they would have to charge you the same amount that they would charge any other customer. Effectively, though, you found out it's $6K for the services rendered. (I'm not commenting on the reasonableness or not of that $6K amount.)
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The system needs transparency-the fiction that the insurance industry gets a volume discount is unjustifiable, it simply allows the actual cost to be hidden.
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Again, not so simple an answer. Yes, it's a simple and reasonable expectation. But there are times I (as a health care provider) can't get a simple answer from an insurance company.
To wit: A patient wanted a particular injection. The company that supplies the kit for this injection charges me $350. Normally, just for an injection I wouldn't get reimbursed more than about $50-60. So I certainly don't want to spend $350 for materials for reiumbursement of $50-60. Times two, as he wanted it to both arms. And insurance may reiumburse 50% of the rate for the other side, as they often follow a Medicare policy of "while you're in there" mentality.
So my office rang up the patient's insurance company to inquire about coverage for this injection. "Well, that's experimental," they said. OK, will you cover it? Will you reiumburse for the materials cost? "You'll need to submit a claim." Well, what if I just give you the codes I'll bill out? Can you then tell me what you'll reimburse? "No, you need to submit a bill first and then you'll hear back from us." Granted this is a slightly uncommon situation, but how the F am I supposed to run a business when dealing with that?
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How a nation like ours has allowed such a fundamental right to get so f'ed up is beyond me.
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'Cause we're run by lawyers and businessmen?