Quote:
Originally Posted by jyl
Seems like a patient should be able to negotiate an all-in price for a surgery like that, and refuse to pay charges not expressly agreed to.
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I typed a response, but it wouldn't post. In short, it's not that simple. On the date of surgery, you have several different businesses. **Separate** businesses. The surgeon. The anesthesiologist. The facility. And depending, there could be a pathologist, an implant manufacturer (i.e. plates & screws), a provider for post-op durable medical equipment (DME) like ice machines, etc. They're all different businesses, so they all bill separately.
I get the gyst of what you're typing, jyl, from the consumer side of things. In cosmetic surgery there's usually a single bill, for example. So it's not an impossibility to arrange for a simpler billing model. But at the same time, in cosmetic surgery, everyone knows what everyone's getting paid. The surgeon, anesthesiologist, and facility have predetermined (and already received) what they're getting. With insurance, no one knows what they're getting until they get paid several months later. (Despite what the contracts stipulate.) And insurance (who sets the rules on this stuff) has determined that each business bills separately for services provided. There's no code for any all-inclusive payment, only codes for individual services provided. If you don't like the way billing is confusing, it's not the providers promoting the system; they don't write the rules.