LocalGrowGuy
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I wish I had more time to respond, but real life n stuff.
-Radiologists, ER Techs, Anesthesiologists, and Pathologists are referred to as RAPE or PEAR providers, depending on the client, because those facilities don’t usually join anyone’s network, allowing the very charges you shit on in your post. Don’t get me wrong, it’s a perfectly fine career choice, but it highlights some biases (bias’, bias’s, ?).
The easiest way I can explain it to my clients is that if you don’t have insurance you are paying retail, or whatever the provider wants to charge you. After all, you chose to go to that provider, right? If people don’t like the prices they should shop around. It’s called consumerism, and there’s a huge shortage of it in our country. If you have insurance then you are purchasing your healthcare wholesale, with discounts. It’s a person’s responsibility to know what their insurance does and does not cover.
“How’s that work, exactly?” When a provider such as an imaging center signs a contract with an insurance company, they are agreeing to bill a certain amount for procedures using CPT codes, over ten thousand of them. The provider agrees to bill you for the contracted amount, and also agrees NOT to charge you for the balance, which is called balanced billing. That’s another conversation. The reason it works, exactly, is because most people have no clue how much or how expensive their healthcare costs are. If they were paying for nuclear imaging themselves, they’re going to shop around for the lowest rate, correct? That’s what the insurance companies want, which is why there are such steep discounts for using a participating provider, and also why copays for tier 1, most generics, is only $10 or $15 not subject to the deductible.
As far as your comments regarding reimbursements, the provider knows before accepting the patient that they will compensated less. It’s the providers choice whether to participate in the network or not. If they don’t participate they can charge whatever they want, like in your examples for MR’s and CAT scans and other nuclear imaging. I have no idea what the actual cost is. I think insurance companies and imaging centers purposely hide costs, and I don’t think anyone would argue they charge higher rates to compensate for those who pay less or not at all. I guess I don’t understand your comment about insurance companies strong-arm doctors. If they have a shitty contract with United, then don’t accept them and use a different provider. I don’t really buy the argument that the insurers are forcing anyone to do anything. Insurance is regulated at the state level, so I’m certain that things where you live are not the same as where I live. Here there are a dozen health carriers. I am an insurance agent. I insure about 15 doctor offices, and if they have issues with a certain company they don’t accept them. Simple as that.
I lightheartedly disagree on the medical billing though. With over ten thousand CPT codes doctors have enough other shit to worry about than submitting a claim with the ‘correct’ codes, or whatever.
I encourage you to read this excerpt. Although the source is not really credible, it makes some good points. You’ll enjoy the graphics, and it helps reinforce your point, but what are the alternatives?
http://www.cracked.com/article_20612_5-seemingly-harmless-groups-that-wield-terrifying-power.html
#3. The Medical-Industrial Complex That Exists Solely to Bankrupt You
‘We all know that the health care industry has the second most jacked up perception of value in the country, slightly behind defense contractors and just above printer ink. But you might not know exactly how bad it really is, so here -- check out this comparison of the cost of medical procedures in the U.S. versus the rest of the world:’
Tell me who is more evil in this, the insurance company as the insurer, or the hospital as a provider? And no one wins.
“People don't think to question it because most of them have never even heard of a chargemaster, and the health industry has managed to steer the health care debate away from asking why we're paying $77 for a single gauze pad when we could buy a whole goddamn box of the things at Walmart for 10 bucks and focusing instead on who should pay for it.
But how have they managed to so completely foul up something as fundamental as health care? The answer is obvious: money. Hospitals are a for-profit industry, and one does have to spend money to make money. Lobbyists for defense, aerospace, oil, and gas have tossed a combined $2.8 billion at Washington since 1998. The medical-industrial complex has spent about twice that.”
Don’t single anyone or anything as a cause, when we are discussing 1/5th of our economy there are many many factors at play, more than can be discussed here.
