How do doctors get paid?

[CuteOldGuy]

Ever think about it? No wonder docs are starting to refuse insurance, and accept only cash. Here's why:

Imagine going to your favorite restaurant. You are greeted at the door by the hostess, who seats you and takes your drink order. You order through your favorite waiter, Andrew, who recommends the special of the day: prime rib with a dinner salad and a chocolate torte for dessert. Soon after, the food is brought out and it is delicious! You have time to enjoy your food. You then receive the bill and pay for your meal, returning to your home satisfied, all your dining needs met. Let’s say, for simplicity's sake, you paid $75 for this meal: $50 for the steak, $10 for the salad and $15 for the dessert.

A change then occurs in the restaurant industry. A new form of eating out has been adopted. Your favorite restaurant has now contracted with over 30 different ”restaurant insurance companies.”

Anticipating another pleasant dining experience, your return to the restaurant with your new “subscribers card.” You pay your $5 “copay.” You sit in the foyer of the restaurant. You wait an hour, even though you made reservations. A harried Andrew greets you and quickly takes your order after you briefly glance at the menu. The food arrives at your table. As you take your second bite, Andrew informs you that “your time is up” and the table is reserved for another party. You are escorted outside with your hastily boxed left-overs.

What has happened to the restaurant? Behind the scenes, the restaurant owner has learned some tough realities of the “new system.” During the first month of taking insurance, the owner sends a form to the insurance company requesting payment for the $75 steak dinner: $50 for the steak, $10 for the salad and $15 for the torte. The contract with the insurance company already states that they will only pay $45 for the $50 steak, but the owner decides that the extra customers brought to the restaurant by contracting with this insurance company will more than off-set this small loss.

The first attempt at collecting the $75 dollars for the full meal is returned unpaid with the note that it was rejected due to a “coding error.” The forms for payment from the insurance company require the owner to list the parts of the meal, not by name, but by the numerical codes. The owner had listed the salad by the wrong numerical code. No suggestions for the correct code are offered, so the restaurant owner purchases a series of books, at a cost of $500, to learn how to assign the correct code to the different parts of the meals. These books will need to be bought annually due to the constant changing of the code numbers. After 30 minutes of study, the owner realizes the dinner salad should be coded as a 723.13, not the723.1 the owner originally put on the form. The salad, it turns out, needed to have two digits after the decimal point, indicating that it was a dinner salad, and not a “main course” salad. The owner mails the corrected form.

In response to the second request for payment, the insurance company does not send a check, but a detailed questionnaire: Was garlic used in seasoning the steak? Was it necessary to use garlic for this particular recipe? Did the restaurant ask for permission to use garlic from the insurance company before serving the steak? Why was salt, a less expensive alternative, not used instead? The owner submits the answers, emphasizing that the garlic is part of a secret family recipe that made the restaurant famous.

The owner waits another week (it has now been 3 weeks since the dinner was served). The check arrives three and a half weeks after the meal was served. The check is for $20 and states that it is specifically for the steak. The check also comes with a letter stating that no billing of the patron may occur for the salad, but no other explanation is enclosed. No mention is made of the $15 dessert.

The now frustrated restaurant owner calls the provider service number listed in the contract. After five separate phone calls to five different numbers (The harried voice behind phone call number four explains that the insurance company has merged with another insurance company and the phone numbers had all changed last week, sorry for the inconvenience…), the owner gets to ask why, when the contract says the steak will be paid at $45, has the check only been written for $20? And what happened to the payment for the $10 salad and the $15 dessert?

As it turns out, this particular patron’s insurance contract only pays $45 when the patron has reached their deductible, which this patron has not at this time. The remaining portion of payment for the steak must now be billed by the restaurant to the patron directly.

The $10 for the salad would have been paid if the patron had ordered it on a different day, but, per page 35 in the contract, because it was billed on the same day as the steak, it is considered to be part of the payment for the steak and no extra money can be collected from the patron or the insurance company.

The dessert, the owner learns, should have had a “modifier” number put with its particular billing code when billed with the steak and the salad.

Realizing that the insurance billing is quite a bit harder than anticipated, the restaurant owner hires a company, who is paid 5% of any money collected to specifically make sure these coding errors do not occur again and follow up on payment rejections. For an additional $99 per month, the billing company will “scrub” the forms submitted for payment to make sure specific clerical errors will not cause future delays in payment.

The owner now must lay off the hostess and the bus boy to pay the billing company, so these duties are now added to the waiter’s other responsibilities.

In the meantime, the restaurant owner has also had the waiter take on the job of answering the phones due to the now high volume of phone calls from patrons questioning why they are receiving bills for meals they ate over two months ago, and why did their insurance company not pay for this portion of the meal? This extra work is now resulting in longer times patrons must wait to be seated, and grumblings from the waiters who “were not hired or trained to do this kind of work.”

The owner now realizes that, although the dinner originally cost $75 to make, only $25 has been paid. The remaining $30 billed to the patron is now in its third mailing, with the first two requests for payment going unanswered by the patron. The restaurant owner realizes a collection agency must be employed in order to have any hope of receiving any portion of payment from the patron.

Each meal served now costs at least an additional $20 due to the added overhead of the billing company, coding books, and the collection agency. These added expenses have nothing to do with cooking food or providing any direct service to the restaurant’s customers.

Service to the restaurant’s patrons has been compromised with these changes as well. The owner has now over-extended the waiter, who was an excellent waiter, but is now taking on the roles of host, phone answering and table bussing.

In order to even meet the costs of providing fine dining, the restaurant owner now must seat twice as many patrons in the same amount of time.

What was once an outstanding business that focused on fine dining and customer service has now been turned into a business in the business of trying to get paid.

Alas, I wish this were a fictional tale, but it is not. The only fictional portion is that this is not your favorite restaurant, but your favorite doctor’s office, which is responsible not for meeting your dining needs, but those of your health.

Megan Lewis, M.D., A family physician in rural Colorado.

I hope this helps those of you who think doctors live such a cushy life. And this will only get worse with Obamacare.

http://idealmedicalpractices.typepad...get-paid-.html

[WTF]

Sounds like you need to start eating healthy at Subway with Jarred!

You do realize that the government makes sure that that eating establishment isn't serving rotten food that will kill you. It affords you legal recourse if in fact they do do something that endangers your life.

You polywags pick and choose good and bad. Never do you point out good things in regards to government.

[CuteOldGuy]

You always take the side of more government, WikiPostingFraud, even when the simplest of concepts escape you. The safety mechanisms were already in place when the restaurant was flourishing. There was still a Board of Health, and all of the other safety regulations. Food safety is NOT THE ISSUE! No one is discussing doing away with health and safety regulations.

You simply want to hijack this thread to make it about your stupid opinions. This isn't about the SAFETY or QUALITY of medicine, it is about HOW DOCTORS GET PAID!! It is about how quality DECLINES when insurance companies and government are in charge of how doctors GET PAID! You, however, missed that point COMPLETELY.

Now, go find a wiki article you can copy, and pretend it's your own words. Let the grown ups discuss the more complex topics.

[acp5762]

Originally Posted by WTF

Sounds like you need to start eating healthy at Subway with Jarred!

You do realize that the government makes sure that that eating establishment isn't serving rotten food that will kill you. It affords you legal recourse if in fact they do do something that endangers your life.

You polywags pick and choose good and bad. Never do you point out good things in regards to government.

Watch this video, see if you can advise this women.

http://www.youtube.com/watch?v=BiS2q...3GlaIG3H0oblzw

[CuteOldGuy]

And I refuse to eat at Subway since I bit down on a push pin that was hidden in my sandwich. I'm sure "food insurance" would have prevented that.

[flghtr65]

Originally Posted by CuteOldGuy

You always take the side of more government, WikiPostingFraud, even when the simplest of concepts escape you. The safety mechanisms were already in place when the restaurant was flourishing. There was still a Board of Health, and all of the other safety regulations. Food safety is NOT THE ISSUE! No one is discussing doing away with health and safety regulations.

You simply want to hijack this thread to make it about your stupid opinions. This isn't about the SAFETY or QUALITY of medicine, it is about HOW DOCTORS GET PAID!! It is about how quality DECLINES when insurance companies and government are in charge of how doctors GET PAID! You, however, missed that point COMPLETELY.

Now, go find a wiki article you can copy, and pretend it's your own words. Let the grown ups discuss the more complex topics.

How many people keep $100,000 dollars in their checking account to cover a routine procedure that requires a one night stay in the hospital? Most doctors will be getting paid by insurance, unless you are an actor who gets paid 2 million per picture or a baseball/football/basketball player with a 10 million dollar contract, those types can pay in cash.

[CuteOldGuy]

You miss the point, too, Fluffy. Gawd, the ignorance on display here is staggering. But the statists have to be what they are. Sad, truly.

[WTF]

Go get your rectum exam at a Taco Stand COG!


Pay for it with chili peppers

You have no concept how Doctors are paid.

[JCM800]

Originally Posted by CuteOldGuy

And I refuse to eat at Subway since I bit down on a push pin that was hidden in my sandwich.

don't they make the sandwich right in front of you ....how'd you miss that?

[Guest040616]

Originally Posted by CuteOldGuy

And I refuse to eat at Subway since I bit down on a push pin that was hidden in my sandwich.

I can't help but wonder if Hanoi James said or did something to the Subway Sandwich maker that compelled him/her to put a "push pin" in his sandwich.

[Jewish Lawyer]

Originally Posted by bigtex

I can't help but wonder if Hanoi James said or did something to the Subway Sandwich maker that compelled him/her to put a "push pin" in his sandwich.

He is so hated that everyone seems to take joy at abusing and insulting him, when in fact he posted an excellent article illustrating the frustrations a Doctor's office has and how it drives up the expense of the Healthcare system.

[i'va biggen]

Originally Posted by CuteOldGuy

You miss the point, too, Fluffy. Gawd, the ignorance on display here is staggering. But the statists have to be what they are. Sad, truly.

Two things I wonder how long it has been since you were in a medical office.
For years it has taken more time to fill out the forms even if you were there last month than the time you saw the Dr.
A friend of mine had a appointment saw the Dr and they prescribed some meds for him. He asked if he could get a refill on another prescription that was about to run out. The Doc said no that would require another appointment. Otherwise it has not been about good healthcare but money for some time. The Dr's go into a specialty line because that is where the bucks are and leave a shortage of general practitioners.

[JohnnyYanks]

Interesting restaurant story. Hardly analogous however. Doctors offices aren't "run" by Insurance companies any more than a restaurant is run by its customers.

This reminds me of the (lazy) thinking that says an NFL player's contract "isn't worth the paper it's printed on" because of (oftentimes) a lack of guaranteed salary; a suggestion that the team, the other party to the contract, has garnered some unfair advantage. Baloney. It's a negotiated (and with collectively bargained parameters) contract that has rights and obligations for both sides, as it should.

Thirty years ago a consumer could find 30 or 50 companies to underwrite a major medical insurance policy in Texas, assuming reasonable health. More, if the consumer is also an employer, in a decent industry. Today? Five, or less, if a discerning consumer. Do you suppose that's because they all made so much money telling the docs how to run their practices? If you really want to know the answer, check out the Death Spiral, a conundrum generally without solution.

I was around before PPO's came to be dominant, then HMO's, when Fee for Service was the prevailing Reimbursement method, when Usual and Customary Charges was the major point of contention, when docs were infrequently questioned about how they conducted their business, what tests they prescribed, what surgeries they performed (do you realized that before pre-certification became the norm, Insurers had to add a clause to their contracts preventing multiple surgeries off of the same incision because docs would often exploit this as an opportunity to pad the bill? "Yeah, while we were in there we found ____, and handled that for you too." Yeah, just like the car mechanic you see on the 6 O'clock news, caught exploiting some little old lady.)

Sorry, COG, but I'm not buying in the least what this lady doc is selling. The system has evolved to where it is today because of decisions and practices on both sides of the fence. And no one's chaining her to the insurance companies - she can opt out and take cash patients only. I know docs who have done this. I used to see one. Or she could focus on tightening up her practice and getting those bills paid the first time through. Like most of them do, pissing and moaning aside.

[jbravo_123]

Originally Posted by Jewish Lawyer

He is so hated that everyone seems to take joy at abusing and insulting him, when in fact he posted an excellent article illustrating the frustrations a Doctor's office has and how it drives up the expense of the Healthcare system.

Which does illustrate that if you make yourself so hated to others, even if you say something that's a good point, your message gets lost due to your lack of credibility to others.

Originally Posted by JohnnyYanks

Interesting restaurant story. Hardly analogous however. Doctors offices aren't "run" by Insurance companies any more than a restaurant is run by its customers.

This reminds me of the (lazy) thinking that says an NFL player's contract "isn't worth the paper it's printed on" because of (oftentimes) a lack of guaranteed salary; a suggestion that the team, the other party to the contract, has garnered some unfair advantage. Baloney. It's a negotiated (and with collectively bargained parameters) contract that has rights and obligations for both sides, as it should.

Thirty years ago a consumer could find 30 or 50 companies to underwrite a major medical insurance policy in Texas, assuming reasonable health. More, if the consumer is also an employer, in a decent industry. Today? Five, or less, if a discerning consumer. Do you suppose that's because they all made so much money telling the docs how to run their practices? If you really want to know the answer, check out the Death Spiral, a conundrum generally without solution.

I was around before PPO's came to be dominant, then HMO's, when Fee for Service was the prevailing Reimbursement method, when Usual and Customary Charges was the major point of contention, when docs were infrequently questioned about how they conducted their business, what tests they prescribed, what surgeries they performed (do you realized that before pre-certification became the norm, Insurers had to add a clause to their contracts preventing multiple surgeries off of the same incision because docs would often exploit this as an opportunity to pad the bill? "Yeah, while we were in there we found ____, and handled that for you too." Yeah, just like the car mechanic you see on the 6 O'clock news, caught exploiting some little old lady.)

Sorry, COG, but I'm not buying in the least what this lady doc is selling. The system has evolved to where it is today because of decisions and practices on both sides of the fence. And no one's chaining her to the insurance companies - she can opt out and take cash patients only. I know docs who have done this. I used to see one. Or she could focus on tightening up her practice and getting those bills paid the first time through. Like most of them do, pissing and moaning aside.

Not to mention that many practices just bill the difference to the patient if something goes wrong and forces the patient to have to battle with their insurance companies instead of the physicians' offices dealing with their errors.

[CuteOldGuy]

Damn. Whatever. Why not print the story and take it your doctor? Find out what s/he thinks about it. Then tell them they're wrong.

Do it. It will be fun! Especially when it's time for "that" exam.