Biggest Medical Rip Off?

All of these stories sound shocking and I know people want to place blame but the issue is complicated. As the spouse of a health professional, I see how much is billed and how much is actually paid. For example, your doctor or hospital may bill thousands of dollars in charges, but actually get reimbursed pennies on the dollar. For ex a procedure is billed at $3800, and $95 is actually collected. I don't think you see that.

Who is to blame? Greed is a factor, yes. Insurance company executives are making $50 million a year. Same with drug companies. Hospital execs are making more than most of the doctors they employ.

Also the way doctors practice is changing. It used to be that doctors billed for themselves. Now many hospitals and for-profit companies are buying out practices and employing the doctors on salary. So you may think that the doctor is going home with tens of thousands of dollars that he isn't.

Another aspect to consider is that your health care and tax dollars that you work hard for, are being used to subsidize sicker, and poorer individuals. Some people are lucky and some people aren't, healthwise. But someone has to pay for it.

I understand the frustration and I feel it too, but it is disappointing when I see people wanting to blame doctors. These are intelligent people who go through many years of schooling and pay a lot of money to have a very demanding career in which peoples' lives are at stake. It's not easy. No one goes into it just for the money, I can assure you. imo most doctors truly want to help people and second guess themselves many times during the course of their careers.

I also pay a ridiculous amount for healthcare coverage, and I am also very aggravated when something is not covered due to a technicality. It's the nature of insurance. Sorry I don't have an easy answer.
Exactly. I am a healthcare professional although not a MD. I see what you are talking about all the time. It is frustrating because most people want an easy fix to a very complicated problem. There are so many things going on that would need to change that all the current regulation in Washington doesn't even address.
 
It doesn't really work like that. When a doctor or hospital participates with an insurance company, they sign a contract which designates how much they will get billed for different things. It may be a certain amount for a certain procedure, or it may be based on time: for ex, a surgeon spends 10 hours on a procedure, so he will collect for 10 hours at X$ per hour. The doctor can bill whatever he wants but the insurance company will pay as per their agreement.

It is different when a provider does not participate with a certain insurance company. Did you ever wonder why your doctor does not participate with every insurance company? Maybe it is because the agreement they offered compensates the doctor at a much lower rate than he/she is willing to accept. If they refuse to participate, the insurance company can't hold them to that price. Sometimes they will pay the full rate the doctor charges, and sometimes this goes back to the patient for using a doctor who is 'out of network'. But the blame seems to always go to the doctor rather than to the insurance company.
Yes I am very aware of what you are talking about. I also know that insurance companies have in the past cut how much they pay if the doctor or hospital doesn't inflate the bill. It is like not using your whole budget because next year you will get less.
 
Yes I am very aware of what you are talking about. I also know that insurance companies have in the past cut how much they pay if the doctor or hospital doesn't inflate the bill. It is like not using your whole budget because next year you will get less.
I don't know what you mean about 'inflating the bill'. Doctors usually have a rate for different procedures. They don't just tack on $1000 depending on who they are billing. The doctors negotiate the compensation with the insurance companies before they sign their contract; there isn't a way for them to increase that amount later.

In some cases insurance companies are basing compensation to physicians on Medicare reimbursements, which can vary widely depending on the doctor's area of practice, but are typically on the lower end of the pay scale so in some cases doctors are forced to negotiate compensation up from there.

In my area, many dermatologists are no longer taking insurance. They accept cash only and they are not hurting for business; it still takes months to see some of them.
 
I don't know what you mean about 'inflating the bill'. Doctors usually have a rate for different procedures. They don't just tack on $1000 depending on who they are billing. The doctors negotiate the compensation with the insurance companies before they sign their contract; there isn't a way for them to increase that amount later.

In some cases insurance companies are basing compensation to physicians on Medicare reimbursements, which can vary widely depending on the doctor's area of practice, but are typically on the lower end of the pay scale so in some cases doctors are forced to negotiate compensation up from there.

In my area, many dermatologists are no longer taking insurance. They accept cash only and they are not hurting for business; it still takes months to see some of them.
So maybe "inflate" was not the right word to use, I didn't mean it the way you took it. What I am talking about is when the doctor bills $12,000 and the insurance company pays only $6,000. Why when you get the explanation of benefits would the doctor put $12,000 on the bill when they know they negotiated for $6,000? I have been told by colleagues the reason is if they don't put the higher price when they bill the insurance companies and only put what they are being paid then when they go to renegotiate the contract the insurance companies will try to pay them less. I also know that if I walked in to a private doctor's office and said I was paying totally out of pocket I would be billed less than what they "actually" bill the insurance company. I would be charged something closer to what they "actually" get paid from the insurance companies. I have seen that doctors have been slowly either moving to all cash businesses in some markets or going "corporate" (earning a salary and not have a business themselves or have the billing managed by a company that maximizes profits) in others.

I think we basically agree that most of medical care is not a rip off. That it is much more complicated than most people understand. The biggest thing I think we agree on is that most posters are blaming doctors and others when they don't understand the system and that the bills they talk about are not what the professional, hospital or lab are actually being paid.
 


Do NOT get me started on this!! My college age son was recently transported to the ER by ambulance in his college town. We just started receiving his bills. I noticed insurance didn't pay anything towards the ambulance. I called insurance figuring it was wrong. Nope. They don't want to pay anything because the ambulance company is not in their network.

Issue here is whether you are transported by a private ambulance, or a Fire Department ambulance. My mom had assigned her Medicare to an HMO, the PRIVATE ambulance company accepts the HMO allowed payment as full payment. The FIRE department wants $250 above what the HMO pays. Mind you, my mom paid 63 years of property taxes to that fire department.

My MIL's husband needed an ambulance, the Fire Department wanted $1,200 above the $350 his Air Force Federal Tricare health insurance paid. She was getting some paperwork taken care of at the VA advocates office and mention this. The advocate told her not to pay that bill, but to call the fire department and point out that this was Tricare insured patient, that the fire departments ambulances were paid for with a Federal Grant, and that the grant had the stipulation that the fire department had to accept whatever Tricare ( or any Federal insurance plan) paid as full payment. An oversight? No way. This is Sacramento, we had 2 Air Force Bases and an Army Signal Depot here, we have 2 additional Air Force bases and 2 additional Army Signal Depots within 50 miles, so we have literally 10's of thousands of military retirees here covered by Federal insurance. The fire department was clearly trying to take advantage of people.
 
They usually sell a 5 pack of generic Flonase nasal spray at Sam's Club for around $27 (less when it's on sale).

Download the goodrx app to check prices when you are filling prescriptions so you know what's going on.

Just bought this today for DH at Costco. Their Kirkland brand is $22.99 reg price. This month it is $6 off, so $16.99 for the 5 pack. Either place is still a much better deal!
 
When I was pregnant with DD2, the doctor recommended genetic testing (a blood test) due to my "advanced maternal age". I checked with my insurance company ahead of time to ensure that the specific test was covered - it was. I got the blood drawn at my in-network doctor's office (I'm sure you can see where this is going), and later received a bill from the lab for $3500, which my insurance had declined to cover any of because the lab was out of network. I didn't have a choice as to what lab it was sent to, and didn't know that this was something I needed to check.

My insurance company wasn't willing to budge when I contacted them, so I called the lab to see if there was anything they could do. They immediately offered that I could just pay them the "out-of-pocket rate" of $250 since the test wasn't covered by my insurance. I agreed and settled the bill, happy not to be on the hook for the full amount, but I was pretty baffled. They billed my insurance company $3500, and then when the insurance company wouldn't pay, sent me the full bill. They apparently would have happily accepted the full $3500 from me had I sent them a check, but since I called them, they reduced my bill to $250. I consider that pretty shady - why didn't they just send me the $250 bill to begin with?
 


Whoa, I didn't check back until now, but looks like I hit a nerve. Bottom line, you absolutely have to review all your medical bills and advocate for yourself since no one else will. Until health care becomes a NON political issue in the US, we are in trouble.

Follow up on my cryotherapy "surgery" (freezing of a mole). In spite of paying every month for Medicare AND full BCBS coverage, I got a bill for $155. Even though I double checked the provider directory and at the doctors office that they were in network, they assigned me to a nurse practitioner that wasn't in network. So they "only" got $500 from insurance, and I was supposed to pay the deductible. I called and complained, and they did me the huge favor of waiving the deductible.

Trying to do this in an emergency situation would be awful.
 
So, I have only read the first post, but I was looking for a new doctor and the info they gave me, they charge for signing forms or even providing forms like a school note. Seriously.
 
So, I have only read the first post, but I was looking for a new doctor and the info they gave me, they charge for signing forms or even providing forms like a school note. Seriously.
Yes. This is the kind of thing that made me change doctors. Keep shopping. There are still good doctors out there. I would bet that doctor was affiliated with some sort of hospital system or company that does the billing for them. Those are the ones that usually nickel and dime you. I do understand that time is money but somethings just seem a little ridiculous.
 
I know people who don’t hesitate to pay $7000 for a Disney vacation or $35000 for a new car, but if they have to pay a few hundred for a co-pay think it’s the end of the world. We don’t think twice about a $200 a month cable bill or $150 a month for a cellphone bill, but if we have to pay that for prescriptions you would think it’s the end of the world.

That's because I'm also paying a pretty high monthly premium. There was a time when having insurance meant those costs were covered.
I have to pay full price for all my Rx's and lucky me they don't count towards my deductible. So yeah I kind of think it's the end of the world, you can cancel your cell phone and cable but some just can't really do that with meds.
 
Follow up on my cryotherapy "surgery" (freezing of a mole). In spite of paying every month for Medicare AND full BCBS coverage, I got a bill for $155. Even though I double checked the provider directory and at the doctors office that they were in network, they assigned me to a nurse practitioner that wasn't in network. So they "only" got $500 from insurance, and I was supposed to pay the deductible. I called and complained, and they did me the huge favor of waiving the deductible.

This has happened to me. Go to in network radiology place, the radiologist who reads the xray is out of network. I called and complained, fee was waived.

Every place I go to, I ask, 'will the doctor who reads my results be in network? I only want an in network doctor to read it'.
 
So, I have only read the first post, but I was looking for a new doctor and the info they gave me, they charge for signing forms or even providing forms like a school note. Seriously.
Pediatricians now typically charge to fill out school/athletic forms. Mine was charging $10/form. They get hundreds of these requests and it takes time. I think they have a good reason for charging.
 
When I was pregnant with DD2, the doctor recommended genetic testing (a blood test) due to my "advanced maternal age". I checked with my insurance company ahead of time to ensure that the specific test was covered - it was. I got the blood drawn at my in-network doctor's office (I'm sure you can see where this is going), and later received a bill from the lab for $3500, which my insurance had declined to cover any of because the lab was out of network. I didn't have a choice as to what lab it was sent to, and didn't know that this was something I needed to check.

My insurance company wasn't willing to budge when I contacted them, so I called the lab to see if there was anything they could do. They immediately offered that I could just pay them the "out-of-pocket rate" of $250 since the test wasn't covered by my insurance. I agreed and settled the bill, happy not to be on the hook for the full amount, but I was pretty baffled. They billed my insurance company $3500, and then when the insurance company wouldn't pay, sent me the full bill. They apparently would have happily accepted the full $3500 from me had I sent them a check, but since I called them, they reduced my bill to $250. I consider that pretty shady - why didn't they just send me the $250 bill to begin with?
Your case is a bit different as that test is not a typical request and I'm guessing that it goes to a specialized lab.

In the case of common lab work like annual blood testing, you can most certainly request that your labwork go to your in network lab. I have them write it on the chart, but each and every time I have blood drawn, I tell the tech, 'this has to go to X lab'. I have not had a problem yet.
 
So maybe "inflate" was not the right word to use, I didn't mean it the way you took it. What I am talking about is when the doctor bills $12,000 and the insurance company pays only $6,000. Why when you get the explanation of benefits would the doctor put $12,000 on the bill when they know they negotiated for $6,000?

The billing office is not going to look up each procedure to see what each insurance company is paying before they submit the bills to insurance. The provider has their 'rate' or 'cost' for a procedure, and they bill it, then the insurance company pays as per their agreement. The math used to compensate you will show up on your explanation of benefits form. It is bookkeeping.

If you ask your doctor what your insurance will cover, they won't know. There are many insurance providers and each has multiple plans, all paying out different amounts with different deductibles and copays.

Providers have been getting better at estimating what you will owe if you ask their billing department in advance, but they have to know exactly what procedure you will be having and what your insurance plan covers.

Ultimately, it is the patient who is responsible for knowing what his copay and deductibles are, and who participates with his plan. Unexpected costs may still come up and you deal with it when it happens.
 
Pediatricians now typically charge to fill out school/athletic forms. Mine was charging $10/form. They get hundreds of these requests and it takes time. I think they have a good reason for charging.

LOL, it has always taken time. Besides with computers, nobody is sitting there filling out anything, the doctor is signing a sheet that is printed out. They enter the data during the visit and print it out right there. Actually they have the receptionists print it out, they just scribble their signature on it.
It took more time when they weren't charging for it.
 
LOL, it has always taken time. Besides with computers, nobody is sitting there filling out anything, the doctor is signing a sheet that is printed out. They enter the data during the visit and print it out right there. Actually they have the receptionists print it out, they just scribble their signature on it.
It took more time when they weren't charging for it.
They hand printed it when they did it for me. You have to realize that while it has always taken time, new documentation requirements are also taking more time.

Pediatricians and family doctors are among the least compensated physicians. When it comes down to it, running an office is running a business. They are paying for rent and staff. If you like and trust your family doctor or pediatrician, them charging you $10 to fill out a form shouldn't be a deal breaker.
 
They hand printed it when they did it for me. You have to realize that while it has always taken time, new documentation requirements are also taking more time.

Pediatricians and family doctors are among the least compensated physicians. When it comes down to it, running an office is running a business. They are paying for rent and staff. If you like and trust your family doctor or pediatrician, them charging you $10 to fill out a form shouldn't be a deal breaker.

I never said it was a deal breaker.
You are free to think they have good reason to charge for it, I'm free to think it's a ridiculous way to nickel and dime people.
 
I never said it was a deal breaker.
You are free to think they have good reason to charge for it, I'm free to think it's a ridiculous way to nickel and dime people.
Our pediatrician doesn't charge extra for forms. They have always bent over backwards to help.
 
Ours was an ambulance ride. We are covered by insurance and should only have a copay. Naturally we get a bill for the entire amount. Call insurance, it was out of network. Ask - what ambulance is in network - NONE! ok this means we no coverage. We were told to appeal, we did and won. And we didn't even have to pay the copay.
 

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