Government run health care

[Edwina's Secretary]

Then why would doctors only want Medicare patients?

Sincerely asking....

[Grace]

Then why would doctors only want Medicare patients?

Sincerely asking....

Is this addressed to me? I didn't say that all doctors take Medicare, nor do all doctors refuse Medicare patients. I have read that doctors refuse to take Medicare patients because of the time involved, and reimbursements. Why some doctors seek Medicare patients - I have no idea.

For example (and this isn't about doctors, but supplies) - I purchase strips to use with my meter, to test my blood glucose. I buy 100 strips, that cost $100. However, Medicare will only reimburse the supply company $53.94 of that $100. So who is paying balance of $46.06? My secondary pays part, but the rest is lost. So the medical supply company has to eat the loss.

[Edwina's Secretary]

But that is true with "private" insurance as well. My Explanation of Benefits show the "full price", the discount price my carrier has negotiated, the amount they will pay and what I must pay.

The difference and there is always a difference - is "lost" as you say.

When I see my PCP doctor my copay is a percent of what the insurance covers. As the doctor does not know how much this is...I pay nothing at the time. My doctor send the bill to the insurance company - they decide what they will pay - send that back to my doctor and them he must send me a bill for my percent of the bill.

I have tried to pay something at the doctor's office but it cannot be done that way. I must wait...and so must my doctor!

[Grace]

But that is true with "private" insurance as well. My Explanation of Benefits show the "full price", the discount price my carrier has negotiated, the amount they will pay and what I must pay.

The difference and there is always a difference - is "lost" as you say.

When I see my PCP doctor my copay is a percent of what the insurance covers. As the doctor does not know how much this is...I pay nothing at the time. My doctor send the bill to the insurance company - they decide what they will pay - send that back to my doctor and them he must send me a bill for my percent of the bill.

I have tried to pay something at the doctor's office but it cannot be done that way. I must wait...and so must my doctor!

Before I went on Medicare, my copay was always the same amount. My husband, who is not on Medicare, continues to pay the exact same amount for copay each visit. It's written into our policy.

What you describe, is the way it is for me now, with Medicare. The copay may vary from one visit to another.

Interesting.

[Cataholic]

But that is true with "private" insurance as well. My Explanation of Benefits show the "full price", the discount price my carrier has negotiated, the amount they will pay and what I must pay.

The difference and there is always a difference - is "lost" as you say.

When I see my PCP doctor my copay is a percent of what the insurance covers. As the doctor does not know how much this is...I pay nothing at the time. My doctor send the bill to the insurance company - they decide what they will pay - send that back to my doctor and them he must send me a bill for my percent of the bill.

I have tried to pay something at the doctor's office but it cannot be done that way. I must wait...and so must my doctor!

We switched, once again, health plans. LOL, same deal- way less coverage for much higher premiums. They pay the first $2000, I pay the next $3000. Yeah, I was at that $3000 figure by May. May! Anyhow, I went into my doctor for what I KNEW was a sinus infection. Knew it, knew it, knew it. Of course, antibiotics were prescribed. As I left, I asked for a copy of my bill, so that I could maintain my own records at home as to the $3000 payments. The clerk said she had NO IDEA WHAT THE CHARGE WAS! I was stunned. I just had a service at an established doctor's office and they couldn't tell me what my bill was ? WTH? I stared at her, and she said just what ES said, and that I would get a bill within 8 weeks. LOLOL. CRAZY!

[Edwina's Secretary]

Her is an example of how my employer provided - yet still expensive insurance works. We have met our deductible (we must each pay the first $500 of expenses.) This doctor submitted a charge of $104.27. Cigna discounts that to $64.97. Coverage is 80% so Cigna pays $51.98. I am responsible for $12.99.

Who pays the $39.30 between what the doctor charged and what Cigna and I paid?

Don't know. I could be cynical and say the doctor's charge was higher knowing there would be a +60% discount applied but I don't know that.

But the situation Grace described with her diabetes supplies is the standard operating procedure of PPO coverage.

[sasvermont]

Although I have never worked in a doctor's office, my best friend manages an office of a surgeon. Yes, they (the doctorS) submit a number for reimbursement, assuming they will get a portion of the amount billed. Each insurance company has their own little payment schedule as to how much some service is worth. So, yes, the doctors pad their bills, knowing they will get less. Not much different than car dealers starting at a higher price and taking what they get in the end.

I also know that the different insurance are noted for rejecting claims by doctors... giving them a hard time....but in most cases, after contacting the company, the payment is made to the doctor. Cigna has the worst reputation for rejecting doctors' and patients' claims.

I don't think the doctors misrepresent what they have done, as much as they bill the max and hope for the best.

I also know that the doctors' medical malpractice insurance carrier audit the doctors for billings, note taking, procedures, etc. I am not sure how often Medicare/Medicaid does audits.

I would like to believe that doctors are not so guilty for padding bills - hospitals and nursing homes are another story.

All that said, I really don't have any first hand information. Just second hand.

[Edwina's Secretary]

Cigna and Aetna are two I would rather not have. I am sure they differ across the country but they still would not be my choice.

However, I don't really get a choice. It is what my employer or my husband's employer decides to offer.

And...as Cataholic points out - that can change. I have a client that has BCBS right now. A 12% increase this year so the broker is getting quotes from other carriers. If it changes - it is possible covered employees and their families will have to change doctors as well. Especially if it is a different HMO.