Bingo. Negotiation is not terribly accurate though. More like the price sheets in auto parts. I worked in a parts house once and they had four or five columns in their price books. Likewise the insurance companies have similar prices depending on the plan you are in. Doctors can participate in any plans they wish and are not shy about retiring from plans that try to pinch too many pennies. But the trade off is losing customers... er, patients.
A friend had a doctor for many years as he raised his family. Even before Obamacare they went "boutique" requiring a $2,000 annual payment just to be a patient. They knew their customer base would drop greatly so they advertised that you would have much shorter scheduling times for appointments, lol. But like Costco, I expect they now make more money on the boutique premium payment than they do on the payment for services.
Because that's what the test is really *worth*. A close family friend (who is a MD/surgeon) was the MEDICAL big cheese at a large US insurer. He was responsible for identifying "billing dodges" that looked correct on paper yet were duplications, in practice.
E.g., many "blood tests" are performed "automatically" by the machine that performs the assay(s) -- because no one ever asks for the *individual* tests (perhaps was something that was done before the introduction of automation?). He recounted encountering a practice that would submit bills for all these "little" tests, individually. Knowledge of how medicine is actually *performed* is needed to know that these tests are really individual line items on a "composite" test that ALWAYS includes all of them!
I get a flu shot every year. The original billing always shows two charges: ~$25 for the vaccine and ~$15 for the "labor". Despite the fact that the federal government often provides the vaccine free of charge! (and, does it
*really* cost $15 to jab a needle in someone's arm?)
[I would have to check last year's bill to see what the *actual* charges were and their "repriced" valuations]
The negotiation happened long before the blood was drawn. You can *claim* it isn't a negotiation but, rather a "declaration" on the part of the insurance company. But, the doctor can refuse to enter into a contract with the company -- he's not FORCED to do so. Thus, the insurance company has to balance how tight they want to turn the screws before running the risk of alienating entire practices (and, folks "talk" so it's likely that other practices will also refuse to sign up... eventually, the insurer loses customers because the available doctors can't meet the needs of the patient base)
The unfortunate reality is that it is IN THE BEST INTERESTS OF INSURERS for healthcare costs to be high AND increase! While it may sound counter-intuitive, would *you* carry health insurance if you could get your "body" repaired for prices comparable to auto repairs??
You also get free vaccines, colonoscopy, etc. There's a fair bit on the "free" list that previously was (optionally) covered by your insurer.
You really don't get it do you? That list will *always* have names of doctors who leave the plan. I suppose they could get the list updated more frequently... or you can take some responsibility and contact the doctors yourself. Most importantly stop blaming the government for the status quo. *EVERY* insurance company has the same sort of stale list.
It is an Obamacare problem. In order to finance at least some of the welfare expansion that comes with Obamacare they thought "Oh, lets just cut reimbursement rates, that'll fix it". Well, it sure didn't. It backfired. There's people out here who are fuming mad. Same in other states because this is not at all a California-only problem, that was just one out of tons of examples. Needless to say, and predictably, this contributed so "Shellacking 2.0" which provided a landslide shift in Washington.
AFAIK they never joined. But were listed anyhow.
Yup.
The list had lots of doctors on there who never agreed to participate in the first place. Now what would you call that?
A proper freshly made list does not have this many fake entries. But this one did. Another government program at its finest.
And where does Obamacare dump the welfare sign-ups?
The reality out here is this: People on zero-pay welfare plans don't really care about costs. The people who were forced into a high cost Obamacare plans could usually only afford bronze level with very high co-pay. However, they don't have that kind of money. Many are up to their ears in credit card debt because of poor choices they made. So, short of relying on payday loan sharks needed medical care gets postponed, procrastinated upon, self-medicated, until one fine day the people end up in the emergency room. Just like they did before.
It is a necessary first step. Once we have the lion's share of the population covered it will be much more apparent that the problem is not the government or entirely the insurance companies. Rather the problem is the health care system that is designed for and by doctors.
I am not likely to live long enough to see it, but I expect in 20 or 30 years we will have a single payer system like most of the civilized world. It is the only health care system that makes any sense just like public water, roads and schools.
Didn't your mama never tell you: "nuttin' fur nuttin'"? :>
The problem is healthcare dollars in the US are spent in the wrong places.
This is because doctors are paid based on how *much* they do (regardless of how *effective* it is -- imagine being paid to repair a power supply; would you ever think of *improving* the design or choice of replacement parts if it would CUT your future business? I.e., what's the DOWNside of just repairing it to its original, poorly designed condition??)
And, because consumers (patients) want "no expense spared". They act as if they are ENTITLED to unlimited healthcare simply because they have been paying an insurance premium (directly or indirectly, via employer).
My S/BinL couldn't conceive. Insurance shelled out $50K over the course of a few years because they were "entitled" (?) to bear children! Of course, THEY were subsidized: by you, me and everyone else who "used" less healthcare than we paid for.
When I first moved to Chicago, I didn't have a local MD. Ended up with tonsillitis a week or two after arriving. Visit one of those walk-in care places. "I've got tonsillitis" (I've had it enough to know the symptoms by feel *and* sight) OK, MD doesn't want to take my word for it... that's understandable. A few minutes later, "You've got tonsillitis!" (gee, where have I heard that before?)
Writes me an Rx for some antibiotic I'd never heard of (I've a long history with antibiotics so know most of them by name). And, offers to save me the trouble of going to drugstore as they will dispense this (broad spectrum) antibiotic out of their own, on-site pharmacy. I quiz him on the name/nature of the antibiotic. yada..yada..yada.. "something NEW!" (yeah, something the drug rep asked him to PUSH earlier this week!)
"Is there any reason I can't take erithromycin? (sp)" He frowns. Then shrugs. "It bothers some people's stomachs..." "No problem. I'll eat something before I dose myself!"
[I have a fair number of allergies so I'd be much happier living with something I already *know* than risking a new "miracle drug" that is going to cost me more and have unknown consequences on my organism]
His Rx was $2/tab. The e'mycin was $0.25/tab. WHAT WOULD JOE AVERAGE PATIENT HAVE DONE IN THAT SITUATION? (i.e., would he have questioned the Rx? Would he have asked re: cost?
[Free Viagara on Medicare?? Gee, when do you think you no longer "are entitled" to an erection? Willing to live with blindness, deafness, etc. as natural consequences of aging. But, someone *else* should pay for you to be able to have geriatric sex??]
At the other end of the problem, you have people who defer treatment (out of fear or lack of funds/access) and end up with bigger problems.
And, you *always* have folks who would much rather ignore the advice of doctors (diet, exercise, rest, stress, etc.) and then end up with more expensive maladies that could have been prevented if they hadnt been so lazy (or selfish).
Neighbor grumbled because he was Dx as NIDDM (Diabetes 2). Despite the doctor's (actually, doctors' is more correct!) continued warnings about weight, lack of exercise, poor diet, etc. But, no real problem as he can take meds and deal with the problem.
A few months later, the heart attack came. Again, grumbling about the DOCTOR... because the doctor had warned him of this along with the diabetes, etc. But, no real problem as he can do the outpatient cardiac rehab, etc.
A few months after that, the stroke. Again, grumbling about the doctor.
Christ! How many times do you need to hear "I told you so" before you start thinking, "Gee, maybe this guy actually KNOWS what he's talking about!"
Last time I was in their house, the "exercise room" (an entire room set aside for exercise equipment) had a thick layer of dust on it. The only item that appeared to have been *used* in the room was a chair... and the use was evident because the chair had broken under the *weight*!
One of the necessary requirements for controlling healthcare costs is to have a healthier population to begin with! You can never hope to keep control over a "system" where there are no constraints on the "controlled variables". People grumble because smokers are charged a premium. But, grossly overweight aren't??
OTOH, when do you cross over into being a "nanny" state? "Your premium is higher because you don't eat brussel sprouts!" :<
Talk to a knowledgeable financial planner and the single best important piece of advice they will give you is to attend to your health. To not NEED healthcare -- even if you are forced to pay for it!
What?! They certainly negotiate the rates they (and therefore you) pay the hospital and doctors. I figure they (or I) pay between $.10 (tests) and $.40 (hospitalization and surgery) on the charged dollar. My insurance company made a hospital eat the cost of an admission and an overnight when they decided that the problem could have (and was) treatable without the admission (in the ER). I call that negotiation.
I can't tell you why they can't keep it up to date. But no insurance company I've ever dealt with claims their list is accurate and they even have language in the policy that you can't rely on it. The only way to be sure is to call the insurance company from the doctor's office while you wait for your appointment.
You snip all the relevant content and then argue with my conclusion. No, you don't argue, you just contradict and insult.
"Doctors join and leave plans all the time. " Do you dispute that fact? Doctors often change plans when they feel they can get more revenue from another provider.
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