Originally Posted by free4now
The absolute worst part is the way doctors require patients to sign a statement saying if the insurance company rejects a claim the patient has to pay. Even if the doctor is "in network" for their insurance company.
If the doctor and insurance company have established a contract for working together to decide what procedures are covered, why should the patient bear the fallout when they can't agree?
A. If a doctor and patient decide a service is needed, the doctor provides that service, and the insurance company rejects it, you feel the doctor
should pay for it? Think we have a doctor shortage now?
B. Now the "the doctor and insurance company have established a contract for working together to decide what procedures are covered."
That's almost as common as the misbelief that doctors get paid by the prescription, or that the AMA runs medical practice in this country.
In fact, if the doctor signs a participation agreement with an insurance company, she generally agrees in advance to accept
whatever they deem the "proper" fee to be. For* noncovered services, it is between you and the patient; better to tell them in advance if a recommended service is not covered by insurance - unless you'd rather be surprised. Insurance companies often do not play nice with doctors; it is not a collusion, but rather an objectionable, reluctant and tense tug of war.
I used to make house calls to needy and elderly patients. The trip charge (about an hour round trip) was not covered by Medicare. I billed the patient a small amount for that (not nearly enough to cover the 3 additional patients I didn't see that day due to lost travel time). They were uniformly grateful, often not only paid the bill but threw in a batch of cookies. I always told them in advance that a travel fee was necessary or else I simply could not take the time to make house calls.
In fact, most doctors spend hours of time and money fighting insurance companies who on their own
decide that particular services are "not medically necessary" or are "not covered." The only doctors who work with
insurance companies to determine one-sided policies are the ones who work for
the insurance companies (i.e. on their payroll).
So, feel free to rant at the system (I do it all the time
)* -- I strongly support universal health care for reasons such as yours. Just wanted to clarify the misunderstandings.