$350 per year to remain a patient?

[Rustic23]

I just got the medicare bill for a Colonoscopy.
Doc charged $2,500. Medicare paid $400, I think TriCare paid about $200. I have not gotten the tricare statement yet.

Now, my guess is most people would be glad to pay what Medicare paid, and maybe even the Tricare payment. It is the $2,500 bill that scares people. So maybe if doctors would let people know what they will actually take for a procedure, they would acquire more leverage with Insurance companies as people drop them.

 

[ziggy29]

Supply and demand, I guess. If particular doc is so highly sought that demand for his/her services outstrip the number of hours in the work day, might as well milk it.

Still, traditionally such a doc would simply stop accepting new patients. I guess this is the brave new world of capitalism and medicine.

 

[Marquette]

If you define health care as no different from any other small business, you will eventually see the principles acting in their own competitive interest.

In light of that, one of the trends in retail is to fire your worst customers. A small percentage of customers cost retailers an inordinate amount of money. Sprint recently cancelled accounts for a handful (maybe 1,000?) customers that were a net negative.

Maybe one reason for the fee is that, in addition to getting some money to pay off those student loans, you end up with a client base that is, obviously, more willing to pay for service. This means you are able to drop the people that consistently go 90 days late on paying their bills, the complainers (I'm guessing that mental bias will shift once someone willfully pays $x and they'll start to assume they made the best possible decision), the people that were primarily after high-touch, low-profit services, etc.

 

[Rich_by_the_Bay]

In light of that, one of the trends in retail is to fire your worst customers. A small percentage of customers cost retailers an inordinate amount of money. Sprint recently cancelled accounts for a handful (maybe 1,000?) customers that were a net negative..

As in any business open to all comers, 5% of the patients account for 90% of the maintenance - demanding, threatening, don't pay, drug seeking, doctor hopping all the time rather than sticking with the agreed-upon plan, calling after hours for routine refills, etc.

While patients are occasionally asked to find a new doctor, it is problematic. First, the reasons behind such behavior often relate to fear, vulnerability, the underlying illness, depression, loss of control, and displaced anger. Culturally, the profession tries to address those things as part of the patient's health so the threshoold for "giving up" is very high. Second, abandonment during an active illness is both unethical and legally dangerous even if due process is followed.

It's hard to predict how an annual fee would affect that. I guess you'll still have that small group of "problem patients," but they'll at least pay their bills. .

 

[growing_older]

We have a pediatrician who is wonderful. He's been limiting his practice to no new patients for many years and if he instituted such a fee, I would gladly pay it.

If I were seeking a new doctor and I had to pay the concierge fee before I even got the know the doc or before I had a chance to see the kind of care that was delivered, I'd be pretty reluctant to do so. I've had to change doctors several times due to limits on who accepts what insurance plans and of all the doctors I've seen, I cannot think of one who would be worth such a fee. Maybe that means I need to look for another new one again and not settle for adequate.

 

[Gotadimple]

Now, my guess is most people would be glad to pay what Medicare paid, and maybe even the Tricare payment. It is the $2,500 bill that scares people. So maybe if doctors would let people know what they will actually take for a procedure, they would acquire more leverage with Insurance companies as people drop them.

Rustic, can you clarify this statement (in bold)? People drop insurance? or People drop doctors?

In the case of Medicare, the fee schedule is designed to cause a loss of income -- to be made up from patients who are on group or individual policies and are younger than Medicare age. The government expects industry to subsidize it's programs -- that includes the insurance companies who process the claims and answer the phones for Medicare beneficiaries. No one benefits in government administered health care programs (unless they're committing fraud!).

Physicians have a fee schedule of what they would really charge (called usual and customary) -- insurance companies negotiate a fee DOWN from the UCR because they are providing the physician with a stream of patients where payment is certain. Medicare, OTOH, is a take it or leave it proposition -- if you're a doctor and want to see Medicare patients, you take the fee schedule or you don't see them at all. Which is why many physician practices no longer see Medicare patients.

At any rate, I'd be interested in you clarifying your statement above.

-- Rita

 

[jIMOh]

I just got the medicare bill for a Colonoscopy.
Doc charged $2,500. Medicare paid $400, I think TriCare paid about $200. I have not gotten the tricare statement yet.

Now, my guess is most people would be glad to pay what Medicare paid, and maybe even the Tricare payment. It is the $2,500 bill that scares people. So maybe if doctors would let people know what they will actually take for a procedure, they would acquire more leverage with Insurance companies as people drop them.

The biggest problem with healthcare is people want something (health care) and are NOT willing to pay for it.

I know of no other industry with as much price controls and middle men as health care. Maybe my gas and electric bill... maybe.

 

[Rustic23]

While I used a recent procedure which was covered under Medicare, in the past couple of years I have seen statements from Medicare and from a private insurance. In both cases the amount charged was greater than 50% of the amount the doctor accepted.

I doubt if any lay person not affiliated with the medical field could give you a true idea what a procedure actually cost. And, by that I mean what the client pays, not what the medical industry says they spend.

I have never seen your statement that Medicare fees are designed to force the doctors to operate at a loss in writing. Is there a reference for this? I am not looking for a p*ssing contest. Your post sounds well informed, I was just wondering what is the source. If it is true, then obviously a national medical care program along the lines of medicare is doomed from the start.

 

[Rich_by_the_Bay]

I have never seen your statement that Medicare fees are designed to force the doctors to operate at a loss in writing. Is there a reference for this? I am not looking for a p*ssing contest. Your post sounds well informed, I was just wondering what is the source. If it is true, then obviously a national medical care program along the lines of medicare is doomed from the start.

I do not believe they are systematically designed to cause the provider to lose money, but there are many situations where that is the case. And of course, a breakeven situation is a losing situation due to overhead or the opportunity cost of additional time.

MC used to reimburse about $40 for a house call. A loser. $75 for a comprehensive office visit. A loser. Don't have the exact numbers but it was not rare for this to happen. A national program would have its challenges in that regard, agree.

But National Health Care isn't even remotely on anyone's agenda for the foreseeable future. Lets get everyone covered first, including the unemployed and indigent. Then we can work on tweaking the system.

 

[NW-Bound]

MC used to reimburse about $40 for a house call. A loser. $75 for a comprehensive office visit. A loser.

Thanks for info. Until recently, when I stopped being covered by my employer's insurance, I did not bother to know about true medical cost. Not my problem!

Well, now that we are on $10K /annual deductible, I care, and really want to know how the system works.

You did not state the time for those numbers. However, I remember > 25 years ago, a Sears repairman charged me about that (or more?) for a house call. It was just to diagnose the problem, after which he gave me the part number to buy and replace myself.

And people always think all medical doctors are getting rich. Thanks goodness I am an engineer (not that I have ever had any interest or inclination in a medical training).

 

[Rustic23]

Rich, what were the average insurance reimbursement for a house call and office visit. As I said not trying to make waves. Looking for education and who better than a doctor involved with it.
thanks

 

[Martha]

Rich, isn't a lawyer's retainer applied against future charges? This sounds more like a club membership.

Coach

Not necessarily. A retainer is often paid so that you can have the lawyer at your beck and call.

We really do have a crisis in primary care. Here is an area of practice where you have to be a super issue spotter, deal with the rigmarole of running a business, and get paid less than just about anyone else in your line of work. A yearly membership fee is reasonable in these circumstances.

 

[freebird5825]

Rich, what were the average insurance reimbursement for a house call and office visit. As I said not trying to make waves. Looking for education and who better than a doctor involved with it.
thanks

please keep posting, Rich. i'm also getting an education here too.
i have a really great doctor but we never have time to discuss stuff like this. we keep our discussions to medical issues with an occasional joke thrown in there. he is a very busy guy. and he's very supportive of my FIRE decision after the fact. he tells me this is the best i've looked since he's known me. and is totally jealous! LOL

 

[Rich_by_the_Bay]

Thanks for info.You did not state the time for those numbers. However, I remember > 25 years ago, a Sears repairman charged me about that (or more?) for a house call. It was just to diagnose the problem, after which he gave me the part number to buy and replace myself.

It is not time-based in most cases. If I spend 90 minutes it is the same as 30 minutes. Not to mention transportation time or costs. Reimbursement for those: 0.

 

[NW-Bound]

I did not phrase the question correctly. What I meant to ask was the time frame (year) of your number, so I can guesstimate the effect of inflation, and not the duration of the visit. I read that you have been in academics, and so thought your number might not have been current. It cannot be current, can it, judging from the low number you cited at $40/house visit?

The Sears charge was also inclusive, meaning out of my pocket, without extra for travel. So it is compatible with your number. I know it sounds demeaning to compare a doctor's visit to an appliance service call, but people may need to see how Medicare reimbursements work. I am getting an education here.

 

[Nords]

I'd pay something to stay with him, but not $350 x 2 annually. For the first year...

So he made you an offer, and now you can make him a counter-offer. But you're no longer debating whether he's good enough or not, just how close to the line you think he is.

But again, before you negotiate I'd hope to have another doctor standing by to step in if your offer has a lower priority than the checks of his other patients...

 

[SarahW]

Hmmmm, I wouldn't even consider paying the $350 and I'd be looking for a new doc ASAP.