medical cost and insurance vs quality of treatment observed

Grumpy

Grumpy

The Grumpy Grease Monkey mechanical engineer.
Staff member
one of the specialist doctors, Ive had for about 25 years now has performed a standard series of annual tests
just to verify Im in reasonable physical shape, I have two types of medical insurance from two separate insurance vendors,
both the fees and coverage are a bit higher/ better than your average medical policys.
(plus I have medicare advantage)
for 24 plus years I have had a standard series of annual tests done and my insurance has covered the costs.
well last month the doctor I was using retired , just before my annual test date,
my endocrinologist ,hes my age (mid 70s) retired, and the doctor taking over the practice is a woman in her early 30s,
I show up for the scheduled annual test and the waiting room nurse informs me that the new doctor who is taking over the practice, now charges $250 for each of the several annual tests performed,
and that's over and above what the insurance pays.
I stated that seems a bit difficult to justify in my opinion as up until the change in doctors,
and for the last 24 years, every annual test has been covered.
the specialist doctor practices, charges were always covered, so I ask them to check,
and rescheduled once they see my insurance covers the cost!
I get a letter today, stating the doctor will no longer provide services, as I refuse to pay his new upgraded charges.
I simply said well, I guess Im no longer in need of his services.
they act shocked that I won't willingly kick in close to $1K , they offer to bill me over three months if that will help?
I just restated the obvious... I refuse to pay his up charges as my insurance already pays more than most insurance pays.
honestly the practice and charges seem to be a SCAM, I checked with my primary doctor to see if theres been a any issues with my insurance or reduction in what they cover... he stated that theres been no reduction or changes
 
I got to thinking about this... lets assume the new doctor gets paid $250 for each test from the insurance and $250 in his/her upgrade charges
thats $500 per patient, and I know the test takes about 45 minutes , but the testing done by office techs not the doctor, which I rarely saw for more than 30 minutes if at all other than to stop bye and briefly chat.
if the doctor grossed $500 a patient and only saw each only once a year, if he/she sees, maybe 12 a day,
and if he/she only works 4 days a week and only 45 weeks a year, so he/she can take 7 weeks vacation,
that alone would in theory result in about
1 million in revenue, and you know without doubt, theres a great deal more revenue being generated, through prescription's scheduled minor surgery etc.
yeah, he/she has office, supplies and staff expenses, insurance etc, but Id bet the cash flow was already far exceeding that level,
if each patient kicked in what I was expected to pay the practice would be easily tripled that or more!
hey everyone deserves to make a decent living off their skills but ,
it seems like this new gal wants to retire comfortably financially set by the time he/shes 50 or so!
 
Have you tried calling your insurance provider about the surplus fees this new doctor is pushing to you? Most insurance providers have contracts with health care professionals to accept a given amount for procedures and that’s it.
What good is it for any insurance carrier to stipulate you must meet some pre-determined deductible before a scheduled copay begins if the doctor charges excess fees for covered services.
My insurance is the typical program - once I put out $6500 in medical costs including prescriptions everything is covered 80/20 until I spend another $1500 then everything is covered 100% up to $500,000 per individual. This is a contract agreement that cannot exist if any in-network provider just arbitrarily bill you more for covered services.
For years now, we pay out of pocket nearly $8,000 to $10,000 by the second week in February every year so right about now everything is covered 100% until December 31.

What you may not know - there are seemingly endless compensation perks out there for doctors and healthcare providers (those that have the ability to direct patients to other services and hospital managed services) to reimburse college tuition, office and staffing costs, malpractice insurance and more. The typical small time doctor in private practice in a no-frills operation makes a minimum of $375,000/yr. Including those Jr level drs in medical practice with a team of other doctors in a shared practice. Once that practice refers a patient to a particular hospital for outpatient services (run by that hospital), that hospital typically pays substantial fees to the practice. It may be the cost of their office, tuition paid, staffing and additional accreditations. The typical doctor who‘s practice is by name affiliated with a hospital makes in excess of $750,000/yr. An open MRI machine generates more than $32 million of income per year, a cardiology team that provides exploratory venous catheterizations generates revenue in excess of $26 million per yr. A typical physicians practice of 4 staff doctors and 2 PAs or nurse practitioners are expected to outsource at least $150 million in hospital services per yr. It’s easy to see how big the system becomes and how much money is out there.
Part of what is hidden is why insurance providers insist that everyone must have a Primary Care Physician of record regardless if you have a PPO or an HMO plan and it’s not for controlling errant medical costs or procedures like you may think. It‘s primary to aid medical providers for their contract referrals under the insurance providers agreement.

Don‘t think for a moment that your cherished politicians are left out of the compensation circle. The average hospital pays forward more than 8 million each yr to each party.
 
thank you for that info,
btw how are the knee replacements working/any pain?
 
No pain whatsoever however I don’t have the range of motion I expected. My left leg beds more than my right leg at this point. At times I feel the range is improving ever so slightly. This past fall and winter I basically vegetated but as the weather breaks soon I will be outside trying to get ahead of the landscape neglect from last year.
Hopefully I can get going on building a garage this year and all this work will get my strength back. It’s a major problem sitting down on restaurant chairs that have seats 15” and 16” high and armless. So much of what you never have to think about has now become a challenge to pull off.
 
yeah! I know the drill... pain sitting. moving, getting back on your feet..thanks for the update!
 
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