Comments on: Why the Health Insurance Industry is Backing Hillary

By: Matt Horn

Matt Horn — Fri, 16 Nov 2007 22:09:15 +0000

The only way I would correct the analogy is that the house is already built and in need of repair. Do we fix the electrical first or the plumbing? Thanks for you insight, we all see it from different angles, but I think it is great that we are having these discussions.

By: drmatt

drmatt — Fri, 16 Nov 2007 16:53:27 +0000

As I have said before, I doubt there is one person who understands the whole system in all it’s complexities, being such I do not believe that band-aids applied by people like catron, or for that matter the people he criticizes is going to fix anything. We must first decide what we want from our medical syste, exactly in detail, and only then can we talk about how to design and build it. This is like talking about how to build a house before we know how many rooms we want, how many bathrooms, what kind of heat and so on.

By: Matt Horn

Matt Horn — Fri, 16 Nov 2007 16:19:05 +0000

Thanks for the insight drmatt, I am a big proporent of transparency and it looks like there are more hurdles out there that we need to look into before we can move forward.

By: drmatt

drmatt — Fri, 16 Nov 2007 12:02:08 +0000

Matt, The insurance company doesnt get a discount strictly, as a provider under their plan they pay me the MAB (maximum allowable benefit) that I have agreed to take because I signed the contract. This amount is different ins. co. to ins co. so it really is impossible to tell you the rate, it is also diff provider to provider. there is bargaining power in numbers, a large practice is likely to get paid more than a small practice providing the same service, to top it off, it is illegal for me to talk to other practices and compare what I get paid for a particular service compared to what they get paid!!!! They do update you when reimbursement changes but not in a timely fashion, usually once a year and it doesn’t matter when they changed it, strictly speaking this is not a contract change it is just a change in rates, they can change them four times a year if they want to, the contracts are written by the insurance companies so like credit card contracts it is a “take it or leave it” deal. This update comes in a rather sterile envelope in the mail with the thousands of other pieces of mail that deluge a practice. It cost money to go through all those codes in the computer and make changes too. I may be able to find my original grid but it is three years old. For Medicare you can go online and get thier reimbursement rates, however it will be meaningless unless you know what the codes mean. 99213 is the most used code which represents an acute/simple problem, cold, sore throat, knee pain, you could start there.

By: Matt Horn

Matt Horn — Thu, 15 Nov 2007 22:44:36 +0000

well guys, I think we are all on the same page with transparency, just a different sentence. drmatt, that grid is exactally what I am talking about. I want to know what it would cost me based on your grid not necessarily get an advantaged rate. If I am insured, I want to know what the discount is. If I am a cash payer, I want to know what the price is. Rich, I know most have coverage, but some of us don’t use the old co-pay system and would like to know costs up front. drmatt, do the companies not send out updated reimbursment sheets? I would think they would be contractually obligated to do that. I know my key carrier doesn’t change contracts mid year, and usually sends someone out to deliver them if there is a change after that period.

By: Rich

Rich — Thu, 15 Nov 2007 19:31:17 +0000

Oh, so you mean the charges, not the underlying cost.

In my pracitce, the average guy on the street IS the guy with the contracted rate.

By: drmatt

drmatt — Thu, 15 Nov 2007 19:17:25 +0000

Matt, I am sorry to hear you dont think it would effect cost, in my small solo practice, overhead directly related to insurance company billing/reimbursement requirements was 8K a month or about 100K per year. can’t imagine getting rid of that wouldnt bring down costs. As far as the “average guy” bill, the insurance companies require that you charge everybody the same, you can’t give out pricing advantages it is illegal. The way I devolped my pricing schedule was like this, I drew a graph, billing codes down the side, insurance companies across the top, I filled the boxes with what the insurance companies said they would pay for something, then I found the highest reimbursement for any given billing code and added 15%, that is what you would get charged as an average guy. By the way, the 15% was so that you would catch increased reimbursement rates, they routinely not tell you when reimbursement was increased and you couldn’t collect it if you didn’t bill it.

By: Matt Horn

Matt Horn — Thu, 15 Nov 2007 17:17:23 +0000

Rich, I want to know what they charge as a line item per CPT to the average guy on the street. Of course, I also want to know what the insurance contracted rate is as well.

By: Rich

Rich — Thu, 15 Nov 2007 16:42:31 +0000

“I want to know not only the doctor’s cost…”

That’s interesting - do you mean globally/in general/on average, or the costs incurred by a specific doctor?

By: Matt Horn

Matt Horn — Thu, 15 Nov 2007 15:19:57 +0000

drmatt, while I don’t believe that eliminating insurance would have any significant effect on the cost of care, I do agree that we need full transparency. I want to know not only the doctor’s cost, but also the insurance company’s contracted rates so I can make a more informed decision. I left the co-pay world years ago, and would like to see how that would effect the market as a whole, but am also concerned with freedom of choice for the consumer. It really is silly to pay more for a haircut than a trip to the doctor.