One thing to keep in mind is that a lot of healthcare facilities charge private insurance more because Medicare pays so little. In a lot of cases its really the only way they can stay afloat.
Again, speaking from experience as a manager of an EMS company in NJ. Regardless of how much was done for a patient by a paramedic team, Medicare would only reimburse a small amount (somewhere around $100 - which in some cases will not even cover the cost of the medications given). And, if there happen to be 2 paid organizations (the paramedics and local BLS - since NJ was, and still is, a 2 tier EMS system) it was a race to bill Medicare because whoever billed first got the money. My company's patient base was pretty steady at 65% Medicare patients. So , they have to make up the difference somewhere. They do this by charging other patients, who have insurance, a higher rate, and/or negotiating a rate with insurance companies. I will say that we were also very good about helping out people who could not afford to pay, or could only pay very little. We had people who paid as little as $5.00 per month, with no interest or finance charges, to pay off their bill. We also wrote off a lot of charges to 'charity care' for those who could bot afford even $5.00 a month. I imagine if the Medicare reimbursement rates became the standard, we would see a lot of medical facilities close up shop. There is just no way to break even, much less turn a profit at those rates. On Wed, Aug 19, 2009 at 9:51 AM, Gruss Gott<[email protected]> wrote: > > From Forbes, here's one huge reason why your healthcare costs need to > be financed with insurance: > --------------------------- > > In simplest terms, it works like this: Doctors and hospitals determine > "list" prices for procedures, but hardly anyone pays those fees > (unless they're uninsured). > > Rather, they pay their portion of a rate negotiated by their provider > and insurer. If the insurer is Medicare, Uncle Sam sets the rate. > > Because of this system, patients typically have little idea how much > procedures actually cost and how much their insurance is willing to > pay until they receive the bill in the mail. Doctors don't have to > compete to provide good care cheaply, and both insurance companies and > the government are able to exercise considerable market power in > negotiating prices. > > A recent report by the industry group America's Health Insurance Plans > inadvertently highlights the problem. > > The report, meant to highlight private insurers' role in keeping down > costs, also shows how distorted the pricing system has become. One > example: An out-of-network doctor in California billed $4,500 for an > outpatient office visit for which Medicare would only pay $145. > > Expensive diagnostics are lucrative for doctors and comforting for > insured patients, who can blissfully ignore the high costs that > ultimately get redistributed through higher premiums. > > http://www.forbes.com/2009/08/18/health-care-prices-business-washington-reform.html > > ------------ > SIDE NOTE: keep in mind that doctors can negotiate with any insurer > they like. In other words, providers can be Medicare only, Medicare + > 1 private insurer, or everyone. That increase those admin costs > because now the provider has to service every claim form on the > planet, but it also means he can pull the ole switcharoo: > > He can pretend to love Medicare, while giving priority appointments to > his highest negotiated rate for common services. And it might be his > admin staff that makes this decision so he/she might not even know! > > For example, if I'm an admin for Dr. Johnson I might decide I like > Medicare patients because of the *volume* of services they're likely > to need, but also choose to give priority appointments to patients > with insurance coverage X because we've got the best negotiated rate > with them. > > And, of course, I'd LOVE uninsured or underinsured people because > they'll be paying my list rates. > > And also keep in mind that doctors aren't employees of a hospital; > they're bringing their insurance patients there in exchange for perks > which the hospital bills back to insurance via those negotiated rates. > > So that doctor that likes to commute by helicopter? That cost shows > up in the hospital's rates. Which raises premiums and causes > bankruptcies. > > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~| Want to reach the ColdFusion community with something they want? Let them know on the House of Fusion mailing lists Archive: http://www.houseoffusion.com/groups/cf-community/message.cfm/messageid:302191 Subscription: http://www.houseoffusion.com/groups/cf-community/subscribe.cfm Unsubscribe: http://www.houseoffusion.com/cf_lists/unsubscribe.cfm?user=89.70.5
