I had no clue.
Through our convoluted health care system, I have no idea what the cost of my services I provide to my patients will cost them. You see, I'm employed by my hospital system. I earn a salary from the hospital system. The amount billed to a patient is dependent on rates they set, not me. And those rates are typically inflated well above what the hospital will receive from an insurer for my services. And of that, an individual patient has to pay their co-pay, which varies from insurer to insurer, and a deductible, which varies from insurer to insurer. And how much of their insurance premiums are going to the care I provide my patients? Really, it's impossible for me to determine what I cost a patient.
And for those without insurance? OMG. I have no idea how this is handled. Seriously.
But it turns out we'd better start learning.
It seems the New York Attorney general's office has asked the insurer UnitedHealthcare to halt its planned introduction of a method for ranking doctors by quality of care and cost of service, warning of legal action if it did not comply:
Linda A. Lacewell, a senior lawyer in the office of Attorney General Andrew M. Cuomo, wrote in the letter that the ranking would apparently be used to steer consumers toward selected doctors. “To compound the situation,” she wrote, “we understand that employers may act on these ‘ratings’ to offer financial inducements such as lower co-payments or deductibles to promote ‘cost-effective’ doctors to their employees.”But there might be a bright side to this bogus website the UnitedHealthcare wants to publish: maybe with this program I'd find out how much I cost UnitedHealthcare.
Ms. Lacewell said patients might be steered toward doctors based on flawed data and UnitedHealthcare’s “profit motive.” She wrote, “Consumers may be encouraged to choose doctors because they are cheap rather than because they are good.”
But I still won't find out what I cost my patients, will I?
-Wes
Dr. Wes,
ReplyDeleteEven when you are in solo practice as I am, you may still have a tough time "knowing" what the patient will end up paying. I know what I charge. I don't usually know what their insurance "allows". Then we have to figure out whether I (and the hospital/ surgery center) will be considered in-network or out-of-network. I am usually out-of-network, but when there is not a plastic surgeon within a certain distance (50-100 miles) can be considered in-network by some insurance companies. Then you have to find out what the patient's policy says is their share (deductible + % of allowed). I can generally give them a fair ballpark amount, but that's all it will be. I feel I am much more "transparent" with my charges than the insurance industry is with their payments. Oh well, you and I get to see both sides (consumer and provider). I remember this when I am dealing with patients.
Enjoy you blog. Keep up the good work.