B) Waaaaaaay long story short, having spent a few years designing physician office systems in the 90’s, I can say that insurance companies represented something like 90% of a physicians revenue stream. Though I cannot prove it in court, it is pretty evident to me that inscos intentionally, and sytematically engage in plausibly deniable behaviors that have a massive, improper and negative impact on that revenue stream. With properly filed forms that represent reduced costs to the insurance co, perhaps only a third was just simply paid in the expected 30 day time frame. The remainder would be lost, delayed, miscoded, and so on. 120 days later, IF you were well organized and had a billing staff dedicated to fighting for your revenue, you might get 70% of your billing. It was not uncommon back then for a small practice of 3 doctors to have a anywhere from 6-12 billing clerks in a back room.

As a result of this, medical practices have had to evolve as far away from this dependency, or literally go out of business.

Your physician is NOT the badguy here.

That is money grubbing no matter how you slice it. That is the “We want to tap the big cash pool of the insurance companies. We’ll make up the negotiated discounts on the uninsured. We get everything we want pricewise, we just use two pricing modules to attain it. The insurers get a guaranteed profit by getting a price break while setting rates based on full cost. Everybody wins. Well, except for the uninsured, the working poor, the young, but how much power do they have? See? Win/win.

The deal here is that the imaging center is willing to settle for say $70 plus your co-pay, However, if the test is somehow disallowed, they’ll try to bill you at their full cash price, say $500.

When possible, I’ll get the rate of payment from my insurance company, and write that amount as the upper limit on the contract before signing.

Getting the numbers from my insurance company is so much easier than getting the price from the receptionist. Odds are, they don’t have a clue and never negotiate prices with patents anyway.

The largest part of the problem we are having with healthcare is that the doctors don’t want to do this. I’m not talking about emergency care, I’m talking about ordinary medical service.

When I went in for a MRI that was covered by insurance, I could go to any MRI center in the state. I paid the same price, and my insurance payed out the exact same network negotiated rate. I had the procedure done in the “Open MRI” that was two blocks away during a long, late lunch.

However, I had plenty of sick leave, an I would be willing to drive over to the eastern shore and lie in one of those claustrophobic tubes if it would have saved me $100. The point I’m trying to make is that frequently, there’s no incentive to try to control costs. Since everything costs the same, I’m, going to the one that’s close on my lunch hour. I’m at the more expensive, newer imaging machine that isn’t like one of those tight tubes.

Likewise, if 60% of the population is only paying a $20 copay on prescription drugs, where is the incentive for big pharma to compete on price? I’m gonna pick the purple pill for my acid reflux because I saw that ad on TV and it costs the same as the slightly less expensive one that’s advertised less. I’m not even going to shop around to the different pharmacies for a better price, it’s a $20 copay at every store.

In fact, the only kind of medical services that are either flat in price or actually going down in cost are the elective ones like laser vision correction and cosmetic surgery. I wonder why that is?

I hope the ear tubes do the trick. Chronic/recurrent ear infections suck.