WHISKEY TANGO FOXTROT -- $4,000 PROGRAM FEE!!
I understand that it does seem unfair. I am an idealist and see many things in life that don't seem fair and my initial reactions are the same as yours.
That said, I am an independent health practitioner. What I know from experience is that there are many things about the insurance/payment game that don't make sense. For example, a service that is listed with a charge of $130.00 may be paid at a rate of $62.00 by one insurance company, $78.00 by another insurance company and $101.00 by yet another insurance company. In order to see patients from any of the three insurance companies a practitioner has to contract with the insurance company, agreeing not to charge the patient more than the contract price the insurance company is willing to pay. Practitioners have to contract with insurance because there are not many people who are able to self-pay, therefore t not contracting with insurance would mean no clinic. Also, it is not financially possible to see only patients with the lowest end insurance, overhead costs are just too high. A doctor in a private clinic may have to find options for additional revenue in order to offset low insurance reimbursement rates. Hospitals often to not need to implement such tactics because they are often eligible for some time of government funding.
Again, I understand your frustration. You may want to check out a surgeon that is employed by a hospital as compared to an independent physician.
That said, I am an independent health practitioner. What I know from experience is that there are many things about the insurance/payment game that don't make sense. For example, a service that is listed with a charge of $130.00 may be paid at a rate of $62.00 by one insurance company, $78.00 by another insurance company and $101.00 by yet another insurance company. In order to see patients from any of the three insurance companies a practitioner has to contract with the insurance company, agreeing not to charge the patient more than the contract price the insurance company is willing to pay. Practitioners have to contract with insurance because there are not many people who are able to self-pay, therefore t not contracting with insurance would mean no clinic. Also, it is not financially possible to see only patients with the lowest end insurance, overhead costs are just too high. A doctor in a private clinic may have to find options for additional revenue in order to offset low insurance reimbursement rates. Hospitals often to not need to implement such tactics because they are often eligible for some time of government funding.
Again, I understand your frustration. You may want to check out a surgeon that is employed by a hospital as compared to an independent physician.
size 8, life is great
Doctors contract with different insurance companies. While they may have standard fees set for services, they agree to a certain rate with each company they decide to contract with.
Example - Doctor sets his office visit at $100. BCBS negotiates a contract with him to pay $50 for an office visit, Aetna contracts to pay $75. Each insurance company could contract a different price depending on the agreement between their company and the physician. If the doctor doesn't like the rate the insurance company agrees to pay for a particular service or services, they may decide to not contract with them at all, meaning a person would have to pay the full standard price whether insured or not. Make better sense?
I can fully understand a talented surgeon such as Dr K charging a fee above and beyond what the insurance is willing to reimburse, as the rates of reimbursement can sometimes be ludacris. If it takes the doc 6 hours to perform a complex surgery, and the insurance company agrees to pay $1500 of a $7000 fee, the doctor will constantly be in the hole. People forget to realize that the doctor does employ and pay a staff, and that he's not just sticking that money in his pocket and running!!!!
Dr. K also gives his time FREELY to patients who he hasn't even performed surgery on and likely won't. Myself included. I've had many conversations with the man on his OWN TIME (!) and he didn't charge me a dime. Any fool who thinks he is a con artist is too stupid for surgery, in my opinion. I couldn't speak more highly of this man, and would recommend him to ANYONE considering surgery.
Example - Doctor sets his office visit at $100. BCBS negotiates a contract with him to pay $50 for an office visit, Aetna contracts to pay $75. Each insurance company could contract a different price depending on the agreement between their company and the physician. If the doctor doesn't like the rate the insurance company agrees to pay for a particular service or services, they may decide to not contract with them at all, meaning a person would have to pay the full standard price whether insured or not. Make better sense?
I can fully understand a talented surgeon such as Dr K charging a fee above and beyond what the insurance is willing to reimburse, as the rates of reimbursement can sometimes be ludacris. If it takes the doc 6 hours to perform a complex surgery, and the insurance company agrees to pay $1500 of a $7000 fee, the doctor will constantly be in the hole. People forget to realize that the doctor does employ and pay a staff, and that he's not just sticking that money in his pocket and running!!!!
Dr. K also gives his time FREELY to patients who he hasn't even performed surgery on and likely won't. Myself included. I've had many conversations with the man on his OWN TIME (!) and he didn't charge me a dime. Any fool who thinks he is a con artist is too stupid for surgery, in my opinion. I couldn't speak more highly of this man, and would recommend him to ANYONE considering surgery.
Janice
320/170/150
SW/CW/GW
320/170/150
SW/CW/GW
First of all, I'd rethink that lapband. Do some research on THAT! If you want a story, let me tell you - THERE is your story.
Okay regarding program fees. Dr. K is a brilliant DS doctor. It is as simple as this - if you don't want to pay the fee, go somewhere else. I worked for a very large insurer for many years and I can tell you that program fees are indeed legal and we by no means became livid - we were all for it. It was $4000 that WE didn't have to spend or negotiate with the physician.
I understand where you're coming from, but it is coming across as much ado about nothing. There are many band surgeons (but seriously, don't get the band) who don't charge a program fee. I would simply choose one of them. If you want the best, pay to see Dr. K. If you cannot afford the fee, discuss it with the office but I don't think this surgeon is right for you as you fundamentally disagree with his practices.
Okay regarding program fees. Dr. K is a brilliant DS doctor. It is as simple as this - if you don't want to pay the fee, go somewhere else. I worked for a very large insurer for many years and I can tell you that program fees are indeed legal and we by no means became livid - we were all for it. It was $4000 that WE didn't have to spend or negotiate with the physician.
I understand where you're coming from, but it is coming across as much ado about nothing. There are many band surgeons (but seriously, don't get the band) who don't charge a program fee. I would simply choose one of them. If you want the best, pay to see Dr. K. If you cannot afford the fee, discuss it with the office but I don't think this surgeon is right for you as you fundamentally disagree with his practices.
Dr. K. doesn't do bands. She's actually (maybe) on board with the DS and had a big fit because Tricare doesn't cover it. So now she's worked out a new plan for insurance, to her credit, but is having a big fit because ONE SURGEON charges a fee she doesn't like.
But she's taking this on for the benefit of others, donchaknow.
FMR.
But she's taking this on for the benefit of others, donchaknow.
FMR.
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