07-03-2019, 05:21 PM
(07-03-2019, 03:42 PM)GMDino Wrote: Oh my word yes.
My college roommate is a doctor now.
We had a discussion about how he has to charge (round numbers here) $75 to collect $50 from the system. So he has to charge EVERYONE $75 or it would be Medicare fraud. And he really only wanted to charge $50.00.
So I, being the problem solver that I am, suggested he just charge everyone $50 and settle for the 37.50 he'd get from Medicare.
His answer was "Do you know how much I owe in school bills?! I need $50 from everyone."
Nonetheless he WOULD charge less if he could...according to him.
Prices are negotiated between the insurance carrier and the medical providers. No one is dictating prices to Medicare. But, large networks can negotiate better prices, with BCBS of GA for example, by refusing to accept it and all their clients are out of network and decide to change insurance. Thus the insurance company loses revenue. Same applies to larger insurance carriers. They can dictate prices if most of the patients in an area have their insurance and if the providers don't accept their reimbursement rates the provider will lose patients and suffer financially.
That's why there is a trend for big companies buying up smaller companies to increase their negotiating leverage.
So patients with different insurance carriers pay different prices for the same services.
Plus there is the constant price creep your friend described. He has to charge more for something because the insurance company tries to reimburse for less. They nickel and dime you on everything. Thus both the provider and the insurance carriers need large billing and coding departments to maximize their respective revenue.
