[quote=scaredyclassic]From the regular internist docs point of view, chasing down $ from insurance companies is more of a bureaucratic nightmare than I think even the most cynical among u can imagine[/quote]scaredy, I can imagine it because I have heard this from my providers, also. It’s especially hard for them now to know who to use for ancillary services such as lab and x-ray for each and every one of their patients. They’ve got to have competent people on staff who keep up with all these carrier nuances on where to send a particular patient (OR, in the absence of the patient, their “specimen”) to the “right” lab and the “right” radiology group. If they don’t (especially in the case of a patient specimen), the patient will get a “surprise” out-of-network bill that could be up to 10x the normal PPO reimbursement rate. If the patient has to report in person (in the case of a blood drawing or x-ray referral, for example) to the ancillary service, they can be stopped at the counter and told that that office no longer accepts their plan and then call their doctor and ask for a referral to a lab/radiology group which does accept their plan (a hassle but at least the patient won’t be gouged after the fact). But if their specimen is sent to a lab that their provider has always used (and the patient’s carrier has always covered in the past) and their carrier ends up rejecting the claim because they recently narrowed their network, (common these days) the huge OON bill is on the patient.
This actually happened to me last fall because one of my longtime doctors had shut down their practice a couple of days after my visit and was short-staffed in the days and weeks following (closing down the billing/books) and my “specimen” got shuttled to the lab it always went to before. However, my marketplace plan carrier had narrowed its network even further in 2015 and rejected the claim, leaving me with a $173 bill in which they paid $19 (and my pre-ACA carrier paid $34) for the same service in several past visits to the same provider (0 copay for me). On a small scale like this, I was able to negotiate a balance billing with the lab, which, if paid by a certain date, would not go on my credit report. It still cost me $125, which is nearly 4x the amount it should have cost. On a larger scale, this provider mistake could have been for lab work for a hugely expensive endoscopic ultrasound specimen which was sent “stat” to a lab while the patient was still anesthetized. What kind of OON bill would the patient be left with in this (common) scenario? The patient has no control over these provider back office mistakes and they sour the patient to ever using the provider again, because it cost them so much out-of-pocket unnecessarily, all due to their provider’s staff not paying attention to detail for each and every patient.
It didn’t used to be like this when the 6-8 major carriers’ PPOs were functioning side by side in SD. They ALL paid for ALL the major Radiology groups and labs in town. I do believe it is harder to run a medical office efficiently now due to the fickle carriers who lower their networks mid-year and eliminate providers without deleting them from their online provider lists and without sending member medical offices any notice that they have done so.
My marketplace PPO carrier reimbursements have also gone to sh!t in the past 12-18 months. My internist rec’d just $58.93 (0 copay) for my “intermediate established pt appt” (of 20-25 mins) last year but in years past, he rec’d $168 (0 copay) for the same type of appt, acc to my EOB’s. A sole practitioner, he has 2-3 FT front office personnel and 2 FT back office personnel in a leased office in a mid-rise bldg situated in a very convenient (and expensive) Hillcrest (SD) location.
How is an established and even renowned local provider with multiple hospital privileges going to survive on these tiny reimbursements? They would have to see 2-3 patients at once all day every day and run from room to room, while their support staff (and magazines) keep their patients (in dressing gowns) occupied while they wait for the doc to come back in from another patient’s room. It’s just crazy. I can completely understand why so few providers are willing to see Medi-Cal patients but the marketplace PPO reimbursements are now getting so low that I’m wondering what the actual current HMO and Medi-Cal reimbursements are for the same service :=0
And we’re not even taking into account how much (required) malpractice insurance costs these providers (varies wildly by specialty). The presence of the ACA has really screwed the providers in favor of paying the multi-layered bureaucracy to constantly mind everyone’s personal financial business who signed up for a plan (or Medi-Cal) on the federal and state exchanges.
Back to the STEM issue, I’m not sure if it’s worth incurring the crushing student debt to become an MD today. If one can go thru what it takes to become an MD without any student loans, then maybe it is worth it. But don’t expect to make what your predecessors (in your specialty) may have made in the past. A new MD has to love what they are doing and feel they are making a difference in their niche in society because I feel going forward that the “psychic rewards” (whatever they may be) are going to outnumber the monetary rewards of practicing medicine.
