Quote:no, but that brings up another point...the healthcare facilities charge so much because they know insurance companies will pay it...kind of like gas, we have to have  it so they can charge whatever they want to for it...I fully understand your argument, but I still say to charge such exorbitant  fees is nothing more than corporate greed...The healthcare industry needs to be revamped and regulated to ensure that consumers and insurance companies are not gouged with ridiculous fees for services because no one else can provide this service...

 

Actually, hospital payments rates are contracted for the majority of their patients. Medicare, Medicaid and Tricare are government programs, so you don't get to negotiate a rate, you simply take what they offer or don't participate. Commercial payers like Blue Cross, Aetna and United Healthcare negotiate individual contracts with physicians and facilities that pay on some percentage of the Medicare rate (good rates are 110 - 120% of Medicare, bad ones can be 80% or lower). Once the service is rendered the insurance company has the leverage because they can (and do) simply deny the claim and not pay it short of a judge forcing them to. They also deny claims for illegitimate reasons or say the service is the patient's responsibility and force the physician to rebill the claim costing labor time and a delay in cash flow or force the patient to spend time on the phone demanding they pay the claim. You've not seen corporate greed until you've seen how an insurance company works to hold on to their dollars!

 

The contracted rates also affect the hospital's fee schedule because the fee you send to the insurance company on the claim has to more than the contracted rate or they only pay the amount you bill. That constantly drives the fee schedule rates up because providers/hospitals are only allowed to have one fee schedule by law, therefore the fee has to be more than the highest contracted rate across your contracts.

 

All of these things factor in the administration of the health care and the need for this support is one of the largest influences on cost. In large provider groups the billing support staff requires at least 1 person for every 3 doctors. That's after the cost of the location, clerical staff, clinical staff, and supplies. But what choice do they have, either pay for staff to collect the money they're owed or go out of business. The same goes for hospitals but they gauge their staff need on number of beds and dollars in revenue. And none of this even covers government audits, insurance companies who take back the money they've paid by reducing or withholding payment on a different patient, the cost of IT in the new world of electronic medical records, or the cost of continuing education and compliance with ever-changing government requirements. One of my employees spends almost 2 months each year just reviewing and communicating the annual updates from CMS and ACHA to the Medicare and Medicaid programs. The bureaucracy of healthcare is something to behold and incredibly costly to the entire industry.

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