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Why is medicine the only retail service that can't figure out billing?

Posted on 9/2/15 at 2:51 pm
Posted by Golfer
Member since Nov 2005
75052 posts
Posted on 9/2/15 at 2:51 pm
You get a cheeseburger meal from a restaurant and pay $8.95 not:

$1.95 for cook
$2.50 for use of the griddle
$2.00 for the burger and bun
$1.00 for the server
$1.50 for the condiments

All on separate bills, with different payment requirements and no explanation of what you are actually being billed for.
This post was edited on 9/2/15 at 2:52 pm
Posted by SouthOfSouth
Baton Rouge
Member since Jun 2008
43456 posts
Posted on 9/2/15 at 2:55 pm to
insurance covers different things differently
Posted by Golfer
Member since Nov 2005
75052 posts
Posted on 9/2/15 at 2:57 pm to
quote:

insurance covers different things differently



From a consumer's standpoint, I don't give a shite. I'm going in for one service. Figure it out.

If the MRI costs me $500 after insurance, send me one bill and deal with the rest of it on the back-end...just like every other retail outlet seems to do.
This post was edited on 9/2/15 at 2:59 pm
Posted by ashy larry
Marcy Projects
Member since Mar 2010
5568 posts
Posted on 9/2/15 at 2:57 pm to
quote:

All on separate bills, with different payment requirements and no explanation of what you are actually being billed for.



Not to mention no one can give you the price of anything in advance.
Posted by Teddy Ruxpin
Member since Oct 2006
39553 posts
Posted on 9/2/15 at 3:00 pm to
quote:

From a consumer's standpoint, I don't give a shite. I'm going in for one service. Figure it out.



I'm sympathetic but as the above said, every body is accepting certain items differently.

The consumer is probably the last priority on these things unfortunately.

Your fast food meal would look the same if you bought burgers through food insurance. It's a stupid system when insurance is used for every procedure. But ya, you'd think there would be a better way either way.
This post was edited on 9/2/15 at 3:02 pm
Posted by Croacka
Denham Springs
Member since Dec 2008
61441 posts
Posted on 9/2/15 at 3:01 pm to
What I can't stand is how cash customers typically get charged more


My current dentist is out of network for my dental plan and so I had to be reimbursed by my insurance company. Of course the amount paid by the insurance company doesn't pay for what the dentist charged me, because he didn't charge me the same "agreement" price that they will charge the insurance company.



Looks like I'll just have to change dentists
Posted by Golfer
Member since Nov 2005
75052 posts
Posted on 9/2/15 at 3:05 pm to
quote:

But ya, you'd think there would be a better way either way.


I get that the machine may be owned by one company, the doctor is self-employed, and then the drugs administered by someone else...but that should still fall on the responsibility of the actual office where the services were rendered to manage.

Process everything, route it back to the office, then send me one bill. Where I then pay one bill for the one service and that office will pay the doctor, etc.
Posted by Teddy Ruxpin
Member since Oct 2006
39553 posts
Posted on 9/2/15 at 3:11 pm to
I guess the thought process would be if you were a business owner, would you trust another entity to bill for you? Is that even common to do with a degree of separation like this would be?

I'd be nervous to bill like that, and maybe why it isn't done.

I'm curious why other models didn't work out like a contractor/subcontractor arrangement where the consumer would get one bill. Probably insurance again.
This post was edited on 9/2/15 at 3:14 pm
Posted by Golfer
Member since Nov 2005
75052 posts
Posted on 9/2/15 at 3:16 pm to
Well they are outsourcing their billing anyways to some call center in Dallas that can't answer anything.
Posted by MSMHater
Houston
Member since Oct 2008
22774 posts
Posted on 9/2/15 at 3:29 pm to
quote:

$1.95 for cook
$2.50 for use of the griddle
$2.00 for the burger and bun
$1.00 for the server
$1.50 for the condiments



That's exactly what your dinner bill would look like if each of those were their own entity, with their own scope of services, and their own tax ID.

Your surgery (or whatever) isn't a single service, like a meal, no matter how much people want it to be.

There are concierge healthcare services that allow a one stop shop for exam, diagnostics, medication, and billing...but the markup is SIGNIFICANT, and you would have to file your own insurance to recoup whatever you can.
Posted by Golfer
Member since Nov 2005
75052 posts
Posted on 9/2/15 at 3:31 pm to
quote:

Your surgery (or whatever) isn't a single service, like a meal, no matter how much people want it to be.


Again. From the consumer's standpoint. It is.

The sign out front doesn't say:

Baton Rouge MRI
Jim Smith, MD
Red Stick Imaging Equipment leasing, LLC
Doctors Assistants & Lab Techs, Inc
This post was edited on 9/2/15 at 3:36 pm
Posted by MSMHater
Houston
Member since Oct 2008
22774 posts
Posted on 9/2/15 at 3:31 pm to
quote:

I'm curious why other models didn't work out like a contractor/subcontractor arrangement where the consumer would get one bill


Medical billing can work like that, but there is alot of markup to the patient this way. Some people still choose it.

The concierge route/price at my practice covers your exam, labs, some meds, and any needed biopsies. In that scenario, I make sure each of those entities are paid their contracted rate.

On a normal, insured patient, I bill for the exam, labcorp for the labs, pharmacy for the meds, and Hospital or ASC for the biopsy, and you make sure each entity is paid.
This post was edited on 9/2/15 at 3:35 pm
Posted by LSUFanHouston
NOLA
Member since Jul 2009
37007 posts
Posted on 9/2/15 at 3:35 pm to
This only seems to be a problem when multiple providers are involved. When I go visit my doc for a checkup, I get one bill. If I go to the hospital, or have a surgery, then, yeah, it's a mess.

In a perfect world, you would have one "medical contractor" who would bill you, and then that doctor would hire all the "subs" such as the facility, the pain doc, etc.

However, each of the "prices" not only vary from sub to sub, but also vary based on the insurance company used by the patient.

As long as you have this fractured system of insurance, I don't think there will be much of a fix for billing.

This is one of the many reasons I've long wanted to see the idea of in-network go away, and just have everyone have their rates and the insurance companies pay their share and the individual pays their share. This works for auto insurance.
Posted by lilsnappa
Red Stick
Member since Mar 2006
1793 posts
Posted on 9/2/15 at 7:03 pm to
Salesforce is getting into healthcare LINK

Maybe there's hope after all, Golfer
Posted by Jag_Warrior
Virginia
Member since May 2015
4080 posts
Posted on 9/2/15 at 7:15 pm to
I feel your pain (pardon the pun). As more employers and insurance companies shift the burden to the medical consumer, straightforward billing becomes even more necessary. At a meeting last year, prior to implementation of our HD plan, we were told that we should "negotiate" fees with our medical providers. It's a bit difficult to do that, under even the most ideal, elective circumstances, when there's often no single point of contact available to negotiate with.
Posted by NOMT
Baton Rouge, LA
Member since Mar 2007
575 posts
Posted on 9/2/15 at 7:36 pm to
quote:

Again. From the consumer's standpoint. It is.

The sign out front doesn't say:

Baton Rouge MRI
Jim Smith, MD
Red Stick Imaging Equipment leasing, LLC
Doctors Assistants & Lab Techs, Inc


There's a push to do just that...bundle the payment and leave it to the hospital or whatever entity to split it up accordingly. I assume you are discussing a hospital bill.

Convenient for the consumer (maybe), and terrible for any practitioner (surgeon, etc) that does not do business under the auspice of hospital employment.

As a practitioner, I (or my group) contract with insurance companies. Why should I be subject, then, to whatever a hospital will pay me for a surgical procedure (which would be as little as they could)? You want me to contract additionally with the hospitals?
This post was edited on 9/2/15 at 7:38 pm
Posted by Golfer
Member since Nov 2005
75052 posts
Posted on 9/2/15 at 8:02 pm to
quote:

I assume you are discussing a hospital bill.


3 separate MRI's and X-Rays that have been performed at different outpatient centers of clinics or hospitals.

For instance we are just getting billed with the dye injection from a MRI from February. Why is that separate? If an MRI doesn't need the injection just have it billed as one line:

- MRI with injection $650
- MRI without injection $520

Not 4 different bills that have zero explanation of what the hell they are for.

quote:

You want me to contract additionally with the hospitals?


I want you to figure out how to be customer focused.
This post was edited on 9/2/15 at 8:09 pm
Posted by CajunAlum Tiger Fan
The Great State of Louisiana
Member since Jan 2008
7871 posts
Posted on 9/2/15 at 9:00 pm to
There are plenty of businesses that use a variety of independent contractors to get a job done, but send a customer one bill.

The healthcare system is broken on many levels including this one.
Posted by Tigerpaw123
Louisiana
Member since Mar 2007
17252 posts
Posted on 9/2/15 at 9:27 pm to
Quite simply, medicine is not a retail service, it is a professional service not a fast food restaurant. Frustrating, yes but for the level and convince of care that we have become to expect, it is what it is and the insurance companies and the fed government/Medicare have forced it this way. I can only promise you it would be much easier on the provider end to set a price and demand to be paid that, but then you are "out of network " and that starts a whole new butch session
Posted by Golfer
Member since Nov 2005
75052 posts
Posted on 9/2/15 at 9:56 pm to
In the economic sense, medicine is retail. You have a product or service for sale to the end user.

Law firms, CPA Firms, etc are all still high-end retail firms just like medicine.
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