Bargaining Down the Price of that CT Scan is Now Possible

Click here for an interesting dialogue on health care pricing at the New York Times.
Here is a sample letter:
17.
February 27th,
2007
7:00 am
I would like to know who told you that Physicians negotiate pricing with insurance companies? And have you ever looked at the size of a CPT Code Book that contains Common Procedural Terminology that physicians must use correctly inorder to get reimbursed? Doctors themselves do not know what they are going to get reimburse because the Usual and Customary Rate changes by region. In New Jersey it was or is being modified from Regions A,B, and C to Regions 1 and 2. This is determined by Zip Code. Then the insurance companies utilize data from a company like Ingenix (owned by United Healthcare) to determine a fee. This data is accumulated by Ingenix to help the insurance industry keep track on the cost of services by code. In addition, they provide physicians with a Fee Analyzer (all is not fair in love and war!) to modify their fees or price themselves in line with the average price in the Region 1 and 2. It really doesn’t matter because the physician could charge $500 for an Office Visit or $100 and they still receive what the Usual and Customary Rate is. In addition, the physician never knows what percentage the insurer is paying because the deductible, co-pays, primary and secondary payors vary for each indivdual plan. The insurance industry is a shell game, or as I call it the best form of organized crime. Their is no transparency in the insurance industry. There is no professionalism (look at the people that are physician provider relations representatives) you cannot get a response from them nor can you get someone on the phone. Based on anti-trust laws, if a physician was able to publicly post his pricing, I assume that he would then be able to share what he is reimbursed with his fellow doctors and the patients. Yet, medicine is not like going to Jiffy Lube, only politicians and CEO’s like to make you think it is that easy. Most consumers are uneducated and overwhelmed when they get sick or hurt and do not know what to think when they get diagnosed or hurt. Let’s be realistic, the internet can only provide you with information, it cannot help you truly understand the ramifications of your decisions or the complexities of your disease or injury. One thing always leads to another. Let’s not make healthcare a doctor/patient issue. Let’s make it a people and money issue. Too many CEO’s are making windfall profits and walking away with absurd sums of money as golden parachutes (see William McGuire from United), too many trial lawyers are only interested in suing on behalf of their clients (what ever happened to all this talk about tort reform Mr. President?) Doctors still make a great living, they need to entrust their business to business people especially when they haven’t received reimbursement increases from insurance companies for 3 years sometimes (you and I wouldn’t run a business if we received no COLA or inflationary adjustments) and the consumer needs to understand that medicine is more art and not accounting. Until individual states Department of Banking and Insurance are made up of individuals with diverse backgrounds, not just directors that are former insurance executive awaiting their next big job after their terms are over, nothing will ever change.
— Posted by John Nieradka