Re: How Doctor's Get Paid v1 --Fwd: How doctors get paid

[Guest guest]

That is good, it may help some patients see the whole insurance picture.

>

> ---------- Forwarded message ----------

>

> Date: Sat, Sep 6, 2008 at 11:09 PM

> Subject: How doctors get paid

> To:

>

>

> I was trying to figure out a way of helping my patients understand the

> payment mess caused by insurance in some way that did not require me to

> premedicate with blood pressure medication and antianxiety meds. I wrote

> this little story. Let me know what you think. Anyone is welcome to use it

> if they desire as well.

>

>

> Durango, CO

> ========================================

>

>

> How do doctors get paid?

>

>

>

> Imagine going to your favorite restaurant. You are greeted at the door by

> the hostess, who seats you and takes your drink order. You order through

> your favorite waiter, , who recommends the special of the day: prime

> rib with a dinner salad and a chocolate tort for dessert. Soon after, the

> food is brought out and it is delicious. You have time to enjoy your food.

> You then receive the bill and pay for your meal, returning to your home

> satisfied, all your dining needs met. Let's say you paid $75 for this

> meal:$50 for the steak, $10 for the salad and $15 for the dessert.

>

>

>

> A change then occurs in the restaurant industry. A new form of eating out

> has been adopted. Your favorite restaurant has now contracted with over 30

> different " restaurant insurance companies. "

>

>

>

> Anticipating another pleasant dining experience, your return to the

> restaurant with your new " subscribers card. " You pay your $5 " copay " and sit

> down in the foyer of the restaurant. After waiting an hour, even though you

> made reservations, a harried greets you and quickly takes your order

> after you briefly glance at the menu. The food arrives at your table, but

> before you have time to truly enjoy it, informs you that " your time

> is up " and the table is reserved for another party. You are escorted

> outside with your hastily boxed left-overs.

>

>

>

> What has happened to the restaurant? Behind the scenes, the restaurant

> owner has learned some tough realities of the " new system. " During the

> first month of taking insurance, the owner submits the charges for the $75

> steak dinner. The contract with this particular insurance company already

> states that they will only pay $45 for the $50 steak, but the owner decides

> that the extra customers brought to the restaurant by contracting with this

> insurance company will more than off-set this small loss.

>

>

>

> The first attempt at collecting the $75 dollars for the full meal is

> returned unpaid due to a clerical error. The owner mistakenly used the

> number assigned by another insurance company. The owner mails the corrected

> form.

>

>

>

> In response to the second request for payment, the insurance company does

> not send a check, but a detailed questionnaire: Was basil used in seasoning

> the steak? Was it necessary to use basil for this particular recipe? Did

> the restaurant ask for permission to use basil from the insurance company

> before serving the steak? The owner submits the answers, emphasizing that

> the basil is part of a family recipe that made the restaurant famous.

>

>

>

> The owner waits another week (it has now been 3 weeks since the dinner was

> served). The check arrives three and a half weeks after the meal was

> served. The check is for $20 and states that it is specifically for the

> steak. The check also comes with a letter stating that no billing of the

> patron may occur for the salad, but no other explanation is enclosed. No

> mention is made of the $15 dessert.

>

>

>

> The now frustrated restaurant owner calls the provider service number listed

> in the contract. After five separate phone calls to five different numbers

> (The harried voice behind phone call number four explains that the insurance

> company has merged with another insurance company and the phone numbers had

> all changed last week, sorry for the inconvenience…), the owner gets to ask

> why, when the contract says the steak will be paid at $45, has the check

> only been written for $20? And what happened to the payment for the salad

> and the dessert?

>

>

>

> As it turns out, this particular patron's insurance contract only pays $45

> when the patron has reached their deductible, which this patron has not at

> this time. The remaining portion of the steak must now be billed by the

> restaurant to the patron directly.

>

>

>

> The $10 for the salad would have been paid if the patron had ordered it on a

> different day, but, per page 35 in the contract, because it was billed on

> the same day as the steak, it is considered to be part of the payment for

> the steak and no extra money can be collected from the patron or the

> insurance company.

>

>

>

> The dessert should have had a " modifier " number put with its particular

> billing code in order to receive payment when billed with the steak and the

> salad.

>

>

>

> Realizing that the billing is quite a bit harder than anticipated, the

> restaurant owner hires a person to specifically make sure these errors do

> not occur again. The owner must lay off the hostess and the bus boy to hire

> the biller, but feels these duties can be added to the waiter's other

> responsibilities.

>

>

>

> In the meantime, the restaurant owner has now had to have the waiter take on

> the job of answering the phones due to the now high volume of phone calls

> from patrons questioning why they are receiving bills for meals they ate

> over 2 months ago and why did their insurance company not pay for this

> portion of the meal. This extra work is now resulting in longer times

> patrons must wait to be seated and served, and grumblings from the waiters

> who " were not hired or trained to do this kind of work. "

>

>

>

> The owner now realizes that, although the dinner originally cost $75 to

> make, only $22 has been paid. The remaining $30 billed to the patron has

> now cost $10 in overtime for the biller and mailing a second bill to the

> patron after the first bill went unpaid. By the third billing cycle, the

> owner realizes a collection agency must be employed in order to have any

> hope of receiving any portion of payment from the patron.

>

>

>

> In order to meet costs, the restaurant owner now must seat twice as many

> patrons in the same amount of time. The owner has now over-extended the

> waiter, who was an excellent waiter, but is now taking on the roles of host,

> phone answering and table bussing, as the pay for these employees has been

> shifted to the biller and the collection agency.

>

>

>

> What was once an outstanding business that focused on fine dining and

> customer service has now been turned into a business in the business of

> trying to get paid.

>

>

>

> Alas, I wish this were a fictional tale, but it is not. The only fictional

> portion is that this is not your favorite restaurant, but your favorite

> doctor's office, who is responsible not for meeting your dining needs, but

> those of your health.

>

>

>

> , M.D.

>

> A family doctor in rural Colorado.

>