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people who wear ties and ride in limos . . .

September 6, 2007

ok, so, here’s the deal. I! HATE! INSURANCE! COMPANIES!

being a professional in the health care industry means that i have no choice but to bend over and take . . . i mean . . . everything we do in the office is mandated by insurance companies. what patients we can see and when. how much money dr. makes when she has to write in a chart “3 lesions, all smell.” (dr. had to smell something, and if it smelled nice she would not have to note it) yes, the insurance companies pay us what they will with no say from us, we can take it or leave it, and if we left it i would be out of a j-o-b.

most americans do not seem to realize this. most americans think all doctors are rolling in the dough. not true, i know some doctors who can barely afford to keep their kid in college, doctors who live in modest houses and drive fords, doctors who will be paying student loans decades into their careers. medical offices have some of the highest overhead in business.  please understand this is just my commentary on the u.s. health-care system and large insurance companies.  this is only a blog . . . i repeat, only a blog.  all of the dollar amounts in the examples below are very rough estimates.

say dr. spend 15 minutes with each patient, that’s 4 patients and hour. for variety’s sake lets say the 4 patients are all coming into the office for different reasons, but for simplicity’s sake let’s say they have all been seen by dr. before. let’s call them patients a, b, c, and d. all patients call to book appointments, check in at the desk, fill out paperwork, have insurance cards scanned and copied, are prepped in exam rooms by medical assistants who take heart rate, blood pressure, current medications and an updated history.

“a” is covered by a large hmo with a deductible (meaning we cannot collect any money today), has a simple complaint that requires a simple history, urinalysis and a prescription. this patient has come in contact with at least 3 staff members in addition to the doctor. this patient has used our restroom (that needs to be sanitized regularly), peed in a cup, wore a gown, and required the utilization of our lab supplies. we have spent about $20 in staff labor to process and exam this patient, and we have spent about $12 in overhead (rent for the office space, and the like) and supplies (medical and administrative)  our charge based on our cost and rvu’s (relative value units): $60.  insurance says we can be paid $45, but this amount applies to the patient’s deductible.  now our office is responsible for billing the patient (this costs us $5 in labor supplies and postage)  now we have spent $37 in cash on this patient assuming they pay the $45 bill on time, leaving the dr. with a payment of $8.

“b” is covered by state medicaid.  this patient presents with a moderate complaint, and dr. needs to spend the majority of the visit diagnosing the complaint and presenting the patient with a plan of action.  this patient requires all of the same labor from the support staff: $20, and less in overhead and supplies: $4.  our charge, again based on cost and rvu’s: $75.  state medicaid is a known slow payor, so we have to wait more that 50 days to be paid, and in this time period we have used man-power to contact state medicaid to find out if and when our claim will be paid, this costs us about 20 minites and $3.  state medicaid pays: $28 (remember, this is coming from state tax dollars)  dr. makes: $1.

“c” is covered by a ppo.  this patient has recently had a surgical procedure which has a “global period” of 90 days, doctors may not bill for any services rendered during this period.  “c” is non-compliant and the incision site opens and begins to bleed.  to process and exam cost us the same $20, dr. must stitch the incision site back together (only a physician may administer stitches in the office according to our state regulations)  cost of supplies is $3.  now we have spent $23 on this patient, but because the patient could not follow directions and rest after surgery we make no money.  dr. paid: -$23.

“d” is covered by ppo with a $30 copay, age 50, has no complaint, is coming in for preventive care.  this costs us the same $20 to process and exam.  “d” is given the screening tests routine for their sex and age group, the collection and processing of these tests is $20.  dr. counsels “d” for any applicable health concerns or issues, reviews and refills medications.  even though this patient is scheduled for a 15 minute slot “d” has a lot of questions and takes 25 minutes of dr.’s time and cuts into her lunch time.  our charge calculated in the same way as above: $150  “d” pays the copay at time of service. the insurance company pays us an additional $90.  dr. is paid: $80.

for every hour of exam time the dr. needs to spend and hour on follow up phone calls, research and charting.  dr. was paid $66 for 2 hours and 30 minutes of work.  that’s $33 and hour,  if dr. takes 2 weeks vacation and is not out of the office on an emergency or sick all year she will make $66,000 before taxes this year.  only if every hour is as productive as this example.   this is a middle-class salary, doctors are not rich.  insurance company executives are rich.

insurance company executives wear ties and ride around in limos.  they steal money from my paycheck for my health insurance coverage and then give me and my health care providers hassles with low payments and denied claims.  insurance company executives screw you too.

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