James T. writes:

I listened to podcast #101 about health care economics. I am a physician, OB/GYN in Upstate NY, and I feel you are missing the key facts in your health care coverage. In today's podcast you ask: "why do doctors and hospitals bill for high dollar amounts when they know practically no one pays this amount?" Your guest from Aetna says he doesn't know.
The answer is -- our contracts state we will receive the agreed upon amount or up to 75 percent of our fees, whatever is less. Therefore, in order for doctors to receive the maximum amount for our services under contract, we have to bill for a much higher amount. It is entirely driven by the health insurance contract. I would like to reduce my fees for uninsured, underinsured patients, but I risk the insurance companies challenging our fee schedule and reducing our payments.
I agree it is crazy, but we are relatively powerless to change it. The contracts are not negotiated. They are offered as a take it or leave it offer, unless you are the only specialist in your community and you can force a negotiation.

categories: Health Care, Letters

3:53 - October 8, 2009

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