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timeasmymeasure
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Date: 2007-06-22 03:42 pm (UTC)Highmark is not my favorite company right now... The way they pay from what I understand is a decreasing percentage per "code". So they'll pay, say, 50% of the first "code," 40% of the second, and so on. When Linda had her spinal fusion, the spine doctors refused to take the insurance. Apparently the way Highmark has things set up, the guys who spend 3 hours cutting you open, carefully scraping bone growths away from your spinal column, drilling holes in the bone and screwing you all back together again get paid less for that than the leg guy does for spending 15 minutes setting a bone and putting it in a cast.
(Our insurance co at the time was Carefirst BCBS out of MD, which makes this a "Blue Card" claim, and Highmark has the blue card contract for all of PA, even though they aren't the local insurance company in the philly area)
When the "negotiated price" is about 20% of total, the total naturally hyper-inflates.
In our case, the doctors wanted approx $8k in payment for services rendered. They billed $23k. Highmark paid $3.7k. We paid $4k. The dr office sends a letter saying that they will "accept as payment in full" $X, which is substantially lower than the $18k you owe on paper.
Presumably if we were uninsured, we'd be billed $23k and $X~=$8k.
Presumably, if drs weren't wasting so much time and effort negotiating with insurance companies, they could same many hundreds of thousands of dollars both in clerical staff wages and of their own time (shall we talk about the iterative guessing game necessary to discover which antacid script the insurance company would actually cover?). Above all, the insurance company game is one that extracts money from patients and non-patients alike while paying sub-reasonable rates to drs and pharmacies, in order to become fabulously wealthy and powerful. The sum total of monies being paid for health-related services in this country (lumping insurance in with that) is way too high, with a diminishing amount of that money going to the people who actually provide health services, and we STILL can't figure out a way to actually provide reasonable health services to everybody.