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Author: DeltaOne81 Big gold star, 5000 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: of 308882  
Subject: Re: Poll: Would you sign? (Contract question) Date: 9/14/2005 8:26 PM
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- Once the bill is submitted through insurance, it is insurance fraud if you do not charge the patient the amount the insurance company says is the patient's part. (This is usually part of the language of the insurance providers' agreements with the practices.) If they want to write off a bill, they have to write off the *whole* bill, not just what insurance doesn't pay.

Coming from a medical family, I'm not sure this completey reflects reality. Sure, the patient has to be charged their agreed amount, co-pay or whatever, but let's say you have a $20 co-pay on a $200 service. A bill for $180 gets sent to the insurance company. They pay whatever they feel like based on their own rate tables and the doctor is left with the excess. That's how it works. The patient is paying their agreed part, the insurance pays what they feel like, and the doctor is stuck with not getting the rest.

And if the doctor increases their rates on some procedure, it can be years until the insurance company compensates any more. It's not that the patient isn't paying their agreed part, it's that the insurance company isn't paying the rest of it, because they never agreed to anything with the doctor... and there's really about nothing a doctor can do about it. Yeah, they swallow the change instead of charging it to the patient to maintain good relations.

Another reason the doctor's 'rates' are so high, because they rarely collect more than some of it.
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