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Many times the individual providers don't know the reimbursement rates at the time they sign the contracts.

maybe its time for some terminology:

insurers are the insurance companies

you have providers of CARE, hospitals, clinics, etc

you have the insured, that recieve the care...

said client goes in for "repair", providers provide the care, insurers reimburse the providers.

what is this aspect of the "providers" signing contracts? Who do they cover?

see my doctor and dentist that we use agreed on a reimbursement schedule when they agreed to accept my health care coverage. Its a known amount. Its identified. Thats how it works for my dentist.

For our health care, my doctor when he signed the contract agreed to accept the reimbursements at the rate my coverage will provide. The exact fees may not be specified, but since my doctor is accepting my insurance company, he has to accept the amount they will reimburse him for. If there are any issues, the doctor gets to duke it out with the insurance company.

seems pretty straightforward to me...

It's sad that you mention "free markets" and the above quote in the same post.

Many times the individual providers don't know the reimbursement rates at the time they sign the contracts. The insurers have the leverage - most providers are afraid to NOT sign the contracts for fear of not having any business, and when it's discovered that the insurer isn't performing their end of the contract there's little that the individual providers can do about it. Hence, the class suits but that's little effective relief and thus you've got many individual providers filing bankruptcy, closing their practices, fewer applicants to medical school, etc. A lot of disruption of service for consumers, as well.

It's a market that's not so free, if you're on the consumer end.


said its a free market issue because it is. I notice in your reason for doctors closing up shop that you didn't mention some of the additional costs that face the medical community in todays world. The malpractice insurance costs, the lawsuits or threat of that drive up costs, the regulations that drive up the cost to do business, to name a few. Be interesting to see what these do to the cost to run a medical clinic, subtact them out and then see whether or not a doctor could stay in business at the "going insurance reimbursement rates".

cause if I am reading your point correctly, you are saying the insurance companies are the bad guys because they aren't paying the doctors enough to cover their costs. Whereas, I am pointing out that if doctors didn't have all of these assundry costs to do business in the first place (as a result of our politicos and legal system), maybe they would be alright??

I will get to the rest of your comments later. Its off to a couple of hours of theater classes for the kids...
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