Dr. C an Insurance Question

BPM · June 25, 2006

Dr. C I was hoping you could shed some light on maybe why this issue occurs. It is not the right topic for the forum but this is the only forum I have seen you reply in.

Why do most doctors in the US have self pay prices for cash customers that is double the amount that an insurance company actually pays the doctor for the same surgery?

Self Pay seems be around 15k on average in the US from what I have seen with some lower and some higher. The insurance companies generally pay around 7k dollars for this surgery. That sure doesn't seem right but I know their must be a reason. What's your input?

Trace Curry · June 25, 2006

It's not quite as bad as you think when you break it down. Around here insurance pays about $8000 to the facility, $2000 to the surgeon, and $1000 to anesthesia. So that's around $11,000. With my practice, at least, the self pay patients get a pre-op visit, a consent visit, and as many fills as they want for a year. This usually equals about 8-10 altogether, which would probably be another couple of thousand bucks getting up to around $13,000. The reason we take a little less from insurance companies is that we don't have any choice in the matter, the way medicine has evolved they can tell us what to charge. Imagine if you called a plumber and said my toilet is clogged, and I know you charge $200 to unclog it, but I'm going to pay you $100, and if you don't like it tough because you're under contract with me so you have to.

Dr. C

Cincinnati, Ohio

www.TheBandDoctor.com 877.442.BAND

DISCLAIMER: I am not your surgeon, any comments made by me are not meant to be taken as medical advice, just general guidelines. Contact your surgeon about your specific problem!

Dr. C I was hoping you could shed some light on maybe why this issue occurs. It is not the right topic for the forum but this is the only forum I have seen you reply in.
Why do most doctors in the US have self pay prices for cash customers that is double the amount that an insurance company actually pays the doctor for the same surgery?

Self Pay seems be around 15k on average in the US from what I have seen with some lower and some higher. The insurance companies generally pay around 7k dollars for this surgery. That sure doesn't seem right but I know their must be a reason. What's your input?

BPM · June 25, 2006

What is the cost of self pay..stem to stern through your practice?

Trace Curry · June 26, 2006

Our cost (I say "our" meaning the hospital, who put it together) is $16,500. This includes fills for a year.

Dr. C

Cincinnati, Ohio

www.TheBandDoctor.com 877.442.BAND

DISCLAIMER: I am not your surgeon, any comments made by me are not meant to be taken as medical advice, just general guidelines. Contact your surgeon about your specific problem!

What is the cost of self pay..stem to stern through your practice?

Meow=^..^= · June 26, 2006

Thanx for the awnser... I just found it disheartning....I am a person whos insurance is off and on... I found that if a uninsured person goes to the hospital it costs roughly twice as much for the person WITHOUT the insurance... It is not right!!!! Not just...lol It is not a lot of things... But it is right up there with the "American" way the Poor get poorer... Whatever.... When are we as a nation going to demand quality health care for all????

Wonders *When is the next flight to Canada???*