This just in

[patterfr]

Doctors don't sell the medications that they prescribe, that's illegal, unless you are going to an "iffy" plastic surgeon or some other "wellness" doctor peddling their own line of products,, vitamins, supplements etc. To say that physicians sell the drugs that they prescribe to their patients at all much less with a ridiculous mark-up is an absurd mis-characterization of what's wrong with the medical system. ANd if you are working in the medical insurance industry you should know that. We can disagree on a lot of things, but let's not fabricate things.
As far as mark-up of durable goods, such as splints, products, braces etc etc, after a quick survey of the majority of physician offices, you'd find that if they break even on this stuff it'd be a miracle. Mostly they are there to provide for patients so that acquiring them isn't as difficult if it could be. Charging $250 for any product to the insurance company is only done in the hopes that the insurance company will actually pay anything on some of them. Believe me, the actions of a few dishonest offices can't be used to paint the picture of the whole profession.

And keep in mind that most physicians "collect" less than 20 percent of their charges and you quickly realize that the problems of the medical system have much more to do with lawyers, insurance companies and the govt long before you can get to doctors as the "cause" of the problems. Doctors still make a comfortable living for sure, if you don't think they deserve what they are paid, it's possible that you don't fully understand what they do. Except that next time you or your family is sick or injured, just think about how important there function is and think about what kind of salary you'd set as an average to attract (or prevent discouraging more like it) people to the field. DMV clerk salary? Walgreens Cashier? Wedding photographer? Actor? Pro athlete? Teacher? Cop? Where should it be? I'd be interested in an answer? But don't forget the $200, 000 in debt that most of them start out with and the 10's of thousands or hundreds of thousands of dollars that they gotta pay for malpractice insurance just to keep the PIP insurance workers, lawyers, and courts going

[Douglas]

Id link an image of a bill or an invoice if it werent illegal. I am not fabricating things. There are different medications. Not all of them pills. Some are injections, creams, and some pills. But they are medications.

You can disbelieve me if you want to, so you can push your agenda. But I know what I see. I see doctors doing everything they can to get as much money as they can. Like I said, they unbundle things, they see someone for 5 min and bill an hour consulation, and they do injections and charge tons of money for something they paid $5 or less for. I see doctors change their bills because their original had a code that wasnt allowable (not by insurance regulations, but by the AMA and CPT guidelines).

Give me facts on what you say, because I am giving you facts on things I see with my own eyes. Dont give me something you probably heard from Glenn Beck or Rush Limbagh.

[Douglas]

And I want to clarify this.Im not saying all doctors do this. Like any profession, there are good and bad ones. Its the bad ones ruining it for the good ones. Probably 95% of what I see daily is fine and dandy. Nothing I take more then 1 or 2 looks at while im paying it. But that 5% can be a doosy at times.

[brian.austin]

Let's turn this around for a moment. Look at it from a business perspective.

My doctor runs a pretty tight office. The office is newer but not extravagant. There are two doctors, two or three PA's, three or four nurses, and two admins from what I've seen. My doc and I have talked business quite a bit while he was casting me up from a recent fracture.

The nurses and admins don't generate income on their own. The admins don't generate income on their own. So, right there, he's looking at maybe $250,000 in salaries (not even including benefits) a year. Typical burden rate (insurance, FICA, taxes, unemployment, etc.) is around 35% in AZ. So it's probably about $337,500/year.

Then there is rent. Utilities. Supplies. The ever present medical malpractice insurance (remember, he's not just covering himself here). Taxes. His own salary. His own education (keeping up with the latest medical changes). His lawyer. His accountant.

Get the picture? Those are FACTS, btw. Part of running a business. Almost any business, really.

Where does that money come from? Insurance companies have determined that a "fair" office visit should only be a certain amount. I'm not actually arguing that (too much) but where is a doctor supposed to make enough money to cover all of that? We get this impression from the media that these guys are working 2-4 hours a day making millions per year. They aren't. Not even close. The stuff we see on TV isn't even close to reality.

What really gets me is the irony here. Douglas, I respect your opinions and your points. You make some good ones. But have you ever considered that WHY the docs have to do the things you're describing is because of the very system you work for?

[patterfr]

brian
you should run for president. the arguments you have made in this whole thread have been remarkable. I have never read such clear thinking and understanding of things. While I haven't always agreed with everything you've said, I'll nominate you as the person on this whole forum who may be the best at trying to understand things form another's point of view. I can learn a lesson from that. As can a lot of us.
I swear i would vote for you. alright, enough of that......

As a clarification, I probably overstated the case about doctors selling drugs being illegal. Certainly a conflict of interest, but not illegal. And I'd venture a guess that much less than 5% of patients buy their meds from the doc. (Ironically, I just had to pay 200 bucks for antibiotics from my vet for my dog and I saw a whole line of people not even complaining about their bills there. Seems we don't mind paying cash for Flopsy, but ask for a $5 copay at the people doc's office and you're a scammer and a cheat and a fraud. Funny....
And it is the vast minority. But this is not the problem Douglas that is hurting the medical system in this country.

And I'll accept that 5% of offices are up to some shenanigans. That's probably true.
Most docs have to employ billers, medical assistants, PA's, secretaries, receptionists just like Brian said. It's a business and most docs aren't that good at the business side of it from what I've seen out of them.

[Douglas]

Well, let me put it to you this way. Say you live in florida and drive a car. You have, by law, $10000 in pip coverage. All bills related to your accident are paid at 80% up to $10k. Including lost wages or household services that you have to pay someone to do because you are disabled and cant do them.

This coverage exists whether you are at fault or the one hit. In fact, if you are driving a van with 10 people in it including yourself, and the other 9 people do not own a vehicle for whatever reason, then depending on the situation those people who never paid a penny of premium are covered. Lets see health insurance say that.

But lets keep it simple. You are driving your car to work and some schmuck rear ends you while you are at a stop light. And because of this you are injured. Let say a broken wrist and some back pain. You go to the ER and require some treatment and a surgery. All the stuff I mentioned above is paid for you without question 99% of the time. (The 1% is where you own an 84 buick, live in a 'pay by the week' room, and you say you make $5000 a week and the person hit you at 1mph yet your doctor says you will be out of work for 2 months and now you require someone to do a bunch of stuff for you.)

Now the point of this coverage is to make sure you are covered and hopefully have enough to get you to where you were before the accident. Knowing your limit, should we pay your doctor $250 for a nerve injection that cost him $18? Lets not forget hes charging a couple hundred for the visit. Plus another couple hundred for the procedure.


Thats when it bugs me. Its not when a doctor bills a few bucks over or something like that. It bugs me when the injured person's benefits are being eaten up. Ive gotten phone calls from people asking what to do because they still in pain and their benefits are gone and dont have anything else to fall back on. (which is one reason I upped my own coverage.) Why should you, as my insured, pay the cost of the doctor's entire shipment? Why would I allow that happen?

[brian.austin]

Originally Posted by gsk

I believe it. Obama himself even said that doctors will not treat a diabetics foot properly so they can get $30, $40, or even $50 thousand to cut the leg off. Those darn doctors are nothing but money grubbing charlatans. Instead of taking the Hippocratic oath, I think they should be taking the Hypocritical oath.

How about reading the other side's take on the issue before believing the Messiah like that?

Obama was waaaay out of line on that statement. I know a few people who have had amputations due to diabetic complications. To a person, all admit that they didn't do what their doctors told them...and they regret it.

Lack of personal responsibility is not a medical systems fault.

[brian.austin]

Originally Posted by Douglas

Well, let me put it to you this way. Say you live in florida and drive a car. You have, by law, $10000 in pip coverage. All bills related to your accident are paid at 80% up to $10k. Including lost wages or household services that you have to pay someone to do because you are disabled and cant do them.

This coverage exists whether you are at fault or the one hit. In fact, if you are driving a van with 10 people in it including yourself, and the other 9 people do not own a vehicle for whatever reason, then depending on the situation those people who never paid a penny of premium are covered. Lets see health insurance say that.

I'm not sure if I follow the line here so far but I feel like you're saying that MY health insurance should help pay for someone else's coverage?

The auto insurance you have is a liability policy, not health insurance coverage. There is a difference.

But lets keep it simple. You are driving your car to work and some schmuck rear ends you while you are at a stop light. And because of this you are injured. Let say a broken wrist and some back pain. You go to the ER and require some treatment and a surgery. All the stuff I mentioned above is paid for you without question 99% of the time. (The 1% is where you own an 84 buick, live in a 'pay by the week' room, and you say you make $5000 a week and the person hit you at 1mph yet your doctor says you will be out of work for 2 months and now you require someone to do a bunch of stuff for you.)

Now the point of this coverage is to make sure you are covered and hopefully have enough to get you to where you were before the accident. Knowing your limit, should we pay your doctor $250 for a nerve injection that cost him $18? Lets not forget hes charging a couple hundred for the visit. Plus another couple hundred for the procedure.


Thats when it bugs me. Its not when a doctor bills a few bucks over or something like that. It bugs me when the injured person's benefits are being eaten up. Ive gotten phone calls from people asking what to do because they still in pain and their benefits are gone and dont have anything else to fall back on. (which is one reason I upped my own coverage.) Why should you, as my insured, pay the cost of the doctor's entire shipment? Why would I allow that happen?

So we should have a different payment schedule based on injuries or medical coverage? Or, as a "rich" person by Obama's standards, I should have to pay higher rates for the same coverage, even though I keep myself healthier and visit my doctor less than the average person?

I don't see the fairness in that. I don't see the fairness in anything the Left seems to believe. I work on my career. I worked and went to college, both full time, to better myself and my potential income. I run a side business to help pay for bills and toys. I stay out of trouble, respect the law, help others around me, and do my civic duty whenever called.

Yet I'm supposed to pay for someone who has decided NOT to do any of that and be punished for my own drive to success. I REALLY don't understand this entitlement attitude or why it's promoted so much in the media. I'm not sure I ever will. That whole formula is just a disaster waiting to happen, both socially and economically. We have plenty of references for it in history.

[Douglas]

Originally Posted by patterfr

brian
you should run for president. the arguments you have made in this whole thread have been remarkable. I have never read such clear thinking and understanding of things. While I haven't always agreed with everything you've said, I'll nominate you as the person on this whole forum who may be the best at trying to understand things form another's point of view. I can learn a lesson from that. As can a lot of us.
I swear i would vote for you. alright, enough of that......

As a clarification, I probably overstated the case about doctors selling drugs being illegal. Certainly a conflict of interest, but not illegal. And I'd venture a guess that much less than 5% of patients by there meds from the doc. (Ironically, I just had to pay 200 bucks for antibiotics from my vet for my dog and I saw a whole line of people not even complaining about there bills there. Seems we don't mind paying cash for Flopsy, but ask for a $5 copay at the people doc's office and you're a scammer and a cheat and a fraud. Funny....
And it is the vast minority. But this is not the problem Douglas that is hurting the medical system in this country.

And I'll accept that 5% of offices are up to some shennanigans. That's probably true.
Most docs have to employer billers, medical assitants, PA's, secretaries, receptionists just like Brian said. It's a business and most docs aren't that good at the business side of it from what I've seen out of them.

And what really sucks are those off shore ones. 'Hello. My name is John Smith from real American billing company". Right....

As for copays, they are an annoyance. Mainly because we feel if we pay all this money for the coverage, how come theres still money owed? (btw, my copay has gone up $5 last and this year. While my premiums have gone up... And this year, theyre going up 33% woot!)

Im not much of a fan of today's doctors anyway. Perfect example. 2 years ago, I decided to use my benefits. I give blood and they always comment on my low pulse. Enough that I decided to see a doc. So I take a half day off (in august when its 95 and I have no a/c in my car). Drive home first because since I was going under the pretense of doing an establishing visit. Take a shower because I dont want to be sweaty for an exam. And here is all that happend. Filled out paperwork and after waiting, I saw the nurse and answered questions. Waited longer. Finally the doc came in and he spoke to me for maybe 5 min while spending 4:30 min looking at the chart. Then commented on how my blood pressure was high and handed me a prescription for blood pressure meds and left....

A prescription for high blood pressure. No history of it in my family. And again, I just drove 45 min home in a hot car and had taken a hot shower. So yeah, my blood pressure is high. And after that episode, it was probably a bit higher. Threw the script away and never went back to that place. But thats all I hear people say. They go to a doctor and spend minimal time with them, are handed an rx and the doctor leaves. Maybe if we felt we got our money's worth, it wouldnt be an issue.

[Douglas]

Originally Posted by brian.austin

I'm not sure if I follow the line here so far but I feel like you're saying that MY health insurance should help pay for someone else's coverage?

The auto insurance you have is a liability policy, not health insurance coverage. There is a difference.

That was just a set up. I know theres a difference. I wasnt saying if it was good or bad. Im sure using the the case of the van, that if youre a bean counter, then youre crying over it. But anyone else would say thats awesome. Imagine if you could prove you caught a cold from someone and their coverage have to pay for it. Again, not saying good or bad. Just an interesting thought.

So we should have a different payment schedule based on injuries or medical coverage? Or, as a "rich" person by Obama's standards, I should have to pay higher rates for the same coverage, even though I keep myself healthier and visit my doctor less than the average person?

I don't see the fairness in that. I don't see the fairness in anything the Left seems to believe. I work on my career. I worked and went to college, both full time, to better myself and my potential income. I run a side business to help pay for bills and toys. I stay out of trouble, respect the law, help others around me, and do my civic duty whenever called.

Yet I'm supposed to pay for someone who has decided NOT to do any of that and be punished for my own drive to success. I REALLY don't understand this entitlement attitude or why it's promoted so much in the media. I'm not sure I ever will. That whole formula is just a disaster waiting to happen, both socially and economically. We have plenty of references for it in history.

Im not sure where you are getting this from my comment. My point was, why should you out of your benefits pay for an entire shipment of medication when you used only 1 unit of it? And I pointed out how thats not the only charge being billed. But also the visit charges and procedure charges. You wouldnt have a problem with paying for a complete shipment of medication, when its not all for you? The next guy that walks in gets a unit out of that shipment and his insurance gets a bill for the same $250. They dont deduct what they got paid for your unit from what they bill the next person.

Anyway, this has gone way off tangent. I still stand by what I said yesterday

[patterfr]

DOuglas
Your assertion that the$250 dollar bill is outrageous for an $18 injection just shows that you aren't looking at the whole picture.

That's like saying why would you pay a photographer $100 for a portrait when it only costs $1 to print.

Who's paying his office rent, his insurance, his employees, the electric bill, his student loans, his copy machine repair, his transcription fee, his office upkeep, his ...you get the picture. It's a business. And often it can't be measured by the face time. How many patients can they see in a day and do injections. 20?
Say they charge say only double the cost of the 18 dollars, and say the insurance pays the full 36 dollars billed and doesn't randomly deduct a certain percentage.

20 x 18 profit for each equals 360 dollars. That's an outstanding windfall, no?
C'mon, keep some reality here.

[gsk]

Originally Posted by Douglas

And what really sucks are those off shore ones. 'Hello. My name is John Smith from real American billing company". Right....

As for copays, they are an annoyance. Mainly because we feel if we pay all this money for the coverage, how come theres still money owed? (btw, my copay has gone up $5 last and this year. While my premiums have gone up... And this year, theyre going up 33% woot!)

Im not much of a fan of today's doctors anyway. Perfect example. 2 years ago, I decided to use my benefits. I give blood and they always comment on my low pulse. Enough that I decided to see a doc. So I take a half day off (in august when its 95 and I have no a/c in my car). Drive home first because since I was going under the pretense of doing an establishing visit. Take a shower because I dont want to be sweaty for an exam. And here is all that happend. Filled out paperwork and after waiting, I saw the nurse and answered questions. Waited longer. Finally the doc came in and he spoke to me for maybe 5 min while spending 4:30 min looking at the chart. Then commented on how my blood pressure was high and handed me a prescription for blood pressure meds and left....

A prescription for high blood pressure. No history of it in my family. And again, I just drove 45 min home in a hot car and had taken a hot shower. So yeah, my blood pressure is high. And after that episode, it was probably a bit higher. Threw the script away and never went back to that place. But thats all I hear people say. They go to a doctor and spend minimal time with them, are handed an rx and the doctor leaves. Maybe if we felt we got our money's worth, it wouldnt be an issue.

Did you tell the doctor yourself that you were there becuase you were told your pulse was low?
Have you checked you blood pressure since that visit? Were you given a follow up visit and did you keep it?

[patterfr]

Mine's going up.
Does that count?

[patterfr]

Originally Posted by brian.austin

How about reading the other side's take on the issue before believing the Messiah like that?

Obama was waaaay out of line on that statement. I know a few people who have had amputations due to diabetic complications. To a person, all admit that they didn't do what their doctors told them...and they regret it.

Lack of personal responsibility is not a medical systems fault.

I'm pretty sure that was sarcasm Brian.

[gsk]

Originally Posted by patterfr

I'm pretty sure that was sarcasm Brian.

My apologies to Brian. Yes; it was meant as sarcasm. Doctors have been the ones getting screwed by insurance companies for years now. The Obama care will be the same. The ones taking "hits" will be the physicians. The general public doesn't see this because physicians for the most part are practicing medicine and not being outspoken.

[Douglas]

Originally Posted by patterfr

DOuglas
Your assertion that the$250 dollar bill is outrageous for an $18 injection just shows that you aren't looking at the whole picture.

That's like saying why would you pay a photographer $100 for a portrait when it only costs $1 to print.

Who's paying his office rent, his insurance, his employees, the electric bill, his student loans, his copy machine repair, his transcription fee, his office upkeep, his ...you get the picture. It's a business. And often it can't be measured by the face time. How many patients can they see in a day and do injections. 20?
Say they charge say only double the cost of the 18 dollars, and say the insurance pays the full 36 dollars billed and doesn't randomly deduct a certain percentage.

20 x 18 profit for each equals 360 dollars. That's an outstanding windfall, no?
C'mon, keep some reality here.

And youre missing my point. You are in the doctors office for lets say an hour, including the obligatory 30-35 min of waiting.

Doctor bills you for the visit. $220
Doctor bills you for the procedure. $164
Doctor bills you for the medicine. $250

So for an actual 20 min of time, most of with the nurse, you are billed $634

Not bad for 20-30 min of time. Now add that up through the day.

And using your numbers 20x18 a day but lets add a whole month. 22 days a month (figuring 30 days - the weekend) = $7920. Plus 20x22xoffice visits, plus 20x20x whatever else they do.

And there are few single doctor's offices. Those that are have what, a couple nurses and a billing person or 2? Most of these are clinics where theres 3-4 doctors on up.

And notice, im not talking about cutting back on the costs of his services or undercutting his prices for these things. Im saying where they are trying to over charge.

Maybe im a cheap bastard. Just like some are bashing Obama's plan because they would be forced to pay for procedures they dont believe in (like abortion), I dont believe I should be charged for medication going into someone else's body. And again, using your example, a 100% markup isnt horrible (at least in the numbers we are saying). But 1000%? Explains why there is a doctor in florida with a very niced sized boat named 'PIP MONEY'.

[brian.austin]

Originally Posted by gsk

My apologies to Brian. Yes; it was meant as sarcasm. Doctors have been the ones getting screwed by insurance companies for years now. The Obama care will be the same. The ones taking "hits" will be the physicians. The general public doesn't see this because physicians for the most part are practicing medicine and not being outspoken.

Then my apologies. I didn't read the sarcasm in it. Surprising since I seem to be so good at it myself.

[Douglas]

Originally Posted by gsk

Did you tell the doctor yourself that you were there becuase you were told your pulse was low?
Have you checked you blood pressure since that visit? Were you given a follow up visit and did you keep it?

Yes. They asked why I was there for the visit, and I told them because my pulse has been considered low. Not dangerous. Just lower then normal.

I have it checked every 2 months when I give blood, and other times in between when I feel like having one of those machines read it. Its never high. Always in normal if not even on the low side of normal.

Yep. They said fill the prescription and come back in a couple months and we will go from there. Threw the RX away and didnt go back to them.

[brian.austin]

Originally Posted by Douglas

And youre missing my point. You are in the doctors office for lets say an hour, including the obligatory 30-35 min of waiting.

Doctor bills you for the visit. $220
Doctor bills you for the procedure. $164
Doctor bills you for the medicine. $250

So for an actual 20 min of time, most of with the nurse, you are billed $634

Not bad for 20-30 min of time. Now add that up through the day.

And using your numbers 20x18 a day but lets add a whole month. 22 days a month (figuring 30 days - the weekend) = $7920. Plus 20x22xoffice visits, plus 20x20x whatever else they do.

And there are few single doctor's offices. Those that are have what, a couple nurses and a billing person or 2? Most of these are clinics where theres 3-4 doctors on up.

And notice, im not talking about cutting back on the costs of his services or undercutting his prices for these things. Im saying where they are trying to over charge.

Maybe im a cheap bastard. Just like some are bashing Obama's plan because they would be forced to pay for procedures they dont believe in (like abortion), I dont believe I should be charged for medication going into someone else's body. And again, using your example, a 100% markup isnt horrible (at least in the numbers we are saying). But 1000%? Explains why there is a doctor in florida with a very niced sized boat named 'PIP MONEY'.

Most of us know about the margins involved regarding photography. I suspect very few, if any of us know about the margins in running a doctor's office.

Until I see a few P&L's from those offices, I'm withholding judgement.

I find your arguments especially ironic given the margins and history of profitability involved with insurance. I don't think there has ever been an industry that has had such a good record of profitability during down economic cycles as much as insurance.

The funny thing is that it's your JOB to make sure they maintain that profitability here. I hardly fault you for that. If it's paying the bills and you're relatively happy, I'm glad you're doing something you enjoy. But you're not exactly the most unbiased debater here.

[roncgizmo]

Originally Posted by Douglas

Yes. They asked why I was there for the visit, and I told them because my pulse has been considered low. Not dangerous. Just lower then normal.

I have it checked every 2 months when I give blood, and other times in between when I feel like having one of those machines read it. Its never high. Always in normal if not even on the low side of normal.

Yep. They said fill the prescription and come back in a couple months and we will go from there. Threw the RX away and didnt go back to them.

Douglas, I think you need to find a new Doctor...

Last time something like this happened to me (my BP was on the high side) They checked it 4 or 5 times to see if it was really that high. If you want to give this guy a try let me know. He's in Tampa around Waters & Dale Mabry.