Mythical & Modern Medicine cntd 3/31/2021 8:19:12 AM
This insurance and payments took bizarre turns. Fees paid by insurance companies varied for the same procedure, for no rhyme or reason. There was a choice for the physician to participate in a particular insurance. Most did in many, for otherwise they would not be able to see patients as now most had insurance. With participation came rules and regulations. 'Carve-outs', deductibles, co-pays, networks, pre-approvals and refusals. Bills became undecipherable. Charges became ridiculous. A visit to the Emergency room would show a charge of $3000. Medicare would pay &800! B.C. & B.S. would pay &500 and Medicaid $80! The hospital would charge $5.00 for an aspirin. Even though the Medicare paid $800 you were liable for $3000 if you did not have insurance! I am not kidding Medicaid , state insurance for the poor paid $21 dollars for he first visit of a patient when Medicare paid $125- when I practiced seven years ago. Medicaid paid $7 for a follow-up visit. Doctors practicing in inner cities with a predominantly Medicaid population could barely pay their liability insurance. Fraud was born. Some doctors billed for thousands of dollars of undelivered or unnecessary service. Entrepreneurs opened up 'Medicaid Mills' with labs, x-rays and doctors for billing for un-needed tests and services. More inspections denials of service payments in retrospect, fines, return of payments, and audits occurred, inconveniencing the predominantly honest physicians. There were codes assigned for services and if the insurance company's computer determined you were billing for too many of the same codes it triggered an audit even when there was no fraud. It went on and on till it became like Alice and wonderland. No one was happy. When I went to a medical meeting years ago we discussed our challenging cases or consulted on a interesting case. Now we complained about insurances, pre-certification, underpayment and paperwork. (to be cntd0
