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| *Ostroff, Fair and Company>>>Health Care |
Medical question about physicans fees? |
Our physcian just raised the amount he charges patients. I thought there was a type of forumla that the doc has to go by in order to determine how much $ to bill to insurances??? If so what is it? It is a book put out by CMS. It will give you the days for global periods for in-pt & out-pt surgeries. It gives you a lot of info. Our book is titled Medicare RVU's. f r e e The insurance companies have a set amount they will reimburse the doctor for for every different procedure. But, the doctor can bill the patients whatever they want to and hope to get the patient to pay anything over and above what the insurance company will reimburse. It's my understanding that many doctors billed uninsured patients more than they bill their insured patients. Physicians negotiate contracts with various insurance providers. Their service fees are then capped by the contract. Since each contract can be different, there is no set answer to your question. The insurance companies also offer different coverage packages to employers. So for example, I have Blue Cross, Blue Shield, but my coverage and out of pocket expenses could be different than my neighbor who has the same provider. Once your physician bills your insurance company, an adjustment may be made to your bill and you will see what is allowed for that particular service when you receive your Explanation of Benefits (EOB) from the insurance company. If you need to know what your out of pocket, or co-pay responsiblity is, you can call your insurance provider. Unfortunately, coverage and fees do change over time, as well as premiums. I hope it works out for you! |
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