Rheumatologists and Rip-offs

For several years I’ve been seeing a specialist for a joint problem I have. The practice is run slightly different than most. It’s an all cash deal. You write a check for the visit. You get the bill and pass it on for reimbursement from your insurance company.

The only exception to the rule is for Medicare patients. Being a rheumatologist most of the practice is old people and not accepting Medicare would cut into business.

When I started seeing this doc 5 years ago, the rates just went up to $65 a visit. Not too bad for a specialist considering my family doc was charging $95 a pop. Follow along here, the specialist was $30 cheaper than the GP. The doc was very open about the billing and that by having patents pay cash there wasn’t a need for an extra person to handle billing. So the doc was making as much profit wanted at $65 and was paying a receptionist $15/ hour.

After 5 years the rate bumped to $75 an visit. No big deal. I pay $129 for the family doc and over $150 for the pediatrician. I had an appointment today. I wrote my $75 check. Then I found out about the price increase. Visits are now over $95. That’s a 50% INCREASE in just 3 months

The explanation?

Medicare called. Apparently if a doctor doesn’t charge as much as other doctors in the region for services, Medicare assumes that their expenses are lower and cuts the percentage of the bill that they will reimburse. That’s right folks if your doctor charges you less than the other doctor, the government will take away money.

The solution is to keep raising your rates. How do you know how much to raise them? Tough call on this one. If doctors talk among themselves and set a standard rate its price fixing and illegal. Fortuity the government hires someone to ensure doctors don’t price fix and everyone gets a “fair” price.

Last fall my doctor got a call form Medicare, who told him to raise his rates, “or else”. So he did, effective Jan 1 the basic visit went up $10. The result? Not good enough. Medicare called again. Rates needed to be with in such and such a percentage of other doctors in the region. Then they told him to the penny what that rate had to be if he wanted Medicare reimbursement.

So that’s what he charges, to the penny.

Tell me again whose fault sky-high medical costs are and how the government can fix it for us.