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PostPosted: Tue Jun 22, 2010 9:54 am 
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Khross wrote:
Diamondeye wrote:
My doctor is very understanding about that, however, so I think he's giving me a special rate because he's fully aware of my bizarre situation right now.
Are you paying in full at the time of service?


Yes.

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PostPosted: Tue Jun 22, 2010 10:02 am 
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Diamondeye wrote:
Khross wrote:
Diamondeye wrote:
My doctor is very understanding about that, however, so I think he's giving me a special rate because he's fully aware of my bizarre situation right now.
Are you paying in full at the time of service?
Yes.
Then he's allowed to give a "discount" for payment in full at the time of service under current Medicaid/Medicare Rules. And, even then, use of this ability is fairly limited. So, be sure you don't accidentally get him in trouble.

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PostPosted: Tue Jun 22, 2010 10:04 am 
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My doctor gives a flat 30% discount for anyone who pays at the time the service is rendered, and has it posted on his wall.

Whether you pay and then file with your insurance yourself (to, say, meet a deductible) or just have no insurance and are paying out of pocket.

How is his use of such a policy 'limited', or how can it get him in trouble?

It seems his right to give whatever discount he pleases based on payment method- just as if he wanted to give a discount for someone paying with cash as opposed to credit card, to offset the cost of the machine.

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PostPosted: Tue Jun 22, 2010 10:08 am 
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Nephyr:

Because Medicaid/Medicare Compliance requires them to charge every customer the same thing. Squirrel Girl can explain it better than I, however; but it is the primary form of price fixing in the medical industry. And Uncle Sam does it.

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PostPosted: Tue Jun 22, 2010 11:05 am 
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Khross wrote:
Nephyr:

Because Medicaid/Medicare Compliance requires them to charge every customer the same thing. Squirrel Girl can explain it better than I, however; but it is the primary form of price fixing in the medical industry. And Uncle Sam does it.


Medicare and private insurance require that all patients are charged that same amount for the same service. This is why "charges" are so high. They must be higher than all insurances will pay, or the doctor will get the lower charged amount instead of the maximum allowable.

If a doctor allows a discount or no charge to any patient, then the insurance can force the doctor to give the discount to all patients.

However, a doctor can make a policy to charge less at the time of service and not have to give that discount to all patients. You see, the insurance company can not pay at the time of service. :P (In fact, I once had the pleasure of telling Cigna that they were welcome to get my discount if they paid me the day of service.)

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PostPosted: Tue Jun 22, 2010 12:15 pm 
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Ah, gotcha.

Thanks!

Is it also possible to make the same argument about method of payment? (ie, charging more for credit cards vs. cash to defray the cost of the card company)

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PostPosted: Tue Jun 22, 2010 12:23 pm 
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Squirrel Girl wrote:
Khross wrote:
Nephyr:

Because Medicaid/Medicare Compliance requires them to charge every customer the same thing. Squirrel Girl can explain it better than I, however; but it is the primary form of price fixing in the medical industry. And Uncle Sam does it.


Medicare and private insurance require that all patients are charged that same amount for the same service. This is why "charges" are so high. They must be higher than all insurances will pay, or the doctor will get the lower charged amount instead of the maximum allowable.

If a doctor allows a discount or no charge to any patient, then the insurance can force the doctor to give the discount to all patients.

However, a doctor can make a policy to charge less at the time of service and not have to give that discount to all patients. You see, the insurance company can not pay at the time of service. :P (In fact, I once had the pleasure of telling Cigna that they were welcome to get my discount if they paid me the day of service.)

Is this different by state? I read an ER doc's blog and one of his fam prac friends says he can charge lower rates for cash customers so long as they don't have insurance. He did specifically mention what you said though for trying to charge less for cash payment with people who already have insurance.

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PostPosted: Tue Jun 22, 2010 1:58 pm 
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Khross wrote:
Then he's allowed to give a "discount" for payment in full at the time of service under current Medicaid/Medicare Rules. And, even then, use of this ability is fairly limited. So, be sure you don't accidentally get him in trouble.


I'm not using medicare or medicaid so I don't see what this has to do with anything. I'm paying cash from my own pocket.

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PostPosted: Tue Jun 22, 2010 2:09 pm 
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Diamondeye wrote:
Khross wrote:
Then he's allowed to give a "discount" for payment in full at the time of service under current Medicaid/Medicare Rules. And, even then, use of this ability is fairly limited. So, be sure you don't accidentally get him in trouble.
I'm not using medicare or medicaid so I don't see what this has to do with anything. I'm paying cash from my own pocket.
Because, as Squirrel Girl noted, Federal law requires him to charge you the same thing he charges Medicaid/Medicare patients.

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PostPosted: Tue Jun 22, 2010 2:22 pm 
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LadyKate wrote:
DFK, if she had insurance she would not have shot herself in the arm to get an MRI...(so she says...lol)

I know google research is iffy but what I saw was that an MRI to look at your shoulder cost around $700-$1250 (checked yahoo answers to get personal quotes).

I also know that you have to have virtually zero income to get on Medicaid as an adult.

Not to judge a book by its cover but my impression was that she made some money but probably too much to qualify for Medicaid and not enough to pay for an MRI.


And then between indigent discounts, hocking her pistol, and other lifestyle sacrifices/community contributions, she should have been able to afford it.

Alternatively, she could do what social workers all do to get working poor to qualify for Medicaid: spend-down and hide assets.

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