Maybe I can help here.
A medical provider has only one published fee
schedule.
It really is not ethical for a medical provider to have more
than one fee schedule. That would be discriminatory. A person who might
suffer at the hands of medical discrimination could have a case.
Instead here's how it goes.
The insurer - on behalf of their
subscribers, sometimes many subscribers - presents a reimbursement plan to the
provider for ie year 2006, saying if you the doctor would like to be a
provider for our program that would be very good. If not that's fine too as
there are other providers that might be interested.
In an ideal world
there would be some negotiation. In the real world the insurer drives the
conversation saying if you agree here's what we will pay. And further the
amount we agree on becomes payment in full. Lastly - provider - the amount
we pay constitutes the amount billed.
The medical provider
delivers a service and bills the insurer his published fee. The insurer
adjusts the amount as agreed and pays the bill. The subscriber is notified
normally by the insurer that we paid for a service on your behalf. You have
great insurance.
Maybe your subscriber plan calls for a co-pay. In
that case you will see a billing for the co-pay.
That's the jist. I
hopes this helps. Flame away.
D Matson / WA State
Bj8
----- Original Message -----
From: David Nock<mailto:healeydoc@sbcglobalnet>
To: Roland Wilhelmy<mailto:rwil@sbcglobal.net>
Cc: John
Sims<mailto:ahbn6@optonline.net> ; 'David Porter'<mailto:Frogeye@swcp.com> ;
healeys@autox.team.net<mailto:healeys@autox.team.net>
Sent: Thursday, May
18, 2006 11:36 AM
Subject: Re: Non Healey-seeking opinions
This is
pretty standard in the medical industry. Since the INSURANCE
company is
there biggest customer they get the better deal. The same
goes in body
shops. How many of you have taken your Healey to the
body shop for a
paint / restoration job and had your car sit in the
corner and wait for
the insurance jobs to get fixed before the Healey
David Nock
British Car Specialists
Stockton Ca 95205
209-948-8767
www.britishcarspecialists.com<http://www.britishcarspecialists.com/>
.
.
On May 18, 2006, at 11:00 AM, Roland Wilhelmy wrote:
> My dentist charges
me more than his patients _with_ insurance. Doesn't
> seem fair.
>
>
-Roland
>
> On Thu, 18 May 2006 12:41:21 -0400, you wrote:
>
>
::Welcome to the real world! I had a dentist once who charged one
> fee
if you
> ::had insurance and a lesser fee if you did not.
> ::
>
::John Sims, BN6
> ::Aberdeen, NJ
|