reply to post by 27jd
We don't make laws, so we can't not allow it. The government does make laws though, and they do make laws in regards to what providers can
bill them (Medicare, Medicaid plans). That's why providers hate government plans.
A law does not allow; a law forces.
While I am sure your company makes plenty of attempts to minimize payouts, the simple truth is that when a business, any business, begins dealing with
other businesses rather than individuals, their perception of pricing changes. A business that regularly charges individuals must, by necessity, pay
more attention to keeping the costs affordable than one which deals with other businesses.
WalMart strives to keep costs low, even if that means reducing the unit size of a product. They sell to people. Wholesalers are less concerned about
the amount at the bottom of the bill, as their customers can simply pass the costs along to their own customers.
We don't force anybody to do anything, we are very clear in all our dealings that we do not make treatment decisions, those are made between
patients and their doctors.
You misunderstand me.
I realize there is no insurance company (to my knowledge) that specifies which tests are to be run under what conditions as a part of their insurance
agreement. However, are you going to tell me that insurance rates will be unaffected by a claim? I think not.
When a doctor sees a patient, one thing in the back of their mind is protecting themselves financially. After all, they are seeing the patient to make
money, not lose it. Now if the glut of malpractice attorneys out there which I alluded to earlier gets a whiff of someone having a problem with a
doctor, they will prosecute as hard as they can, especially since most of them work on a pay-if-you-win basis.
That means that any test that the doctor failed to run, any suggestion that there was something else that the doctor 'should have known about' had
he/she used 'due diligence' can turn a frivolous case that would be dismissed out of hand into one with multi-million dollar consequences. Of
course, those awards do not come out of the doctor's pocket; that's why they carry the malpractice insurance. But their rates do get higher, and can
actually drive a doctor out of business if they go too high.
So perhaps I mispoke a bit and muddied my intent. What I was pointing out is that in order for a doctor to protect themselves form higher insurance
rates, they are required, not by the insurance companies directly but by the combination of legalities, unscrupulous lawyers, and insurance realities,
to run tests they may not really deem necessary for anything other than to cover their own behinds.
Not at all, unless you mean they regulate it indirectly in that many hospitals won't admit somebody without insurance or somebody with
That is exactly what I meant.