Yes you read that right.
A healthcare provider actually writing a post on why you don’t trust healthcare.
People don’t get it confused.
We are providers but we still have to deal with healthcare and the ups and downs just like you.
As a young providers I have noticed trends in healthcare that makes me sick.
In this post I’m going to write about:
- Some of the things that bother me as a provider.
- How the game works on the providers side when it comes to reimbursement.
- How some providers take advantage of the system?
- What you can do to make sure you don’t get taken advantage of?
- How Man of Health ties into this “new image” of healthcare?
Let’s get started.
Things that bother me as a provider.
As a provider things the power of someone’s insurance company really bothers me.
I know health insurance is vital to everyone that has it. I also know the purpose of health insurance is to control the cost of healthcare.
First thing first please know that insurance is controlled by the employers who pay your insurance. This means that they are not going to get you the best insurance available.
This also means that providers typically have to jump through circles to get a patient what they truly need. Claims are denied all the time by insurance companies.
Insurance that is controlled by the government can be hard to deal with also. When healthcare is controlled by the government it decreases the choices people have. When you eliminate choice you typically eliminate competition.
As a provider insurance makes it impossible to keep price in mind when providing care for your patient. There is no set price on anything. The pricing varies on services offered, location of service provided, and who provides the service. So when a patient asks me how much it cost. It is very hard to have a price in mind when offering care to the patient. This really bothers me because you have to take price into account when providing services.
How the game works on the providers side?
Providers are reimbursed.
If a provider owns his or her clinic the are reimbursed for the treatment they deliver by your insurance company or government provider (Medicare or Medicaid).
If the physician works for a hospital or clinic they usually have a salary or they may receive a salary and get a percentage of billing.
- Fee for service:
Providers are paid only for the services the supply. If they don’t do it they don’t get paid. Most states have eliminated this type of service but it does exist in some states. This type of service itemizes every thing received at a doctors visit. This means that you get charged for each service provided (consult, lab, lab review, and procedures).
This type of model could cost you money because a physician maybe incentivized to do unnecessary procedures or tests. Some people actually like this model because they welcome any medical services that could help them.
- Managed Care Model:
The Affordable Care Act placed the Managed Care Model to the front of the line. 70% of Medicaid recipients have managed Care models.
Care is bundled and reimbursed as a bundle. Meaning that no matter what service is provided Medicaid pays out the same. Medicaid actually pays out a little more if you provide less service. This plan is to ensure people don’t receive unnecessary medical services. The problem with this model is providers are watching the amount of services performed, so they won’t loss money.
- Medicaid Reimbursement
Ever wonder why a provide does not take Medicaid one word REIMBURSEMENT.
Each state has a different reimbursement model. Most states pay a standard rate for medical services. Generally Medicaid only pays 60% of what Medicare and Private insurance pays. This is why some providers refuse Medicaid.
How some providers take advantage of the system?
I have already stated that some places don’t accept Medicaid. There is a stigma surrounding medicaid patients that isn’t right. When a provider does accept Medicaid they may not order everything you need because of payment reimbursement.
Some places take advantage of this by accepting Medicaid in a place that has few options for Medicaid recipients. They get in the mindset of quantity over quality. They usually have a crazy number of patients with subpar service.
Some providers use the fee for service to their advantage by ordering unnecessary tests and labs. They are able to charge you for each test and lab. They usually separate your appointments into different visits so they can charge you.
These type of providers are milking you like a cow.
What can you do to ensure you aren’t getting taking advantage of?
The first thing to do is some research on the clinic visit. Talk to the office and find out the reimbursement on your visit. They may not offer this information which is ok.
The second and most important thing to do is to start becoming educated on your health. You should know what labs, procedures, or medications or needed for your health issue.
This is why we provide free blogs and educational topics so that you can learn about your health. You need to take control of your health life.
Ask questions usually the word “Why” can go a long way. Never forget the provider is there to help you. You should be partners with your healthcare provider.
Remember building a health legacy begins with education. Don’t let a provider take advantage of your lack of knowledge about your own disease process.
If you need any help with this contact us..
How Man of Health ties into all of this?
We are here to educate you so that you can become an active partner with your provider.
We are not here to take the place of your provider but to help improve your knowledge base.
We offer Gameplans based on the information your provider provides to you. We are here to make sure you build your health legacy.
We believe in making health simple. It is truly your health, your way.