Doctors say insurers are automatically downgrading their claims and paying less. Insurers say it’s their duty to prevent overbilling.
The practice of automatic downcoding seems to have taken off in the last few years, as health care costs soar and insurance companies use third party vendors and AI programs to reduce costs.
NBC News spoke to doctors’ offices across numerous specialties from around the country, all of whom rely heavily on office visits — rather than surgeries and procedures — for their revenue, and all of whom are experiencing downcoding from insurers.
The problem, doctors say, is that lower and lower reimbursements mean reliable community doctors, like Wagner, could have to make choices that are inherently bad for patients, like cramming more patient visits into a single day to make up for lost revenue, dropping patients on certain insurance plans, or selling their practices altogether.
We already pay $200 for you to see us for 15 minutes. How the hell are you not profitable?
Not to mention the cost for license, malpractice, and billing agents. Also, remember that the insurance companies end up actually paying between 50 and 70% of claims so so for every paid 200 dollar claim there may be one that is done “for free” since it will never be paid. It gets averaged out to be much less.
There is literally an army of people employed on both ends to just argue about these things. That’s where our healthcare dollars go.
The staff to deal with the insurance companies aren’t cheap, same with the malpractice insurance premiums they have to carry, and the monthly student loan debt payments for the massively inflated college cost.
Receptionist has to be paid, nurse has to be paid, utility costs, biohazard waste is different than regular. The needles are money the gloves are money. Unlike a church they’re not tax exempt. Theres IT because of security requirements. Pay the EHR company, pay for continued education to keep their credentials. Etc etc. America has inflated prices because a lack of regulation. In this particular case while they “charge” 200 if the insurance says is only paying 50 due to downbilling instead of 100 as normal thats 50 they dont get and all their costs add up.
I would also say while your doc may only be with you in person for 15min a good one spends time on your chart before and after the visit.
I have a feeling that the stockholders and dividends were involved.
Of the insurer, definitely. Of the hospital, maybe.
Even with all that, 200 for 15 minutes is friggin insane
What do you think is reasonable? They’re a highly educated professional who has spent an egregious amount of time learning and working for less than nothing to peanuts. Engineers and techs are billed out at similar or higher costs, why is that not upsetting?
Pricing is just one of the many things that could be solved or at least greatly improved in a civilized M4A system.
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