by Fulfilling a Dream

Created on: May 25, 2009

Negotiating Health Care Services Under Medicare

There is no good way to allow patients and providers to negotiate prices. It would be so much easier to say, sure why not. However, in the United States there are too many entities that drive the cost of health care. Negotiating the cost could be horribly detrimental to the patient and potentially the physicians. Who establishes the rules? There are several reasons as too why this is not good: balance billing, quality of care, money lost by the physicians, and reputation.

BALANCE BILLING

Balance billing is a very bad thing and it exists in every state. California is the only state, I believe, that has made it against the law. Any provider could be accused of this, either through Medicare, Medicaid, or private insurance. Balance billing is when the provider has received their contract reimbursement rate and continues to bill the patient the remaining of the cost.

Understanding why a patient has to stay with a Medicare participating provider should keep these things from happening. Medicare does not cover services when rendered by a non-participating provider. There is no negotiating of rates. Patients would be responsible for the cost of services at 100%. It is imperative that any Medicare recipient understands this.

The purpose of a contract is ensuring that the promised rates have been paid. These contracts are established before a provider has seen a Medicare patient. It is the physician's job to establish their rates. If they are not satisfied then they should go through the proper channels, which should never be the patient.

Unpaid medical bills in some states could cause a patient to have their paychecks garnished, credit destroyed, and liens placed on properties. In my opinion, this is the worst thing that should happen to someone who was simply seeking medical attention. Can you imagine how much worse things would be, if there were no more rules?

QUALITY OF CARE

Quality of care is huge for everyone seeking medical attention. With negotiating prices, would the quality of service change, depending on cost? This is already a concern for many consumers, in the United States, both uninsured and insured, now.

What happens if a patient has ongoing treatment and missed a payment? What if a patient all of sudden cannot make any more payments? Would the physician say I could not help you anymore, because they are now losing money? It is easier and simpler to have these things established

• 1
• 2
• Next Page >>