My brother is an orthopedic surgeon here in NJ. For a total hip replacement, he'll charge $6000. To my way of thinking, that's not a pretty good price for giving someone back their ability to do something as basic as walk without pain. I'm factoring in his years of training, the risk he assumes every time he operates, his malpractice premiums, and the intuitive, intrinsic value of the services he provides. But, Medicare reimburses him no more than $2500 for a total hip, and many (not all, but a lot) of private insurers base their R&C figures on Medicare and pay about the same. After 20 years of practice, he still participates in most plans anyway, because he is based in an urban area and he knows that many of his longtime patients would not be able to come to him anymore if he dropped out of their plan. Orthopedics is a bit different surgical specialty because you tend to form a lasting relationship with the orthopedist. Everybody gets muscle and joint aches and pains, but thankfully few of us get ANs. In most other surgical specialties you'll see the surgeon once before the surgery, and maybe 2-3 times post-op. They don't have the same incentive of an ongoing relationship-in fact, if they do their jobs right, you'll never have to see them again. The point I'm trying to make is that "reasonable and customary" is usually neither. I'm not surprised that surgeons in the ultra high-risk fields like neurosurgery feel that they should not let the insurers tell them what they should make on a procedure. I know of no physician or surgeon who would knowingly send someone into bankruptcy, but when a car dealer doesn't worry about you when you take out a loan to buy a fancy car, I'm not sure why a physician or surgeon shouldn't be able to ask the patient for a substantial portion of his or her fee, even if the patient has to make some financial sacrifices.
Enzo:
Sorry, but your comparison of a car dealer to a surgeon is seriously flawed. A 'fancy' car - or
any car - is a
want, not a
need. AN surgery (or radiotherapy) is
always a
need. A real physical need. A car is something that one can do without, if necessary. Not so with a growing Acoustic Neuroma tumor that
must be treated. As my neurosurgeon bluntly told me following his diagnosis:
"this thing can kill you". He was correct.
A physician - especially a surgeon - is assumed by most folks to have made the many financial and physical sacrifices necessary to enter the field of medicine (and his or her speciality) based on a desire to help suffering people, first and foremost.
Of course a doctor/surgeon deserves to be paid - and paid well - for their years of training and expertise. Few reasonable people would begrudge them their fees. However, not many of us have thousands or, more realistically,
tens of thousands of dollars sitting in a vault that we can just hand over to a surgeon because he won't accept our medical medical insurance, no matter how expert the doctor may be in their field. That is why medical insurance has become so vital - and is such a hot issue, politically. It affects almost everyone.
I realize that I can only speak for myself here: My medical insurance - through my wife's employer - costs us about $2,600. per year (for both of us) - or close to $48. out of every weeks paycheck. If we had to pay for it without the benefit of the group rate and her employer's subsidy, it would very likely be unaffordable for us. We're grateful for the opportunity to have medical coverage at a price we can afford, even if there are co-pays, deductables ($500. per year) and other expenses not covered by our Blue Cross plan. I think most folks are in a similar position regarding health insurance.
Now, if I have a medical problem that requires me to engage a surgeon to perform a certain procedure and that surgeon refuses to accept my medical insurance as payment, forcing me to make a personal committment to pay him/her out of my pocket (while I'm still paying for my now-rejected medical insurance) because the doctor doesn't think he/she will receive (from the medical insurance company) what he or she deserves as a fee, that is their perogative. Just as it is mine to immediately look elsewhere for a different surgeon - and they are not all that hard to find in the bigger population centers. However, I believe that refusing to accept
any medical insurance (on the part of a surgeon) is downright arrogant. It demonstrates to me that this particular doctor is more concerned with the fee than the patients well-being. Frankly, big reputation or not, I don't even
want that kind of person doing surgery on me, thanks. I pay good money for decent medical insurance and if a surgeon won't accept it based on the doctor's conclusion that their services are worth more money than the insurance company will pay, then I have to legitimately question that doctor's committment. It's not as if they are going to be paid some ridiculously low amount, either.
My wife underwent extensive back surgery (a fusion) in September, 2005 with two very experienced neurosurgeons performing the delicate surgery. Their combined bill was around $60,000. Blue Cross paid them a bit over $32,000. - total - and neither surgeon appeared to feel deprived or mentioned that they felt taken advantage of. My theory is that most doctors (surgeons, anyway) submit a high bill to the insurance company but expect to be paid much less from the insurer. However, it's obviously enough to make continuing their medical practice financially worthwhile. I seriously doubt any neurosurgeons are living on the poor side of town or driving beat-up old cars these days, unless they
choose to do so. Again, I don't begrudge these surgeons (or any surgeon or M.D.) their high incomes - they certainly earn it - but to refuse to accept the expensive medical insurance of working-class people and demand they pay him or her 'out-of-pocket' for his or her surgical services smacks of an elitism and haughtiness that I find deeply disappointing in a physician.
My neurosurgeon charged $23,000. for his services (an 8½-hour surgical procedure) and his very capable surgical assistant charged $5,000. for her services. Blue Cross paid almost the full amount, as it was reasonable. Other physicians involved in my AN surgery also charged reasonable fees. I had to pay a small amount, the co-pay portion, to most of them. My neurosurgeon never asked me for a dime, personally. He told me upfront that my well-being was more important to him than a fee. He said he would accept whatever Blue Cross paid and if there were a co-pay due, his office would take $10. per month if I wanted. There was no co-pay due. My account is paid in full with this fine surgeon. God bless him.
Granted, that is my personal experience. However, it shows me that only
some surgeons are rejecting medical insurance as payment and, in effect, if not intent, telling would-be patients that they must now add financial worries to their list of problems by demanding the would-be patient negotiate the doctor's fee and pay whatever the fee is 'out-of-pocket', even if its tens of thousands of dollars. If this attitude ever becomes the norm, it is not going to fly with the general public. I fear that it will eventually create a demand for 'national health insurance' that some politicians are all-too eager to impose on all of us, patients and physicians, alike. If and when that situation ever occurs, surgeons dismissively refusing patients health insurance and demanding a 'negotiation' that requires the patient pay the doctor 'out-of-pocket' will be a big reason why. I hope this doesn't come to pass.
I deeply respect surgeons and I admire most physicians, but few people can afford to write a personal check for the fees they charge. That's whymost of us pay good money each month for medical ('health') insurance. It isn't about trying to deny a surgeon his or her fee but that surgeons who don't like the insurance industry's fee scale want to reject it and force patients to shoulder the financial burden, alone - when they are
already paying for employeer-subsidized 'health' insurance. I believe that is the wrong approach. It will end up hurting these surgeons. One fine day, they'll find themselves stuck with a
government ('single-payer') medical insurance scheme that they cannot opt out of and that will probably pay them
less than before - for the same operation. Who benefits from
that? Obviously: no one.
Ultimately, this is a political issue and will probably be decided by politicians, to our regret. Some surgeons putting hapless patients on the spot for a hefty surgical fee is not only unfair (although completely legal, of course) but destructive and below the standards of what I would normally expect of someone who took the Hippocratic Oath. Surgeons are hardly car dealers and shouldn't be acting as if they were, refusing medical insurance and making would-be patients, who may be very much in need of their help, 'negotiate' the doctor's fee while the good doctor offers financing advice to help you pay his bill. That is a sad state of affairs. If this is what lies in store for the future of health care in the U.S., get ready to say 'hello' to mandated government-controlled health care that will leave both doctors and patients longing for the good old days when complaining about medical insurance pay rates (and co-pays, etc) were the least of the doctors - or the patients - complaints.
Jim[/color]
