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Fairfax Underground
Welcome to Fairfax Underground, a project site designed to improve communication among residents of Fairfax County, VA. Feel free to post anything Northern Virginia residents would find interesting.
Welcome to Fairfax Underground, a project site designed to improve communication among residents of Fairfax County, VA. Feel free to post anything Northern Virginia residents would find interesting.
Fairfax doctor -- standard?
Posted by:
nofever
()
Date: January 09, 2012 05:04PM
Was looking at the new patient forums for a doctor in the area and came across this. I suspect many do this anyways, but does this clause set off any red flags?
"I understand that the doctor's office will apply for the maximum benefits of covered services from insurance. I am aware there will be a fee $35.00 for a returned check and a 25% service charge for delinquent accounts that are sent for collections."
That could be worded due to people stiffing the doctor for services, but I read that as "We don't have a set price list..... we'll charge whatever we can get away with." This standard?
"I understand that the doctor's office will apply for the maximum benefits of covered services from insurance. I am aware there will be a fee $35.00 for a returned check and a 25% service charge for delinquent accounts that are sent for collections."
That could be worded due to people stiffing the doctor for services, but I read that as "We don't have a set price list..... we'll charge whatever we can get away with." This standard?
Re: Fairfax doctor -- standard?
Posted by:
wnrsm
()
Date: January 09, 2012 06:00PM
It is standard as far as my experience goes. It wouldn't bother me. I have never seen a doctor's price list. They may have them on a menu board - fast food style - if you're in a ghetto clinic.
If you're not insured, it is up to you to get the prices of things before they provide the services. I do that with dentists all the time because "dental insurance" is really a "discount plan" and it is easy to itemize their services.
When it comes to you getting stuck with the bill if insurance doesn't pay, the doctor only charges you what they would have been able to charge to insurance under their agreement. The insurance company negotiates low rates because they don't stay in business by paying out claims.
If you're not insured, it is up to you to get the prices of things before they provide the services. I do that with dentists all the time because "dental insurance" is really a "discount plan" and it is easy to itemize their services.
When it comes to you getting stuck with the bill if insurance doesn't pay, the doctor only charges you what they would have been able to charge to insurance under their agreement. The insurance company negotiates low rates because they don't stay in business by paying out claims.
Re: Fairfax doctor -- standard?
Posted by:
Billing Error
()
Date: January 09, 2012 07:12PM
> ..."We don't have a set price list..... we'll charge whatever we can
> get away with." This standard?
Absolutely standard.
In all cases, insurance comanies have a say AND The Gummamint has a say. However, uncovered charges are at the whim of the office and are, in general, bargainable (Is that a word?).
Just last week I was discussing this sort of thing with a dental office (there're differences between dental and medical billing, but not significantly signficant to you and me). The Dental Association actually publishes pricing guidelines that take into account zip-code, etc. The office manager said most dentists aim for the 85 percentile billing rate for the zip-code - much higher and they'll lose business but more interestingly, much LOWER and they'll take business away from other dentists which, apparently, is a no-no!
Since it is zip-code based, charges for exact-same services in, say, McLean will be higher than, say, charges in Winchester.
> get away with." This standard?
Absolutely standard.
In all cases, insurance comanies have a say AND The Gummamint has a say. However, uncovered charges are at the whim of the office and are, in general, bargainable (Is that a word?).
Just last week I was discussing this sort of thing with a dental office (there're differences between dental and medical billing, but not significantly signficant to you and me). The Dental Association actually publishes pricing guidelines that take into account zip-code, etc. The office manager said most dentists aim for the 85 percentile billing rate for the zip-code - much higher and they'll lose business but more interestingly, much LOWER and they'll take business away from other dentists which, apparently, is a no-no!
Since it is zip-code based, charges for exact-same services in, say, McLean will be higher than, say, charges in Winchester.
Re: Fairfax doctor -- standard?
Posted by:
nofever
()
Date: January 09, 2012 07:29PM
Thanks for the honest input. I guess the way it was written seemed to put me off and question what the deal is, but I guess it's just the way it's done.
Re: Fairfax doctor -- standard?
Posted by:
wnrsm
()
Date: January 09, 2012 08:02PM
Billing Error Wrote:
-------------------------------------------------------
>
> Since it is zip-code based, charges for exact-same
> services in, say, McLean will be higher than, say,
> charges in Winchester.
That explains the WV dental standards.
-------------------------------------------------------
>
> Since it is zip-code based, charges for exact-same
> services in, say, McLean will be higher than, say,
> charges in Winchester.
That explains the WV dental standards.