I have often told the story about the time my wife unknowingly tried to schedule a CT scan at a nearby hospital outpatient department. As luck would have it, prior authorization is all that saved us from a huge bill, of which her share was going to be $2,700. I quickly found a free-standing radiology clinic that had a contract with Blue Cross Blue Shield (BCBS) of Texas for $403. Oddly enough, BCBS was willing to approve a scan at either facility. Nobody called her to explain the huge mistake she was about to make by getting a diagnostic scan at a hospital-owned facility. Here is the thing: Health insurers, Medicare and Medicaid pay hospitals higher prices for the same services that are available elsewhere for a fraction of the cost. Neither do payers alert patients that cheaper alternatives exist.
Author: Devon Herrick
Is a Single Test for 50 Cancers Worth It? Maybe; Maybe Not
Cancer is a dreaded disease. People often worry more about getting cancer than heart disease, the No. 1 killer more likely to take their lives. Indeed, Mutual of Omaha sent me applications for cancer coverage on several occasions. I’ve heard those policies are very profitable for insurance companies because people far over-estimate their risk of…
Why Physicians in Training are Joining a Union
Physician residency is a training program required in all 50 states before medical school graduates are allowed to practice medicine. Residency programs last from three to seven years depending on the specialty. Medical residencies are apprenticeships, where recent medical school graduates care for hospital patients under the direct and indirect supervision of senior doctors who train them.
Feds Are Cracking Down on Sham Consulting, Bogus Speaking Fees and other Physician Kickbacks
Federal antikickback laws are meant to prevent suppliers from rewarding doctors who use their products if those physicians participate in Medicare, Medicaid or other federal programs (this is also why seniors cannot use copay cards for Medicare Part D drugs).