EpiPen Maker Quietly Steers Effort That Could Protect Its Price

171–172 of 172 posts

Re: EpiPen Maker Quietly Steers Effort That Could Protect Its Price

#171

Post by riahi » Tue, Sep 20, 2016, 4:25 AM UTC

phkahler wrote: post #170

riahi wrote: post #167

Earlier quoted context omitted.

There's a lot of rant in this post which I'm going to leave to the side, because I have no idea what happened between you and that physician / billing agency / insurance. "In office surgery" may mean you got scoped, but I'm not an ENT, and I'm not going to speculate on what happened. First point: If you're willing to pay cash and bypass the insurance / CPT / ICD10 / RVU rigamarole, I'd like to direct you to any numbe…

>> You and your insurance company are the only people who know the status of about 10+ variables which will affect your out-of-pocket-cost. What's your deductible's status: Have you exceeded it? What's your out of pocket max for the year? Do you have a copay or coinsurance for ambulatory services vs hospital provided services? Are we in-network with your variant insurance company's policy? Stop talking about what the…

That's the big problem. What we charge is universal across carriers; it's the law. What the carriers then do is try and negotiate me down to accept some fraction. I could charge $5,000 to everyone for a PETCT; Medicare laughs and will pay a set amount. Depending on their market power, private insurance will pay a multiple of what Medicare reimburses. I would be stupid to set my "charge" lower than the maximum a given insurance will possibly pay.

If I charge under what they will pay, they aren't going to reward me with all that savings.

If someone wants to negotiate with me directly, I'll charge you some other price, then write off the rest, just as if you are phkahler insurance co. It's the only "legal" way to offer a discount.

Re: EpiPen Maker Quietly Steers Effort That Could Protect Its Price

#172

Post by phkahler » Tue, Sep 20, 2016, 6:31 PM UTC

riahi wrote: post #171

phkahler wrote: post #170

Earlier quoted context omitted.

>> You and your insurance company are the only people who know the status of about 10+ variables which will affect your out-of-pocket-cost. What's your deductible's status: Have you exceeded it? What's your out of pocket max for the year? Do you have a copay or coinsurance for ambulatory services vs hospital provided services? Are we in-network with your variant insurance company's policy? Stop talking about what the…

That's the big problem. What we charge is universal across carriers; it's the law. What the carriers then do is try and negotiate me down to accept some fraction. I could charge $5,000 to everyone for a PETCT; Medicare laughs and will pay a set amount. Depending on their market power, private insurance will pay a multiple of what Medicare reimburses. I would be stupid to set my "charge" lower than the maximum a given…

What I want is not possible without legislation. I want you to charge your rate and the insurance companies not be able to negotiate other than walking away. The only way the insurance company can save money then is to not cover the full amount and pass the rest on to the patient. Now you have to compete with others like you, and insurance companies have to compete with others like them. The super-awesome doctors can charge whatever they like and only take cash because insurance companies won't cover their services, and that's fine too - I know of a couple guys like that already and they are awesome at what they do.

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