QUESTION: What is the Medicare price for an established patient 10-19 minute office visit?
Before I answer that, an office visit of 10-19 minutes is a fantasy. How many times have you waited days and weeks to see a doctor only to wait once again when you arrive on time while ending up seeing the doctor for a scant 7 minutes or less?
ANSWER: That would be CPT 99212. About $59.
QUESTON: So if my Reference Based Pricing plan pays 120% of Medicare, what would my plan pay?
ANSWER: About $71.
QUESTION: How do doctors make money at $71″
ANSWER: They don’t. They have to make up for it by seeing 40-50 patients a day while charging for as many other things as possible such as an electrical physical.
QUESTION: Why are we insuring a $71 loss? That just doesn’t make sense!
ANSWER: Because we unconsciously want to pay more so we upcharge losses to cover the cost of insurance margins. In this instance a $71 office visit ends up amost double but the doctor doesn’t benefit because someone else does.
With AI anyone can look up just about anything. Your AI companion is standing by…………
QUESTION: If anyone at any time and anywhere can look up Medicare pricing in seconds at no charge why are plan sponsors paying thousands of dollars a year for a TPA to do that?
ANSWER: Because all claims, no atter how small or trivial, go though antiquated insurance plans
