<< I can't believe that those doctors don't take insurance! What is that about? Seems to me they are taking advantage of people desperate and in pain. >>
I don't know why they don't...here is my guess, though...
Many insurance companies dictate how much doctors can charge for everything from a band-aid to a surgical procedure (including how many hours the procedure *should* take). This can work reasonably well in a general practice type setting. Doctors know a "routine" surgery should take x hours, y number of sutures, etc. They set their fee based on anticipated number of hours/materials used.
If the amount exceeds that which they and the insurance companies have agreed upon, the doctor gets to "eat" the difference. (Of course, some doctors inflate their rates so they can be decreased, but that's another story.)
In an adhesion-related surgery, doctors have no accurate way to predict how long it will take. Usually they don't know what they will find til they open the patient up. Suppose they reserved the operating room for 4 hours but ended up in there for 8? Somebody has to pay for the time spent in the operating room. It won't be the insurance company - if they allowed 4 hours for the procedure, that's what the doctor gets paid for. Not a penny more. And it won't be the patient because his insurance usually holds him responsible only for, say, 80% of the total anticipated cost. You think the hospital will lower its operating room rental fee to accomodate the doctor? Hardly. That leaves the doctor.
How many doctors are willing to specialize in an area with so many unknowns -- adhesions removal -- and leave themselves open to losing money? How could they continue to practice? Sure, doctors get paid a lot. But they have tremendous overhead, fees, malpractice insurance, not to mention paying off their student loans, etc. They may make a handsome salary but that doesn't mean they get to keep it all.
Too, for doctors to take many kinds of insurance, they have to staff their office accordingly. If the doctor accepts more than three or four major insurance carriers, he easily could have half a dozen full-time people who only handled the insurance/billing etc. So now the doctor has more people on his payroll, and he may have his fees docked by these insurance companies, anyway. What's his motivation for this, to spend more and possibly get paid less?
And even with full-time insurance staff, errors occur frequently that cost everyone time and money. Have you ever gone through a stack of hospital receipts and tried to match them up to a Medicare statement? I have, and it's a nightmare.
Doctors want to "do the right thing," but they need to earn a living. Insurance companies don't want to lose money. Hospitals have to charge enough to keep the lights on. Patients can only afford so much. Where is the happy medium? It's all so very complicated.
I can understand why a specialist would prefer not to take insurance -- that would leave him free to be a doctor, and worry about doing his work -- not managing a bunch of staff and worrying about paperwork/billing etc. That doesn't mean he is taking advantage of chronic-pain patients, does it?
Some insurance companies will let you use doctors/surgeons not listed in their plan. Suppose you have surgery with a doctor who is not on your plan -- the doctor will require cash/payments etc. from you. Your insurance company may still reimburse you for a portion of the expenses -- you would be submitting the claim instead of the doctor's office, though. That means you get to lay out the cash first, which can be extremely difficult to do. But it is do-able.
Every day in the mail, it seems, I receive those "Pre-approved! Act today!" deals for this or that credit card, with enormous lines of credit. We are not wealthy people by any means, and I haven't worked for years now. In today's world, sometimes all it takes to get a loan is to have a pulse. <G>
While there are doctors and insurance companies who may take advantage of people who are in desperate pain, to use your words, I think this is untrue for the most part. Medicine is geared towards helping people, that is true. But people -- doctors included -- have to earn a living. I thik the current system in the US, which is based in our capitalist society, is imperfect. Medical systems based in socialism are imperfect, also.
Is there a "best" way, an ideal medical system? A realistic, do-able one in which everyone has all their needs met -- patients and doctors alike? What do you all think?
Hope you are having a very good, pain free day!!!
Love,
Lynda M. in AZ
"Man is born to live and not to prepare to live." - Boris Pasternak