Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: THURSDAY, April 8, 1993 TAG: 9304080630
SECTION: EDITORIAL PAGE: A16 EDITION: METRO
SOURCE:
DATELINE: LENGTH: Medium
PHYSICIANS NEED TO PRACTICE RESTRAINT
EVEN THOSE who have what is considered excellent health insurance can still be shocked at what the patient has to pay, in addition to that which is covered by the insurance carrier.My Blue Cross-Blue Shield pays 80 percent of the "reasonable and normal" fee for a surgical procedure. With physician and surgeon representatives on their board, I presume that they are qualified to arrive at a fair fee schedule.
Recently I had a very small lump the size of a green pea removed from my forehead. It took about 15 or 20 minutes of the surgeon's time to complete the operation. His bill was for $1,200. The insurance allowance was $235. Blue Cross agreed to increase the allowance to $385 after a formal appeal. Of that amount, they paid $308. The remainder ($892) was my responsibility.
Before the procedure, I was not wise enough to ask the fee and the surgeon never mentioned what his fee would be. It never occurred to me that there would be such a disparity between the Blue Cross allowance and what the physician would charge.
Probably few patients who feel they have adequate insurance coverage ever ask about the fee in advance, and surely it is rare for a physician to bring up the subject with the patient. If it is mentioned, the patient almost always is referred to the business office to discuss money matters.
Though my bill of $892 is small potatoes as medical expenses go these days, there must be legions of people who are not only stunned when they are billed but financially unable to pay without dire consequences.
Physicians' fees appear to have far outstripped not only inflation but reason as well. This appears to apply more to the specialists than to family- or general-practice physicians. Though any thought of capping or controlling medical fees is anathema to physicians, maybe some self-restraint would be a good prescription.
ROXANNE HILL\ ROANOKE