Sobering Medical Reality: What Doctors Charge versus What Insurance Will Pay

A new study focusing on medical costs in the U.S. has verified what millions of patients who depend on federal and state insurance coverage already know: the typical doctor charges considerable more for services than Medicare is willing to pay for.

medicare-trickle-art

We should all hope for a logical balance in the dollars-for-service conundrum

And this reality creates serious financial challenges for millions of patients involved.

The studyperformed by Johns Hopkins Bloomberg School of Public Health, as well as the Carey Business School researchers – can be seen in the Journal of the American Medical Association, JAMA. It reveals that almost all physicians bill patients much higher than what their federal insurance will cover, and therefore what their patients can afford. More than 50 medical specialties, for example, charge an average of 250% higher than Medicare payouts – an unsustainable fact of American healthcare for far too many folks.

The study also highlighted considerable variance in charges between different parts of the country, as well as medical specialties themselves.

At the high end of specialties anesthesiologists, for example, often bill the patient 500% over the Medicare coverage amount. At the low end, general medicine practitioners charge an average of 150%.

Those specialties that charge the highest above Medicare are invariably those where patients are not able to choose the doctor at all – like emergency care, x-ray interpretation and neurosurgery.

“The study’s senior author, Gerard F. Anderson, says this: “Many patients are shocked two months later, when they get a bill from a doctor they didn’t even meet. No one told them what the exam would cost and later they discover the price is outrageous. But this is happening all the time.”

Charges above Medicare rates also varied by state, with Wisconsin the most expensive and Hawaii the least.

Let us all hope our new President Trump’s administration can bring focus on this honestly unnecessary burden on our Medicare-dependent citizens.

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