These are the thoughts of a cantankerous ol' gynecologist who remembers when things were a little different. I try to find a little humor in my life and the people I meet along the way. Come meet the characters in my world.

Tuesday, September 27, 2011

Health Insurance 101 - 1 "Usual and Customary"

I find there are a lot of terms that insurance companies use that are confusing to consumers.  As someone who has been dealing with them for many years, let me give you the doctor’s version of some of them.  I look forward to your comments.

“Usual and Customary Rate” is what the insurance company decides it wants to pay.  It has nothing to do with what the doctors in the area charge or expect to get paid.  Of course they represent to the patient that the doctor is charging more than s/he should.  Insurance companies also tell patients that they are not responsible for any more than what the insurance company determines is the UCR.  This may be true if the doctor participates with the insurance.  If the doctor is not a “participating provider” (Health Insurance 101-2) you are responsible for whatever the insurance doesn’t pay.   

Insurance companies are not allowed to set a doctor’s charges.  They can tell us how much they are willing to pay.  We can decide whether or not we are willing to work for that amount of money.  If not, we don’t participate. 

1 comment:

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