A Medicare Explanation of Benefits arrived. Several months later the Medigap insurer sent a statement of payment, and two weeks later the radiologist private billing notice came with the patient's final bill. A post-operative chest evaluation on the day of discharge by a pulmonary consultant resulted in a Medicare Explanation of Benefits which indicated that the claim submitted by the doctor's office failed to include accurate information for billing the portion that should be paid by the Medigap insurer. The physician establishes a fair charge for his services and the patient accepts the obligation to pay. A number of things.
Most insurance companies cause physician fee schedules to become inflated.
Most insurance companies pay only a percent of published fees, so physicians must raise rates to obtain a net payment that is fair. Administrative costs for generating these numerous statements and keeping track of partial payments is considerable, wasteful and inefficient. This system is error-prone, since at each step human error occurs with predictable regularity. When a team of physicians delivers care, the payment system is a nightmare for the patient. Patients have none of these advantages and, when assaulted by all these billing experts, they are in no position to understand the system.