Donna: The amount of copay and the amount or even if the doctor can bill a
patient for charges not covered by insurance is determined by the contract
the physician has with the PPO. Some stipulate that the co-pay is all the
doctor can get from the patient. Some do not. This should have been
investigated prior to your surgery and I think the dotor's office has an
obligation to iron this out with you beforehand. However, the consumer also
has a responsibility here.
Managed care is not always the deal it looks to be on non-routine types of
care. I encourage all consumers to look at their policies very carefully and
not assume that the third party payer will "take care of it". this is the
attitude that has, in part, gotten us in to trouble. For those of you who
have a choice of third party payers, compare policies. You may end up getting
better coverage, and better care if you stay with an indemnity plan (they pay
80%, you pay 20%) rather than a managed care plan (PPN, PPO, HMO, etc.)
And my soapbox is: We are spoiled in this country (US). We expect the best,
and we expect it now, but we want someone else to pay for it. Because we have
given up our rights to make our own health-care descisions and now refuse to
take more responsibility, we have a healthcare crisis that is threatening
quality of care in the name of cost containment. The solution to this dilemma
is to empower the consumer to take more responsibilty both for there bill and
for their health. Prevention is the name of the game and so is competition
(more competition for docs, more advanced practice nurses, more allied
professionals, more nurse-midwives, greater use of alternatives that are
proven effective, etc.) But if we want quality and less expense, we, as the
consumer, are going to have to demand it and we are going to have to pay for
it more.
Breastfeeding is a perfect example of cost containment from greater consumer
responsibility and fits into the prevention model.
Alison, TPR Chair who had to do lots of research and didn't like what she
found out.
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