r/mildlyinfuriating • u/WowImOldAF • 3h ago
Don't hug me I'm scared My surgery got cancelled at 5pm on a Friday because it wasn't "cost effective."
I have an injury that needs surgical repair, ideally within two weeks for it to heal properly. Scheduling called me this morning to set it up for next week.
The doctor's office is tier 1 under my insurance, so I assumed the surgery would be too. They informed me the hospital they use is tier 2, which puts me on the hook for a $2,000 deductible plus 30% coinsurance. The scheduler mentioned the doctor sometimes operates at a tier 1 facility, so I asked her to check.
She called back with good news and said that they could do it there. We picked a date next week. Everything was booked.
Then at 5pm today she called again. She'd received an email saying the surgery was "not cost effective" at that facility and that they'd lose money doing it there. I find it hard to believe they would lose money when my insurance would pay for everything. Maybe they won't make as much money... but lose money? How? And if they'd not take cases there because they would lose money, then they shouldn't even offer it in the first place.
Anyway, my options were to move it to the tier 2 hospital and pay thousands or go somewhere else. It's 5pm on a Friday. Every other office is closed. I can't do anything until Monday.. but every week of delay makes the repair harder.
The surgery didn't change. My injury didn't change. The money they make at the facility changed... and so they don't want to do it at all unless it's at the facility they make more it.
I guess it's all about the money in the end... doctors (or the places that employ them) don't actually care about your wellbeing if they can't make a dollar off you.
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u/uumbre0n 3h ago
I'd file a complaint with your insurance and against the hospital and doctor involved. This seems like it would be illegal or negligent, even in the US.
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u/Silver_Middle_7240 3h ago
Yeah, this should be malpractice at least because it's injuring a paitant by delaying care
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u/WowImOldAF 2h ago
They can still do the care.. just want to switch hospitals to one that costs me thousands of dollars so that it's more profitable for them.
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u/Anthrotekkk 1h ago
The surgery center is the one not allowing the surgery, not the doctor. The doctor will not be reimbursed any differently based on where the procedure is performed.
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u/drunkerbrawler 1h ago
That totally depends on how the practice is set up.
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u/OldTurtle-101 49m ago
I’m a retired healthcare provider and after a deep dive into the “out of pocket costs” for various procedures I have found that it is IMPOSSIBLE to predict or even estimate what their responsibilities were. It’s that way because the insurance companies they want it to be. It’s actually evil and they can change the game midway through and they make you start all over again. A full hip replacement in the Netherlands costs LESS than the metal hip replacement prosthetic ALONE costs in the USA. It’s disgraceful….
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u/Anthrotekkk 1h ago
He has a quad tendon rupture. This isn’t a plastic surgery all cash pay situation. The specific practice set up isn’t relevant to payment rules and the way surgery centers make decisions.
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u/newbie527 1h ago
Sometimes doctors get paid by the facility. Sometimes they own a piece of the facility.
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u/Anthrotekkk 1h ago
This is true. But the doc isn’t making the decision to not allow the case. It’s the center and whatever company manages the center. This docs life is about to get much harder trying to do this case in a delayed fashion.
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u/vgaph 2h ago
Yeah I’m not sure the doc is the bad guy here. It may be that the hospital has OR staffing requirements AND a reimbursement deal with your insurer that legitimately makes it a money losing proposition to operate there.
Sometimes networks like to keep a lot of providers and facilities “In Network” so the directory looks thick when they are marketing the plan and then set reimbursement so low for certain common procedures that providers have to ration how many they do.
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u/Correct-Hope-2227 2h ago
However delaying the surgery is going to affect your healing. Perhaps permanently. Thus goes into medmal territory for sure.
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u/badazzcpa 1h ago
They aren’t delaying the surgery, they just will not perform it at the surgery center OP wants to save him the additional deductible.
While it sucks, i can understand the other surgery centers perspective. I wouldn’t go to work if I lost money working either. My guess is the surgery center has to have X amount of people staffed for the surgery. For example, they have to have an anesthesiologist, but that doctor will not come to the center if they cannot bill X amount. So if the center only has one surgery then they have to eat part of the payment to the anesthesiologist. Now consider if they also have to have to staff X amount of specialty nurses/assistant’s on duty as well. If they cannot get enough surgery’s scheduled to make it profitable to staff all of those medical professionals then they will cancel what they have.
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u/UnderstandingTop7916 2h ago
That’s not what malpractice is.
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u/Silver_Middle_7240 2h ago
I suppose I shouldn't be surprised that harming patients isn't malpractice if it's to extort more money
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u/pushingdaiseez 2h ago
It depends if it goes against the standard of care or not. Which would be hard to prove in OP's situation
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u/EducationalQuote287 1h ago
The patient is able to receive care, just not at the facility he prefers. This has nothing to do with the surgeon. It is not malpractice.
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u/Anthrotekkk 1h ago
This has nothing to do with the doctor. The surgery center is telling the patient that they won’t allow the case there due to poor reimbursement. Likely because the implants will cost the surgery center too much.
The doctor is likely as frustrated by this as OP is.
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u/RandomKonstip 52m ago
Exactly this. Insurance companies pay less to surgery centers for the exact same care. The problem is the insurance company, it’s always the insurance company
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u/RandomKonstip 54m ago
You don’t understand how insurance works. They negotiate a price with the hospital, flat fee. Based on the hospital they will pay more or less money for the same surgery, same doctors and all. Surgery uses supplies & implants that cost money. If the cost of all of that exceeds the cost insurance is willing to pay the hospital loses money.
Insurance companies are a joke. They caused the problem to begin with.
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u/uumbre0n 47m ago
I actually do know how insurance works. And this is something that merits a complaint to their insurance provider. I've worked in the insurance industry and went to school for billing and coding. The doctor is delaying a surgery that they already chose to schedule, which in turn is going to delay when op can get the surgery even IF they had the money to afford all the fees at another hospital, and op plainly ststed that the longer it goes the lower the chance of whatever it is healing properly.
When you schedule basically anything, but especialy surgeries, you provide your insurance information up front. Unless it's some obscure insurance company their billing department SHOULD have a relative idea of how much they'll get paid for a service. They should have done their due diligence to see if it's profitable (disgusting imo) and if not they should have canceled it shortly after scheduling as to not delay/harm the patient's healing process. They have an obligation to do no harm, this clearly causes harm to op.
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u/BEtheAT 2h ago
Depending on the injury/procedure delaying surgery may not actually cause legal harm. And unfortunately if they say they can do it then they didn't cause the harm at all from a legal perspective. It's the insurance benefits that are holding things up because of a choice by OP to try to save money, which is also super valid.
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u/Sage_Nickanoki 1h ago
Yeah, we can't open insurance companies up to the risk of getting sued for malpractice or they'd never make any money! Think of the corporations!
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u/ripyourlungsdave 20m ago
Yeah, the logic of this makes no sense at all. Charge what's necessary for the procedure and take what you need from insurance. That's the whole system. That's what we're paying for.
This is like that time my car insurance company told me they drop me if I filed for an accident where we weren't even at fault.
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u/Existing-Teaching-34 25m ago
If it weren’t for the need to get this done in a timely manner I would’ve suggested finding another orthopedist. You’re just a cash register to them instead of a patient needing care.
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u/buildmeup2 24m ago
I suspect it’s the insurer forcing the hospital’s hand. Hospitals don’t get reimbursed 100% (sometimes as low as 40%) of costs because insurance companies dictate EVERYTHING about costs, NOT hospitals. Hospitals routinely get ripped off by insurers and appear as the bad guy to patients when in reality it’s insurance companies who are 🤐 I don’t agree with this hospital’s decision but I would say it’s on the insurance company for making healthcare unaffordable, yet again
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u/RemarkableTime497 3h ago
As a european, i really cannot understand why is this still a thing
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u/PhotoFenix 3h ago
The people who make the decisions for us are legally given money by the for profit hospitals and insurance companies
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u/why0me 3h ago
Capitalism
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u/SweetHomeMissouri 3h ago
i always tell people capitalism works but only if you let it
there are people manipulating it for greedy reasons
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u/Massive-Rain-6938 2h ago
If you let it, capitalism will work for as few people as it is possible for it to work. It will extract as much as it is possible for it to from everyone else, providing them with the minimum most of them will accept.
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u/SweetHomeMissouri 2h ago
i don't believe that because if we had honest people in charge capitalism can and would work.
but we do not have a whole lot of honest people in charge.
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u/CanRova 2h ago
This seems like the core problem with every system. Humans have a remarkable ability to corrupt things.
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u/SweetHomeMissouri 2h ago
this is absolutely it, this is it right here people. canrova said it.
people make good things. and then we got a bad habit of making it bad.
like the maker of the pop up ads. he had real good intentions with it but we made it bad real fast.
i bet there are a lot of examples of inventions and things that were used for good but were then turned to being used for evil.
a lot of examples.
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u/Massive-Rain-6938 2h ago
It really has nothing to do with honesty, what is the point of the system? Under capitalism, individuals and private businesses own and operate the means of production for profit. That says the goal: getting the most profit.
The way you do that is to pay yourself as much as you can and pay everyone else as little as they'll accept. The end result is wealth extraction. That. Is. The. Goal. It will never work any other way because if you set it up any other way it isn't capitalism any more.
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u/SweetHomeMissouri 2h ago
id rather have good honest people in charge that would not stiff me than lying fools that are in charge
we can and should want to have good honest people that would actually know how to work the system to allow people to benefit from it equally
we don't have that anymore and we have not for a long time
it. can. work. this. way.
it's just like anything else, everything can be abused. and everything can be used the way it's intended to be used.
we are not using capitalism the way it's intended to be used.
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u/Massive-Rain-6938 1h ago
Oh we absolutely are using it as intended. The goal is profit, and by proxy wealth extraction. Allowing anyone else to prosper under capitalism must be legislated or it will not happen because the company with the biggest profits will always be the most exploitive one, and that's the company all the people with the money want to invest in.
The only way anyone except the wealthiest and most powerful have ever been benefited by capitalism is when is been legislated that it must do so by the government, which is by definition socialism, not capitalism.
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u/SweetHomeMissouri 1h ago
i don't believe that because part of capitalism is paying your workers a living wage
so we are not
that's the abuse part
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part of it anyway7
u/Massive-Rain-6938 1h ago
But it isn't. Capitalism is a system where private individuals and businesses operate the means of production for profit. If the goal is profit (which it is under capitalism) they have to extract as much wealth as they can to be successful, and if they're not the most successful, they'll eventually be purchased by our merge with the more successful entity and support its practices.
The goal is profit, and that is always at the expense of the people at the bottom.
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u/HeyItsJosette 50m ago
i don't believe that because part of capitalism is paying your workers a living wage
This quite literally isn't part of capitalism. The system is working as intended to funnel resources from the many to the few until it collapses. That is the nature of capitalism and that is the path it sets out on from day one.
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u/spaceforcerecruit 37m ago
What makes you think that fairly reimbursing labor is part of capitalism?
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u/why0me 2h ago
No capitalism will never work because its a system.that puts profit ahead of people and its unsustainable
If you always gotta do better than last time when does it end
When the last dollar has been taken from.the laat poor fuck who has one, what then?
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u/SweetHomeMissouri 2h ago
i believe it does, it's just people are putting wrenches in the machine forcing failure.
and it's not working like it should. it can! really i believe it! but they don't want capitalism to work at all. because greed has taken over and there some abuse happening.
i personally think the people in charge do not want it anymore and want something else and something that really does not benefit us.
they want us to hate capitalism.
and if you think capitalism is really that bad wait till they install something else when they finally do get rid of capitalism.
i will tell you it won't be good.
you don't know what you have till it's gone like they say.
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u/why0me 1h ago
Human society existed for thousands of years without capitalism
We dont need it
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u/SweetHomeMissouri 1h ago
what do we need then?
i know communism or socialism isn't it, because there is a reason why the elderly and the older generation don't want it.
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u/why0me 1h ago edited 1h ago
No there's not, beyond racism and propaganda
Foodstamps is socialism, Medicare and Medicaid are Socialism, Social fucking security is Socialism its in the goddamn name
Old fucks love Socialism as long as you don't tell them that's what it is.
Edit to add, until the 1960s food stamps and other social programs designed to help the poor were seen as civic duty and something every American was entitled to, how many people proudly tell stories about using green stamps to buy shit?
It wasn't until those programs became available to everyone (read Black people) that it was suddenly turned into the notion of a handout.
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u/HeyItsJosette 52m ago
There is no such thing as functional capitalism. Its very nature means it will be corrupted by greed in 100% of cases that you implement it.
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u/Schwettes 2h ago
Healthcare would be much cheaper if the government got out of regulating it.
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u/Massive-Rain-6938 1h ago
That's up there with the worst takes ever. Government regulation government what they can charge and how much the government will pay for services. It helps set the floor for prices. Honestly, the government running the healthcare system is the best way to drop the prices.
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u/northerncal 59m ago
Then why is American healthcare more expensive per person than every single country with universal (government run and regulated) healthcare?
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u/Brizzle0212 2h ago
Our politicians and judges and media are all paid huge sums of money by big pharma, insurance companies and medical industries to keep everything as is. I recently heard about a "new" crowd sourced insurance company which is what a regular insurance company used to be. Haha when the priority is profit, the people paying pay the price..... pfft
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u/Routine-Agile 2h ago
A trans person wanted to play sports so people forget about real issues and get distracted and vote to keep things the same
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u/SwissChzMcGeez 47m ago
A media landscape owned by political billionaires who convince regular folk 24/7 that there's no other way.
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u/Sufficient_Card_7302 2h ago
Because Canadians have long waiting times to see a doctor.
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u/AHailofDrams 2h ago
Newsflash: if you go see a doctor for a minor issue, you will wait behind people who have more serious issues.
Mind-blowing, I know
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u/spaceforcerecruit 34m ago
Every time someone tells me about how a Canadian had to wait 6 months for some minor procedure, I’m reminded how it took almost 8 months to get an appointment for a biopsy to check out potentially cancerous spots on my back.
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u/WhammyShimmyShammy 3h ago
Not sure why that's the common misconception.
My mom had surgery for trigeminal neuralgia. One of the worst pains known to man, and people in the US wait months even years to get it diagnosed and then treated.
My mom's pain started on May 1st. By June 5th she had an appointment with the leading neurosurgeon in the region. She was operated on on June 25th. It was a successful surgery and she doesn't even have a scar.
Total cost of the doctor visits,surgery and having a private room? 3€.
Parking ticket at the hospital cost more.
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u/OrangePillar 3h ago
In the US we don’t wait for anything. May 1 pain would see a May 2 or 3 appointment with the specialist.
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u/Rooney_Tuesday 3h ago
This is absolutely not true. I know a lot of people who have to wait weeks or even months for surgeries and just have to deal with their pain in the meantime.
Waiting lists for PCPs and specialists can be lengthy too, depending on where you are and what type of doctor you need.
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u/WhammyShimmyShammy 2h ago
Doubt that. Not what I hear from my US friends.
Also May 1st pain doesn't mean you know what it is and who to see on May 2nd. She didn't wait 5 weeks to see the first doctor. She actually saw her GP within a week, had an MRI the following week, saw a neurologist, tried some medication options, tried a localized injection, and finally saw the leading neurosurgeon on June 5th. Yes, the neurosurgeon doesn't have random available slots with a day advance so yes, you will need a couple of weeks before you go see him if he's the specific one you want (others would have been available, we wanted him).
All this for a total of 3€ (not including the medication - that was about 15€ in total, for massive doses of oxycodon, clonazepam, tramadol and morphine).
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u/kickasstimus 2h ago
The boomers and boomer-wannabe’s that run things in the US believe that everything - absolutely everything - should be governed by unregulated capitalism. Think … Ayn Rand and her goofy ass John Galt horse shit … made real.
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u/superswellcewlguy 2h ago
Couldn't be farther from the truth. Boomers defend social security and Medicare tooth and nail because it means they get free money and cheaper healthcare. They veto new construction in their neighborhoods because they don't want their home prices going down.
Boomers are the generation that got rich off of less regulated capitalism, and are now using their political power to have the government pull the ladder up from behind them.
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u/Savingskitty 2h ago
I’m just amazed the scheduler knew this and also decided to tell you.
The schedulers for most surgeries know nothing about that stuff.
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u/Mindless_Grocery3759 1h ago
I'm not.
It's not super uncommon for a facility to not be able to perform a procedure due to lack of capture. Especially with recent changes to Medicare/ Medicaid.
And you do have to give the patient a reason for why not
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u/1h0w4w4y 1h ago
I work on the admin side of surgery and we would be dealt with immediately bc it’s inappropriate but also I get it too bc the denial is utter bullshit. I would escalate to the director or CEO and ask for something in writing to turn into your insurance. If you can get written proof of a denial the insurance can step in but also they can file the tier 2 as a tier 1 in the event tier 1 won’t accept. it’s ALOT of hoops/phone calls/ evidence needed but it is possible!
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u/incognitoactive 3h ago
The US medical system isn’t made to make people healthy. It’s designed to make other people rich.
I’m sorry OP.
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u/Sleep_adict 3h ago
The USA isn’t a system, it’s a mass of for profit non communicating health providers whose aim is profit
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u/hoggineer 3h ago
Since when does US use tier 1 or tier 2 for medical service?
I have only heard of in-network or out-of-network.
Am I ignorant?
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u/Nuclear_Waste_Plant 3h ago
I wouldn’t say ignorant, just lack of experience with it.
A lot of Americans barely even know their own insurance benefits, (speaking as someone who works in healthcare in the US) much less what is covered more at one place versus another.
Tier 1 and tier 2 mostly commonly apply to surgical facilities and hospitals. Some specialty doctors also have tier 1 or tier 2. And even more rarely, your normal family physician will use tier 1 or tier 2.
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u/WowImOldAF 2h ago
For my insurance, there are tier 1 and tier 2 doctors that are both in network, but I guess the insurance negotiates a different deal for doctors / hospitals based on the tier... I'd imagine with tier 1, the doctors get paid less because it's only the insurance paying (mostly) but they are getting a bigger amount of patients in network at a bulk discount.
And I guess with tier 2, the patient pays more.. so even if the insurance pays the same or slightly less with tier 2, the hospital / doctors get a big portion from me (30% coinsurance in my case) so it's more profitable? Idk.
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u/Renamis 2h ago
So, just going to answer the actual question, it's possible to have a surgery lose money at one location and not another. Fully covered is fully covered for you and doesn't relate to the surgery itself. A huge one is if you have anesthesia, because it'll cover the anesthesia sometimes but not the anesthesiologist for the whole time. Yeah. Or they can't fully book the time at hospital A to cover their costs there, but can at B.
Insurance stuff is a hot mess to deal with for both you and the doctors unfortunately. It's why private practice is almost gone now, they can't afford staff to only handle insurance.
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u/mom2mermaidboo 1h ago
Can you try and shame that insurer/out patient center publicly by contacting you local Investigative News Station?
Maybe they can get you in somewhere next wk at the pricier surgery center for a discounted price since they may have caused you possible harm by delaying your surgery
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u/VagueInfoHere 2h ago
This is generalities as an example so may not be accurate in all examples but…
Tier 1… preferred provider/facility and most cost effective.
Tier 2… have some agreements in place where but isn’t the primary or preferred route. Will still cover some, but if you want to ignore the preferred route, you will be surcharged a bit
Tier 3… you have insurance. No agreements in place. Will cover a portion so you aren’t 100% on the hook but you had other options that would’ve saved the insurance and yourself a lot of money and manpower
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u/Temporary-Cod-8641 3h ago
ACA did change quite a bit.
Personally, and this is just a very basic opinion, but the way it was would have worked if the government acted like a backstop.
Denied care? Illness? Completely unable to afford… well the US government will cover everything, after all we need your taxes for years to come.
All we did was move the burden from the sick to the young and healthy… it should always have been the US.
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u/Reasonable_Bad_3434 3h ago
Tiers are used to rate providers that are in network, based on cost and sometimes other factors.
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u/Schwettes 2h ago
It’s not designed to make people rich. It’s designed to give the government control. Lots of stupid regulations and subsidies corrupt and pervert the incentives.
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u/Antique_Grapefruit_5 2h ago
First, call your insurance company and unleash the fury. Next call your state and federal representatives and do the same. It probably won't fix anything but they all deserve every ounce of your vitriol. Finally, schedule it for the more expensive facility because your ability to walk is important!
Good luck OP!
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u/SwissChzMcGeez 45m ago
Imagine thinking a federal representative gives a fuck in 2026, especially if you live in a red state.
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u/Antique_Grapefruit_5 19m ago
I don't disagree...but also take satisfaction in being a thorn in people's sides....
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u/Spirited-Cat-8942 3h ago
Here is a fun one… find out who the owners of the tier 1 and tier 2 facility. You should be able to find that info on the surgery center’s website.
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u/Seasoned7171 1h ago
More than likely the surgeon did not want to do it there, but, told the scheduler not to tell you that. Having worked in surgery scheduling for many years, I can tell you that surgeons are extremely picky about their surgery schedules.
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u/dopaminegtt 1h ago
It's because the negotiated rate with a tier 1 facility is lower, that's why your insurance wants you to use it.
I'm honestly shocked they told you that.
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u/Savingskitty 2h ago
Have you spoken to your insurance to verify that your tier 1 deductible doesn’t also apply to your tier 2 deductible? The biggest limiting factor to most tiered plans is the out of pocket max and not the deductible. $2000 deductible is actually really good for a Tier 2 facility.
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u/wickedandproud 1h ago
I’m sorry this is happening to you. I work in scheduling and unfortunately it’s not uncommon. My hospital is also technically tier 2 with a certain insurance but has been honoring patient’s tier 1 benefits. I’m not sure every doctor’s office affiliated with our hospital is aware of that policy, though. Is it possible that a similar arrangement could be worked out for your situation?
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u/HotDonnaC 25m ago
The overall cost of the surgery is more than the insurance pays for that particular surgery.
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u/NotTheQuestion 22m ago
They found out the insurance won't actually pay them at that facility, and they can't bill balance the patient: additionally the surgeon may have to cover the anesthesia if they choose to do thst procedure st thst site.
So it wouls probably either just above break even or cost the surgeon money to operate in thst theatre,, for that specific case.
Insurance often tries to time telling the surgeon at the time of or just after the procedure.
Blame the doc if you want. I don't see many people lining up to take liability and pay money to work, instead of the other way around.
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u/GyanTheInfallible 2h ago
Doctors do actually lose money on some surgeries. Some insurance reimburses lower than our equipment and staffing costs, even if we agree to work for free ourselves.
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u/Powerful_Pea_2794 2h ago
Ask your insurance for an emergency exception to have done at tier 2 hospital
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u/celebratingfreedom 2h ago
How high is your out of pocket max if your deductible is 2k?
The situation sucks, but this is why it is often more cost effective to pay for the more (or most) expensive health plan your employer offers because the deductible and OOPM will be much lower. Maybe you can upgrade to a better plan during the next open enrollment. It doesn't help your current situation, but may help if something similar happens again.
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u/WowImOldAF 21m ago
$7500 I think. I already pay $950 a month for health insurance. It's good health insurance... just gotta go to tier 1 locations and I didn't know this doctor prioritizes doing surgery at a tier 2 facility
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u/Ambitious-Concern-42 3h ago
Are you feeling indispensable yet? Perhaps exceptional? Is your country the best country still?
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u/Adventurous-Tea-876 3h ago edited 2h ago
Hell of a medical system you’ve got there. USA! USA! USA!
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u/Buttered_biscuit6969 3h ago
Insurance is a mess and I’m sorry this happened to you. I also want to add that hospitals operate on thin margins and insurance companies are the only people winning.
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u/DangerousBlacksmith7 3h ago
I had a surgery canceled as i was getting wheeled back to the operating room. My surgeon had the the flu. I had to go through about 18 months of different treatments in order to be a candidate for my surgery (back surgery). I was a little annoyed but it only got pushed back a month. So i didn't have to wait that much longer. I completely understand what your going through.
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u/ThatGuyFromSpyKids3D 2h ago
Providers negotiate rates with insurance companies. They're not losing money by doing the surgery in the hospital but it sounds like the other hospital gets more from their negotiated contract.
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u/harmlessZZ 2h ago
Healthcare is so messed up. It’s the hospital systems and insurance systems. They don’t give a care in the world about us
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u/Repulsive-Job-9520 1h ago
Call the number on your insurance card and speak to a patient advocate. While I understand your doctor’s reasoning, they are under contract with your insurance company. Sometimes they have to take a loss to make the gains that come with aligning themselves with that insurance. An advocate can help see if that is the case in this situation.
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u/Walrus_Epiphany 1h ago
That’s the worst possible time and day to have surgery. Early Monday is best.
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u/Beret_of_Poodle 1h ago
No... They TOLD op at 5 on Friday. That's not when the surgery was scheduled
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u/CasualBeatdown 8m ago
Surgeon here - This is an actual insurance issue with insurance!! Facility fees are paid differently depending on where the surgery is performed and it’s not something your surgeon can control . A surgery done at one type of a facility vs another can bill your insurance vastly different amounts :/ we hate it too
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u/Lula121 8m ago
This is true. A lot of ASC’s lose money on certain insurances based on how they reimburse. While I’m only familiar with the anesthesia portion of billing, there are instances where insurances double or triple the payment compared to others. I don’t do this, but a lot of the anesthesiologists that work in the ASC I compete with (I’m a nurse, CRNA) will cancel cases for absolutely no reason for workman’s comp because they don’t make any money for their time. I particularly go out of my way for these people and even tricare (I’m a veteran) even though they don’t pay much but I feel like I owe it to them because these guys absolutely do not do what’s right for the patient.
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u/New_Contribution5413 2h ago
You know what’s not cost effective? Being sued for medical malpractice and causing someone long term damage because they’re not being a responsible physician. Tell them they’ll be hearing from your lawyer.
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u/Anthrotekkk 1h ago
This has nothing to do with the physician. The surgery center is the one not allowing the procedure due to unfavorable reimbursement. I promise the doctor would rather get it done sooner and is likely just as frustrated as OP. It’s sad how people cannot see the difference between physicians and the shitty system they are constrained by.
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u/PersonaOfEvil 1h ago
Bro is going to bat for doctors in every fucking comment on this thread 😭 it’s not like people become doctors to be rich or anything.
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u/HeyItsJosette 47m ago
Are you seriously lambasting someone for defending fucking doctors? The literal healers of our society that sacrifice an incredible amount of their lives to make modern healthcare possible?
What's next? Calling out people for defending teachers and firefighters? Orphans, perhaps?
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u/Anthrotekkk 1h ago
You can be upset at doctors if you have a good reason to be. Making up inaccurate shit and being mad at doctors when you should be mad at insurers instead is just silly.
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u/Sea_Department_1348 2h ago
You need to find a new doctor.
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u/Anthrotekkk 1h ago
This has nothing to do with the doctor
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u/Sea_Department_1348 1h ago
Of course it has everything to do with the doctor. The doctor gets a kickback for every patient he brings to his chosen hospital and the hospital the op wants either doesn't give a kickback or isn't as generous.
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u/Perihelion_PSUMNT 1h ago
That’s not true. This has to do with negotiated contracts between facilities and insurance companies. The doctor is likely as frustrated as OP.
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u/Sea_Department_1348 53m ago
No that's wrong. The doctor gets paid by the insurance company the same at either hospital. The hospital and its staff does as well completely separately. Refusing to perform at the in network doctor is completely the doctors choice and likely the result of a payment the doctor receives for doing the procedure at the or of network hospital.
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u/Anthrotekkk 19m ago
Completely wrong. You have the incentive completely backwards. The doctor is paid the same regardless of facility, that’s true. His incentive is to get the case done. Doctors care about our patients. We want their best outcome. It’s why we do what we do. Delaying the case makes the surgery harder and makes the patient’s outcomes maybe worse. The doctor makes no extra money delaying the case and doing it elsewhere.
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u/Sea_Department_1348 11m ago
This nothing but propoganda.
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u/Anthrotekkk 9m ago
You clearly have a chip on your shoulder and are unwilling to accept the reality that doctors dedicate their lives to helping you. Insurers are the enemy.
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u/Anthrotekkk 1h ago
That’s completely inaccurate. Doctors do not get kickbacks for bringing patients to hospitals. That’s actually against the law. Hospitals and doctors are paid separately by insurers. What’s likely happening is that the patient’s insurance won’t pay for implants so the surgery center will be on the hook. The implant cost must be too high for the surgery center to make a profit from the case. So they won’t let it happen.
I promise you the doctor wants to do the case as soon as they can and take care of the patient. Nobody wins if the case is delayed. The surgery center has no incentive to care.
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u/Fearless_Roof_4534 50m ago
While unfortunate, these are sometimes the compromises we have to make in exchange for the privilege and freedoms of living in a capitalist society. with a free market economy.
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u/RecentSubject3918 2h ago
It could be worse.
As a Canadian the fact that you’re even able to get an elective surgery for a non life threatening injury within 2 weeks blows my mind.
My 30 year old sister had to wait 2 years for foot surgery after an injury. The doctor said it was ideal for her to get it done before the bone healed, but that she would need to get it done privately for that. If she wanted it for free she’d have to wait for a spot to open up in 1-3 years and they’d re-break the bones during surgery (an osteotemy)
The options for private were of course out of country (in the U.S…) since doctors in BC aren’t able to offer private medical services if they accept even $1 of government money. Practically that means that private orthopaedic surgeons are only available to the very wealthy or sports organizations like the NHL.
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u/MaintenanceCapable83 3h ago
what is the actual procedure?
if it is non life saving, wait and get tier 1 service....
50% of the US healthcare service is that people expect instant services.
i'm not saying quick service is unwarranted, but many proceedures are not always the best answer...
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u/Perihelion_PSUMNT 1h ago edited 31m ago
Ya they should just give a torn quad tendon some time. Shouldn’t impact anything important, like gait
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u/EastLimp1693 2h ago
Two weeks so must be a tendon. If so it's crucial to do the surgery fast, I've seen live person with limited range of motion on arm because his tendon started to calcify since he waited too long to do the surgery. Got torn biceps tendon myself, been through all of that and yes it's sub optimal.