Discussion-Reimbursement

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For medical professionals and institutions, the importance of reimbursement in healthcare cannot be overstated: this is how they are paid, of course, and how they are able to continue providing services to consumers. But, as folks on both sides of the equation know, healthcare is far from simple, and neither medical decision-making nor healthcare reimbursement rates are simple—they are continually being reformed.

Ideally, healthcare providers would be able to make course-of-treatment decisions for their patients through patient symptoms, diagnosis, open discussions, and insight gleaned from the patient’s medical history. In other words, in an ideal world, consideration of how providers will be paid would not hinder physicians from making the soundest medical directives for the patient. However, we do not live in an ideal world, and complications in healthcare reimbursement often interfere with what may be the best course of treatment for particular patients. This is an important consideration for medical professionals, administrators, and lawmakers. However, a new trend is emerging: doctors who don’t take health insurance. These providers have opted to take cash payments, set up payments plans, or offer a monthly subscription. A growing number of doctors simply are not taking contracts with insurance companies, although the concentration varies by region and by specialty. That leaves patients to pay the market rate the doctor charges, and then submit a receipt to get reimbursement for out-of-network coverage, if they have it (1).

What are the ethical implications associated with each model? If you were the business office manager of a small practice, which payment model would you prefer and why?

Discussion-Reimbursement

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