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Strategies & Market Trends : The Residential Real Estate Crash Index -- Ignore unavailable to you. Want to Upgrade?

To: ild who wrote (7821)	1/3/2003 11:43:07 PM
From: endless	Read Replies (1) \| Respond to of 306849

<< hospital is above reasonable and customary>> I don't know if anybody is interested how these charges are determined, if you are, read on. It doesn't have anything to do with real estate other than maybe they should come up with something like this for real estate commission (gg) "Reasonable and customary charges" for medical care are based on relative value work units, a jointly developed grid developed between the Fed Government and the American Medical Association to determine medicare reimbursements. Almost all insurance companies also use this as their $ basis. It's pretty complicated but basically has these three components and a federally determined multiplier (adjusted annually for inflation) that determine a rate: complexity of service + geographic location + risk factor (law suit o-meter..). My husband is a surgeon, so I really am only familiar with this type of service, but I am sure hospitals get paid under similar protocol. I.E. a surgeons service for a laparoscopic appendectomy (remove appendix) has a RVU of 8.7 in Los Angeles that entitles him to collect $536.60 from MediCare patients. MediCare pays 80% of that amount. MediCal pays on the average about 50%. Most decent insurance companies will pay 100% or a little bit better, dependent on the negotiated contracts, less deductible. Most insurers specify that patients cannot be charged more than their contracted rates. It is important to be aware of this as a consumer. Needless to say doc's are not falling over each other to take care of MediCare patients and will do MediCal only if they have to under emergency circumstances...