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    Readers share their two cents on $4.07 insurance payment

    In his recent blog post “My $4.07 check: A sign of the times,” Henry Rosevear, MD, shared how, after managing a patient with an obstructing stone and billing $1,332.25 for his services, he received a check from the Colorado Indigent Care Program, the patient’s insurer, for $4.07. His blog post prompted a wave of comments, commiseration, and suggestions. These comments have been compiled below. If you would like to share your opinion on the topic or if you have had a similar experience, please provide your feedback by posting a comment in the box below, or by sending the editors an email at [email protected] 


    I am a urologist who is part of a 20-urologist group (soon to become up to 70). I have a mixed practice due to two office locations. One office is in an affluent area and the second is in a blue collar town. Our “pod” of five physicians work in four hospitals. Two hospitals are in affluent areas, one hospital is in a blue collar town, and one hospital is in a poor inner city. We see many un-insured and Medicaid level patients mostly within the inner city hospital. However, we are seeing more un-insured and Medicaid patients travelling to the more affluent area hospitals for their health care.

    Two of these hospitals provide a stipend for covering the Emergency Room and hospital consults. We just started this stipend at a third hospital due to increasing demand of un-insured and Medicaid patients and on-call responsibilities. We have calculated the stipend and it covers very basic urologic skills such as Foley placements, stent insertions, simple ureteroscopies, and mildly complex consults. But, it does not cover patients who require detailed management such as trauma, advanced cancers, or complicated stones.

    Here's the way I see it from 13 years of practice.... the hospitals should be providing private practice physicians financial compensation to work at the hospital and cover un-insured or Medicaid patients. We should be compensated for leaving office hours (of paying patients) or spending time away from family to do a consult or operate. The days when a physician was paid handsomely for surgery and one could just "write-off" the pro bono work are gone.

    Also by Dr. Rosevear - The return of prostate cancer: A step backward

    My question for you is how much the hospital was paid for the patient you stented for $4.07? Did the hospital receive $1,900 from the Medicaid program and then $2,500 from state aid? If the answer is yes, then the hospital should be passing the payment to the providers.

    Can you have a conversation with your hospital about such a stipend?

    Another thought is that hospitals have endowments, fundraisers, and philanthropic support. Where does that money go? Does it go to help the administrators or the physicians who bring business to the hospital? Private practitioners cannot ethically fundraise for their office or personal gain.

    I see one dilemma. What if the hospitals hire a staff urologist to compete with the private physicians? What if the hospitals restrict patient flow to the private physician? Will that prevent the private physicians from maintaining a healthy/vibrant practice?

    To my understanding, a single payer system sort of exists: Medicare. But, it covers the physicians a little bit more respectfully than the uninsured or Medicaid patients.

    More than happy to talk some more.

    Marc A. Greenstein, DO

    Next: "There is no answer that will make doctors happy."


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