DEAR DR. GOTT: I read with interest your explanation about how medical fees are calculated. You do such a great job of explaining all aspects of everything! Could you please tell me why, if physicians are willing to accept whatever the insurance companies will send them, people without any insurance benefits are expected to pay the full amount? This really has bugged me for years. I’m a nurse and hear this complaint often from patients who can’t afford medical coverage and fall through the assistance gap.

DEAR READER: I wish I could, but sometimes the thought process logic eludes me. When a physician or facility agrees to “accept assignment” it is with the unconditional understanding they will likely not get the full asking price, so to speak. There may be instances when an insurance company’s reimbursement is quite close to the amount requested but for the most part, the amount “recognized” and paid is substantially lower and must be written off. [Read more...]