Re: Question for DR. SANCHEZ

Pete wrote:
> Thanks Dr. Sancha (as always - you are a gentleman and a scholar). I
> guess there must be a lot of affluent people in Spain who need PVP's,
> since they have to pay cash price :-) . Rule of thumb in the U.S.
> for the indigent or non insured (I am not talking PVP's), the doc's
> have two sets of books IMO (which has always pissed me of). This is
> not advertised of course and is my opinion, but I can prove it by my
> own experience with a general surgeon who dropped my insurance. The
> old time doctor's are especially kind to their older patients, I
> believe.
> What they do is charge the insurance company one price and the ins
> comp pays the allowed amount which is way less than the price charged
> (say 25-50%), could even be less for the cheap ass ins companies. If
> they go to low, then the doctors start dropping them which has
> happened to my blue cross federal ins. It used to be one of the best
> in the world and now it is one of the worst because their allowed
> amounts are dropping too low.
> But if someone doesn't have insurance at all (or if the surgeon
> doesn't accept the insurance), the doctor may give the person a break
> (call it a professional courtesy) and only hold the patient
> responsible for say 50% of the amount they charge for the procedure
> to an ins company. I'm sure you know what I'm talking about. I
> would expect that you only have one fee for your PVP's since they are
> not covered in Spain anyway, although you may give the less fortunate
> people a break, but I guess that could get tricky.

Sorry Dr. Sancha...I didn't want you to misunderstand what I meant here. By
"one fee" I meant that would be the fee you would charge for your total
surgical time plus the fibers (thus it could vary depending on the
situation), versus the two different fees I was talking about above...Pete


>
> This what I call "two sets of books" in the U.S. has always bothered
> me, and IMO is a game between the insurance companies and the
> providers. But it is nice that the providers at least will give the
> patient without insurance a break (i.e. they could charge him the
> full price if they wanted to, and a lot of doctor's will try to do
> that, and you have to write them a letter requesting a professional
> courtesy).
> All of what I am talking about mainly applies to surgery. In the
> U.S. most people who have insurance only go to what we call preferred
> providers (PPO's), but the problem is that when you have surgery
> there are at least four (and could be more) separate bills you get
> (i.e. surgeons fee, facility fee, anesthesiologist's fee, and
> pathologist's fee as a minimum - could also add radiologist). So all
> the patient can do is make sure the surgeon and facility are covered,
> because it becomes too unwieldy to control all four or five of the
> charges involved.
> Hope I didn't bore you with our U.S. stuff. I'm sure you already
> know about it. Take care...Pete
>
> fgomsan@xxxxxxxxx wrote:
>> Pete,
>>
>> Bigger glands need more time and more fibers. This means more cost
>> for the patient. Patients tell me often that what I propose is more
>> expensive than what some other surgeons do, but I tell them It is
>> what it takes to get a good result and to do a good job. Insurance
>> companies in Spain do not cover this procedure yet. They only cover
>> procedures offered by the national health services, so I guess it
>> will take a year or two before they can start covering it.
>>
>> I must say though that although I am very agressive with PVP in a
>> patient who is 50 years of age, with the intention of avoiding the
>> need for reoperations in the future, I might not be so aggressive in
>> an 89 year old catheterised patient. If his life expectancy is short
>> maybe there is no point in being aggressive, because long term
>> survival is not expected. I just make sure the patient will void well
>> without a catheter and that's it.


.

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