storm2k t1_j1sxtpt wrote
because it's what makes financial sense for doctors. overhead for running your own practice is out of control and insurance payouts are slimmer than they used to be. being a salaried doctor for a major practice and just doing doctor stuff and having someone else there that deals with the insurance payments and all that jazz is a way better deal for almost every doctor. plus changes made under the aca have encouraged this along with all the hospital consolidation. this is why almost every doctor is now a part of summit health, atlantic health, rwjbh physicians practice, hackensack meridian health, or optum (i'm hesitant to include cooper in this because i can't tell if they have a network of doctor offices in addition to the hospitals, but it would not surprise me if norcross has his hands in this sector as well).
btw, this isn't just a new jersey thing. this is happening all across the nation, for the same reasons. we're actually an outlier in that we have multiple system options. many parts of the country have but one option that you're stuck with whether you like it or not.
further, if you're getting a bill from a doctor's office that doesn't match up with what your insurance was billed, that's insurance fraud and incredibly illegal. don't just sigh and pay it. report it. don't let it just go by the wayside.
notuguillermo t1_j1uayqo wrote
Report to whom? I’ve had many fraudulent billings from Atlantic Health over the years and have never been able to find assistance.
storm2k t1_j1v27ov wrote
start with your insurance company. if they're sending your insurance one set of codes and then a bill to you for different ones, that's proof of fraud right there. your insurance company is going to take swift action to make sure they're not paying more out to the doctor than they're supposed to. compare the explanation of benefits you get to the bill you get, and if things are different, that's your proof.
otherwise, contact dobi which is the arm of state government that deals with this sort of thing.
SnooBooks4898 t1_j1umhv9 wrote
This is the correct answer. Large physician groups receive better compensation from insurance companies. The rationale is that physicians within that group will refer to other physicians in the same group and the end result will be better continuity of care, therefore lowering healthcare costs overall. For example, if your Summit Health primary care physician refers you to a gastroenterologist who also works for Summit Health, Summit profits from the services provided by both doctors. If they refer to someone outside of their system, the practice they refer to collects. The continuity of care piece comes in that health records are seamlessly accessible to all providers. This also allows Summit to monitor the “appropriateness of care. Used to be if Dr. A was friends with Dr. B, she might refer patients to Dr. B for bullshit, unnecessary testing or consultation. Dr B becomes wealthier as a result. Bottom line…it’s not going away.
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