plugs lasted 2 days @$#^*(

[indrep]

Dr. G

I will agree to disagree.

Many companies now package their plugs individually and most offer a replacement program for patients who lose their plugs. This also seems to be a very cost competitive product with many manufacturers.

Sazy
Remember you are not paying for the cost of plugs alone, the doctor has expenses to pay, staff, rent , utilities, etc. So you are really paying for the plugs, diagnosis time, implant time and skill and in most cases a 10 day follow up period.

[kitty]

List prices of plugs...

Plug prices

In case you are interested.

My temporary plugs were $25 each. I had all 4 plugged. That's $100.00. The full fee billed for this was about $1297.00. My provider was reimbursed $493.10 as a network provider.

[indrep]

plug cost

Kitty,
Were the plugs billed on your statement at $25 each? And you are sure they were the temporary type? Typically when a supply is billed to the insurance company it is billed at cost plus some reasonable handling charge or cost plus 10%. Over the years eye care professionals have taken some very large deductions in their surgical reimbursements from payors. I understand the need to make a profit, but a $25 charge for the temporary plug itself is probably a *bit* much considering you were then charged for the procedure. Since the procedure code is the same for inserting temporary plugs as permanent ones, there may have been an oversight on the supply charge.

Now in some instances he might have to bill seperately for the supply, procedure, etc. and he knows that he is only getting the $493. This amount, $493, fits the normal allowable amount for four punctas occluded on the same day. In other words he may have billed the $25 each for the plugs but he didn't get reimbursed for them. So the $493 covers everything, a global pay.

[DrG]

I will agree to disagree.

Many companies now package their plugs individually and most offer a replacement program for patients who lose their plugs. This also seems to be a very cost competitive product with many manufacturers.

Sazy
Remember you are not paying for the cost of plugs alone, the doctor has expenses to pay, staff, rent , utilities, etc. So you are really paying for the plugs, diagnosis time, implant time and skill and in most cases a 10 day follow up period.

Sorry, but I haven't been notified of this benefit. I purchase plugs monthly from Odyssey or one of their distributors. Perhaps as an industry rep you can cut me in on this wonderful windfall.

[kitty]

Kitty,
Were the plugs billed on your statement at $25 each? And you are sure they were the temporary type? Typically when a supply is billed to the insurance company it is billed at cost plus some reasonable handling charge or cost plus 10%. Over the years eye care professionals have taken some very large deductions in their surgical reimbursements from payors. I understand the need to make a profit, but a $25 charge for the temporary plug itself is probably a *bit* much considering you were then charged for the procedure. Since the procedure code is the same for inserting temporary plugs as permanent ones, there may have been an oversight on the supply charge.

Now in some instances he might have to bill seperately for the supply, procedure, etc. and he knows that he is only getting the $493. This amount, $493, fits the normal allowable amount for four punctas occluded on the same day. In other words he may have billed the $25 each for the plugs but he didn't get reimbursed for them. So the $493 covers everything, a global pay.

The EOB just showed the total cost. It did not give the breakdown of the plugs. My point being is the difference between what the provider would bill out of network or private pay vs. what the reimbursed rate is. There is a significant "profit" in my mind.

The two permanent plugs were billed at just under $800. I don't have time right now to look and see what the provider was paid