A doctor, hospital, clinic or any other medical facility can charge you and/or the insurance company "what is reasonable and necessary," for their services. The problem lies with who has the burden of determining what is reasonable and necessary. Outside the confines of a judge and jury, the doctor, hospital etc usually makes that determination. It can be a narrow or as broad as one wants. What is reasonable and necessary for a doctor in Texas or a doctor in Dallas, Texas or a doctor at xyz hospital.
The healthcare industry sets their prices. IF the doctor in question participates in the insurance company's network then he must abide by the charge schedule outined in the network agreement.
July 11th, 2008 at 9:54 am
A doctor, hospital, clinic or any other medical facility can charge you and/or the insurance company "what is reasonable and necessary," for their services. The problem lies with who has the burden of determining what is reasonable and necessary. Outside the confines of a judge and jury, the doctor, hospital etc usually makes that determination. It can be a narrow or as broad as one wants. What is reasonable and necessary for a doctor in Texas or a doctor in Dallas, Texas or a doctor at xyz hospital.
July 11th, 2008 at 9:54 am
The healthcare industry sets their prices. IF the doctor in question participates in the insurance company's network then he must abide by the charge schedule outined in the network agreement.