This is the best way that I can think of to explain how medical services are billed and paid for, and it’s by using something that everyone understands – a restaurant.
Imagine that you have a restaurant in a downtown area. You set up a menu with prices based on what it costs you to provide the food and earn a reasonable profit. You have to make sure that your menu prices are going to cover your expenses, even if you have only a few patrons. The prices will be a little higher than one might expect, but if the food’s good, people that can pay will pay. You get a few walk-ins each day, but not any large numbers at first.
A representative of several office buildings approaches you, all of which are more than a 1/2 mile away but are all owned by the same company. They offer you a spot on the bulletin board in every building lobby in return for a 15% discount. You estimate that these office workers could fill about 25% of your restaurant each lunch time, and you have almost no one else, so you agree to accept the discount if they present a card.
A representative of an office building right next door now approaches you. They have 5,000 workers! They tell you that they will put your name on their bulletin board – which only holds a few cards – if you agree to give their members a 30% discount off the menu prices. You can bank on having the restaurant 3/4 full just from those workers, so you agree.
Now you have a really humming lunch hour, and because of the volume (your staff is working straight through without any empty seats) you’re making a profit. However, your dinner seats sit empty.
You decide to go out and speak to several local organizations to get them to host their meetings at your restaurant. You give them what would amount to a 45% discount, however, since you know in advance exactly what type and how much food and staff you’ll need, it’s a discount that’s easy to take. You’ve even included the gratuities, so one check from each club (paid a week in advance) makes things really easy.
Wednesday nights are really slow, so everyone walking in the door that night gets 10% off the menu price, and groups of 5 or more get 15%, but you take the gratuity automatically to safeguard your wait staff from the cheapskates that show up those evenings.
Someone walks in from out of town, it’s Friday night, and they have a movie to catch. They don’t want to walk from restaurant to restaurant, but they want a discount. Since you’re at 95% capacity, you tell them the price is the price, and they stay and eat anyway. The next diner comes in, is hungry, but has time to shop around. You’re full and have a waiting list of 30 minutes. You let him know that the new restaurant down the street needs patrons (and you can’t vouch for them) and you’ve heard that they will give a discount, even on a Friday night.
Pretty soon you have more patrons than you can handle. Your food is the best in town. You have plenty of people now offering to pay the full menu price, but are clogged with discounted patrons. You increase your menu price and offer a nominal discount to a high-end downtown apartment building. All dinner club meetings are now on Wednesday nights, and there is no longer a discount night for walk-in patrons. You’ve also opened a catering service that charges 30% above menu prices.
You take what you’ve earned and send a portion to the local city rescue mission to feed their residents, and even send your cooks over twice a month to help out. You’ve never refused to serve someone who was starving and had no money, and offered to assist them in finding a reasonable supply of food for subsistence. Now the poor people of the area and seniors using meals on wheels are getting some of the best cooking in town free of charge. You take some of the money that you’ve earned and increase the benefits for your employees, and you award a college tuition scholarship each semester to your most deserving employee.
Some in the area fault you for charging too much, and are upset that they cannot bring in their own drinks. They say that your patrons pay more money for less food and wine, and that you could charge much less if you didn’t “waste” so much, or weren’t so “greedy.”
Since local law makes you liable for all drinks served on premises, regardless of the origin, you decide it’s smart for patrons to only drink what you have stocked in your own bar, staffed with one of the best bartenders in town. You also point out that another restaurant down the street has very cheap menu prices, allows patrons to bring their own wine (under the table, of course), serves big, greasy meals, and is a little run-down generally.
People have options as to where they want to go – they can get basic food for basic money, or they can get better food and better service for more money. You’d like everyone in the world to get the same food, presentation, service and drinks that you offer, but all of that costs more, requires more dedicated employees who are more passionate about their craft, and is not necessary for basic subsistence. Those who want to pay very little for your services can join one of the clubs that meets in your restaurant – but they can only get that discount at that time, and have to make reservations and payment a week in advance.
The restaurants are health care providers, the office and apartment buildings are the insurance companies and networks, and the dinner clubs are the HMO plans. The walk-in patrons from out of town are those that did not bother to obtain health insurance (but could have afforded it) or are utilizing an insurance without a network or that has a high risk of non-payment, court appearances, or other paperwork, such as automobile insurance, worker’s compensation, or personal injury lawsuits.
So what’s the point? If you are wondering what you’re paying for or why you’re paying it, you have the right and obligation to ask – it’s your money!
At Terry Rehabilitation, each patient is expertly evaluated, each treatment plan is customized for that patient, and all treatment occurs with a highly trained professional.
Our rehabilitation programs include:
- Hands-on manual therapy techniques – to quickly correct loss of motion
- Supervised therapeutic exercises targeted to specific deficiencies
- Modalities such as cold packs, heat, and electrical stimulation to reduce pain, inflammation, and to increase flexibility
- Targeted home exercise programs that do not require special equipment
- Restoration of functional strength and stability for daily activities
- Work-specific or sport-specific rehabilitation
Contact us to schedule an initial evaluation. If physical therapy is recommended, we will contact your physician in writing regarding the recommended plan of care, allowing him or her to make the most informed decision possible for the care.
