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pay the full
invoice cost for
implants, but
Ms. Teetzel is
seeing a trend
toward a single
level of reim-
bursement,
regardless of
implant costs.
"So if you use a
less expensive
mesh, you'll
make a profit,"
she says, "but if you have one of those doctors that has to use the lat-
est and greatest antibiotic-fused mesh, you're not going to make a
profit."
Keep in mind also that what your insurer initially offers may not be
the final word on the matter, says Mr. Pankey, if, that is, you can find
out what a hospital's being paid for the same procedure. He explains:
"You can go to the payor and say, 'Look, I know you're paying this
amount to the hospital. I can do the same procedure for much less,
but only if you're willing to pay me enough that I can make a small
profit. I can't do it for what you're offering to pay.' I can usually get
something added, or a carve-out, if I have the figures and it's going to
save my insurance company money."
Other ways to control costs
When it comes to controlling costs, mesh may be the most obvious
expense, but it's far from the only one. In addition to using the least-
V E N T R A L H E R N I A
VOLUME MATTERS Get surgeons to agree on one mesh supplier and
you may be able to leverage that purchasing power.
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