the rates given by the insurers are their quotes of what they find appropriate for an average treatment.
and there are on that private clinic sector of course clinics/docs who provide a higher standard.treatment.services than the average, and on a free market they are free to ask for their higher standards also higher fees than others.
and every patient is a free person to decide which service level that patient wants to get/receive.
The issue is not a right of one doctor to ask a fee higher than another doctor for the same service. Who questions this right? The issues are different.
1. A doctor has no right to discriminate patients by asking different fees. This is a professional misconduct. And not only professional misconduct.
2. A doctor has no right to misinform his/her patient by telling the patient that the fee asked is doctor's standard fee for the same service (which is in fact 10 times higher than standard fee of the same doctor for the same service). This is a professional misconduct.
3. A medical facilty affiliated with an insurance carrier has no right to charge for any specific service a fee higher than specified by the agreement between medical facility and the insurance carrier. This is a breach of business contract and a professional misconduct.
4. A medical facility affiliated with an insurance carrier has no right to bill the insurance carrier for a service already paid in full by a patient. This is an insurance fraud.
5. Even if a doctor is not affiliated with an insurance carrier and even if a doctor has standard fees for all patients without discrimination -- even in this scenario, a doctor has only a legal right to ask a fee higher than another doctor, but doctor has neither moral nor a legal right to charge ANY FEES HE LIKES. 'PHYSICIAN' IS A LICENSED PROFESSION. THIS MEANS RESTRICTIONS AND OBLIGATIONS OF THE HOLDER OF THE LICENSE. THE FEE MUST BE REASONABLE. This is true not only for the medical profession. This restriction is a basic ethical restriction of any profession. In licensed professions (such as doctor or lawyer) charging a fee other than reasonable is a misconduct. For example, the definition of a reasonable fee for dental services is simple and clear: it is the fee charged by a dental professional for a specific dental procedure that has been modified by the nature and severity of the condition being treated and by any medical or dental complications or unusual circumstances. This means that the fee must be determined by the nature and severity of the condition being treated and by any medical or dental complications or unusual circumstances. Doctor is allowed to charge fees based only on the factors listed above (patient's conditions, complications, circumstances). Doctor has neither moral nor legal right to ask any fees he likes (just because it is his office and it is him who provides services). In particular, it is misconduct for a doctor to charge fees based on patient's country of origin, ability to speak Spanish, time spent in the country, etc.
Yes, it is doctor's office. Yes, it is doctor's business. But it is professional service and it licensed profession. And doctors know this. Dominican doctors not an exception. There are various mechanisms to punish doctors who ignore their obligations. And doctors know this well. The reason why some local doctors overcharge foreigners is clear: doctors sincerely believe that foreigners are idiots (idiots luckily born in developed countries).
6. More important than all!!! A doctor with a street vendor mentality is not a doctor. His primary goal is to make money -- not to help patients. Patients are his instruments to make money. A doctor with a street vendor mentality will not waste time by studying the subject, analyzing patient's conditions, making reasearch, looking for the best treatment. He is thinking about the best strategy to suck money from patients. Amount of money sucked is his only scale of success. Will a reasonable person to trust his/her health (and possible life) to such Dr. Junk?
