Does anyone understand health insurance?

[wdfifteen]

I got an EOB from my insurance company this morning. I don't know how they can call something this arcane an "explanation" but that's a different matter.

One procedure was billed at $448. (Medicare allows $247.51.) My insurance company will pay $81.76. I paid $16.35 to the doc and insurance company paid $65.41. The doc says we're square - he's been paid in full.

Another procedure: Charged $146.00. Insurance allowed $9.51. The doc accepted $9.51 as payment in full.

How can medical billing be anything but fiction when bills for $448 are routinely settled for $81 and a bill for $146 is settled at $9.51 without protest?

[GH85Carrera]

Try to pay the same Dr. those rates without insurance. You will pay the full price, no discounts at all.

The entire pricing structure is just messed up.

[Neilk]

Because by law you can't bill different rates to different people or insurances, however, what you accept as "payment in full" is completely up to what is in the payer contracts.

It is a completely messed up system.

[Tobra]

Originally Posted by GH85Carrera

Try to pay the same Dr. those rates without insurance. You will pay the full price, no discounts at all.

This is quite simply false. I have never come into contact with a healthcare provider that did not offer a cash discount.

This subject has been covered at length in other threads on numerous occasions.

[Eric 951]

On our honeymoon, my wife eneded to go to an emergency room(she took a spill and broke her foot/needed some stitches). She was not yet on my insurance and was starting her new job in a week and was thus uninsured. We told the hospital that she didn't have ins. and we were able to pay via cc right then for about 50% of the total itemized bill. I thought they were incorrect in their accounting...nope, pay in full with cash or credit and it was steeply discounted.

[Targa Me]

Try this...
Next time you owe a doctor a balance ask them if they'll write it off. Sometimes they do without any problem and other times they won't write off the entire amount but are willing to write off a portion.

[Por_sha911]

Doctors are the most willing to negotiate. Hospitals will do some. Labs that do testing are absolute crooks from Hell. I've had 2 different labs insist the do not discounts until I tell them "fine, I'll pay $5 per month and your paperwork costs will be higher than the total bill or you can sell it to a collections company and get pennies on the dollar or give me a discount and I'll pay in full". Somehow, both found a way to give a discount for payment in full.