How does a mere mortal navigate healthcare/insurance issues

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MrsBDG
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Re: How does a mere mortal navigate healthcare/insurance issues

Post by MrsBDG » Sat Jun 10, 2017 11:45 pm

I had a surgery where the physician assisting was out of network, I called the company several times and they said they would look into it, but I had to write a letter to the insurance company. I believe, based on my having everything I could pre-approved and all in network, they paid the assisting person at their billed rate. Which was more than the doctor's payment

marcopolo
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Re: How does a mere mortal navigate healthcare/insurance issues

Post by marcopolo » Mon Nov 13, 2017 8:06 pm

UPDATE: Perhaps I got indignant a bit too soon.
The original charge for the Anesthesiologist was $2800. They sent a "summary of charges" initially, not a bill. The insurance EOB said they would only cover a small portion due to it being out of network. It was within deductible, so they paid nothing.

I never got an actual bill, and did nothing for quite some time. Just today (six months later), i finally got a bill for $180. The remaining $2620 was written of as "commercial adjustment". Still not real happy about being caught with out of network charges when i did everything i reasonably could, but not too bad.

What is the point of charging $2800 in the first place, if they will accept $180 in most cases? Do any other businesses/professions operate this way?
Once in a while you get shown the light, in the strangest of places if you look at it right.

neuro84
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Re: How does a mere mortal navigate healthcare/insurance issues

Post by neuro84 » Mon Nov 13, 2017 8:20 pm

marcopolo wrote:
Mon Nov 13, 2017 8:06 pm
What is the point of charging $2800 in the first place, if they will accept $180 in most cases? Do any other businesses/professions operate this way?
I don't know about the anesthesiology group, but hospitals do this to increase their "charity care" numbers. They can say they provided X million in "charity care" and therefore keep their nonprofit status, get social capital with the community, etc.

toofache32
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Re: How does a mere mortal navigate healthcare/insurance issues

Post by toofache32 » Mon Nov 13, 2017 9:57 pm

marcopolo wrote:
Mon Nov 13, 2017 8:06 pm
What is the point of charging $2800 in the first place, if they will accept $180 in most cases? Do any other businesses/professions operate this way?
This is the insurance game. Insurance bases many of their fees as a percentage of what is charged out. If the anesthesia group charges $180, insurance will come back and say "we'll give you $30." So they charge much more to try and get the insurance fee up to a level they will actually accept.

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mrc
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Re: How does a mere mortal navigate healthcare/insurance issues

Post by mrc » Tue Nov 14, 2017 9:45 am

toofache32 wrote:
Mon Nov 13, 2017 9:57 pm
marcopolo wrote:
Mon Nov 13, 2017 8:06 pm
What is the point of charging $2800 in the first place, if they will accept $180 in most cases? Do any other businesses/professions operate this way?
This is the insurance game. Insurance bases many of their fees as a percentage of what is charged out. If the anesthesia group charges $180, insurance will come back and say "we'll give you $30." So they charge much more to try and get the insurance fee up to a level they will actually accept.
This is like those ads in the back of Sunday magazines, where a retail price of $2800 is crossed out, as is $2200, $1600, ... For you $180 **But only if you call today!** On typical EOB (Explanation of Benefit) statements, the differences between the submitted charge, plan allowance, in-network allowance, and your final copay resembles classic price anchoring.
Last edited by mrc on Tue Nov 14, 2017 9:47 am, edited 1 time in total.
A great challenge of life: Knowing enough to think you're doing it right, but not enough to know you're doing it wrong. — Neil deGrasse Tyson

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mrc
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Re: How does a mere mortal navigate healthcare/insurance issues

Post by mrc » Tue Nov 14, 2017 9:46 am

duplicate post
A great challenge of life: Knowing enough to think you're doing it right, but not enough to know you're doing it wrong. — Neil deGrasse Tyson

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