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.
Honor to the soldier and sailor everywhere, who bravely bears his country's cause. Honor, also, to the citizen who cares for his brother in the field and serves, as best he can, the same cause. —AL

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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
Honor to the soldier and sailor everywhere, who bravely bears his country's cause. Honor, also, to the citizen who cares for his brother in the field and serves, as best he can, the same cause. —AL

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