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by lotsofpulp
1324 days ago
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My EOBs have always stated what the healthcare provider is owed per the insurance price. It shows what was billed (the fantasy number), then the insurance price (or the discount), and patient responsibility (dependent upon an individual’s deductible/copay/oop max). Is that not true? |
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That's not what patients pay - that's the total allowable reimbursement to the doc via medicare.
I use medicare numbers here because almost all private insurers negotiate as %medicare. If I'm a hot specialty people are willing to pick an insurance plan over (say, cardiology) and there's a shortage of my folks in the area, I might negotiate up to something like 110-120% of medicare. Most of the time I'll be happy to get 105% medicare, and some folks will end up getting something like 95% of medicare.
To hit $1300 there'd have to be:
-A procedure, likely an inpatient or facility service, such as a small outpatient surgery, or an infusion. - Your doc has an in-house blood work lab and your insurer doesn't cover it, and the bill is actually a lab work bill
That latter bit is a gray area - it's actually barred under the Stark Law, as clinical lab work is considered a Designated Health Service that's barred from self-referral, if it's a third-party lab that they own or co-own. If it's their own actual in-clinic lab, though, I'm unsure of how that works out (I don't run my own lab, so I just know of this second-hand).
If you have a private-information-redacted copy of a 'normal' bill for $1300, I'd be happy to eyeball it - either to let you know something is off and worth appealing, or to learn something new for my self.