[beej71]

When I went to an in-network ENT (that I found on my insurer's website) they were billed $850 for my 10-minute exam. The insurance said they'd pay $550. So I got to pay the rest. And this is gold coverage with an already-met deductible. You just never know what the roulette wheel is going to hand out.

Makes me think of that study a few years ago that found most Americans couldn't afford an unexpected $400 medical bill.

[naturalmovement]

You may have had 10 minutes face-time with your doctor, but he spent time before your exam reviewing your case, and time afterwards dictating the notes. So likely 30-40 minutes was spent on you and this does not include the nurses and front desk support staff, the janitor cleaning the toilets, all who need a living wage, rent and/or property tax for the facility, facilities maintenance and upkeep.

Not to mention the $$$ paid to greedy software engineers for all the mandatory e-health software systems which are all recurring-payment SaaS now raking in crazy amounts of cash.

Do you think your doctor is pocketing all that money? The average do-nothing schlub working in tech is making more than his doctor.

[beej71]

I didn't assert the doctor was pocketing it all out that there weren't other expenses. But if it costs $850, I'd like insurance to pay $850.

[naturalmovement]

I don't think you understand how deductibles and coinsurance work.

If you want a near-zero plan, you will pay more per month in premiums.

[beej71]

I do understand, and that's not what happened in this case. I have top of the line gold coverage.

[memcg]

What insurance company do you use? I thought that in-network means the provider has agreed to accept the insurers usual and customary rate and that you are not liable for the difference.

[beej71]

This was Providence in Oregon. I thought that's what it meant, too. But in this case there's a contracted "allowed amount" that is all the insurance will pay the doctor. If the doctor chooses to charge more, you get to pay that.

Which really freaks me out. If you're insured at a contract rate of $5000 and they bill $30,000...?

[EtienneDeLyon]

Did you try looking for a less-expensive ENT?

[beej71]

I did not, but in my experience it's difficult to pry prices out of medical providers in advance.

[washadjeffmad]

As an example, when my ex was trying to price ultrasounds on a breast lump as self pay before choosing where to go, the billing departments refused to quote her without the billing codes for the procedure, which require a treatment plan, which requires an appointment with a doctor at that office or hospital.

It took a month of calling around before a nurse who worked between departments took pity and leaked her the common billing codes. Once she got a quote, the estimates dropped from thousands out of pocket on her insurance to a few hundred, to an office comping the procedure.

She works in healthcare. I wouldn't have even known where to begin after being told no.