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by 11Blade 4820 days ago
The 1076 for the procedure and 300 for the visit were the full billable charges for those codes.

If the insurance had covered them at their contracted rate, the provider would have received probably about 250 for the procedure and 50-120 for the office visit.

Because it fell within your deductible, the initial bill to insurance would have been denied payment and sent back with "patient responsibility" and the 1376.00 would then be your problem. Since you don't have a contract with your provider he tries to get the whole thing.

This is where you can discount it with negotiation.

I am a medical provider, I believe that transparency will help the situation. I also believe that prices should be within a 5-10% window of each provider instead of a price variance of 100-400% depending on secretive contracts.

Unfortunately even providers have been trained to game the system to maximise profit and productivity. It is common to hear surgeons talk about complicated patients and tell them to see a university guy because "frankly its not worth the time and effort" when they can get low hanging easy fruit that pays better/unit-time with less liability.

I'd like to hear what the poster thinks he should have paid for his office visit and 5 minute procedure.

2 comments

Doing some simple math, if a doctor is making $200,000 a year or $250,000 a year working 40 hr weeks with 2 weeks of vacation, their hrly rate would be $100 or $125 per hour respectively.

5 minutes of just their time would be between either $8.33 or $10.41. Fine, throw in a couple bucks for the rubber gloves and scalpel. And something for electricity, paper, etc. Still should NOT me more than 40-50 dollars in my opinion. But I don't know much about this industry...

If the doctor is "in network" shouldn't the patient responsibility be the lower, negotiated rate? I thought was part of most insurance contracts, and one of the reasons insurance is helpful even if someone is healthy and has a high deductible.

What you've described I think is largely responsible for a lot of the rising medical costs.