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Following up on this post...
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shalmestere is undergoing physical therapy for a knee injury last month, and I just got the first insurance statement.
For the initial one-hour visit, the charges add up to $790, which is paid for as follows:
$660.40 "insurance plan discount"
$109.60 "insurance plan pays"
$20.00 "customer co-pay"
$180.00 "not covered"
$0.00 "you owe"
I had to look up the difference between "insurance plan discount" and "not covered": the former is "treatments for which the insurance company has agreed to pay a little bit," while the latter is "treatments for which the insurance company has agreed to pay nothing," but the effect is the same: nobody is paying it. So why do they bother billing for it in the first place? Do they hope to actually get the whole $790 from uninsured patients, while getting only $129.60 (about 1/6 of the total) for an insured patient?
The second one-hour visit adds up to only $540, because it doesn't involve an initial exam. The other therapies cost exactly the same amount as before, despite presumably taking longer (because there's no initial exam). This time it's broken down into
$464.46 "insurance plan discount"
$55.54 "insurance plan pays"
$20.00 "customer co-pay"
$180.00 "not covered"
$0.00 "you owe"
This time the provider is getting less than 14% of their claimed total from us. If 95% of their customers have insurance, and our insurance company is neither better nor worse at negotiating discounts than the average company, then the average reimbursement they actually get for this sort of visit is $98.76, which means their actual costs for this sort of visit must be somewhere below that. So why not just bill everybody the same $99 rather than loading 27% of the costs onto what are probably the poorest 5% of the customers?
When you buy a gallon of milk, there's a price tag on the shelf. You can see the price before you decide whether to buy it, and everybody pays the same price (although some may do it with food stamps). I could imagine charging less (for necessities like milk and health care) to the people least able to pay, but what kind of cockamamie scheme charges MORE to the people least able to pay?
shalmestere is undergoing physical therapy for a knee injury last month, and I just got the first insurance statement.For the initial one-hour visit, the charges add up to $790, which is paid for as follows:
$660.40 "insurance plan discount"
$109.60 "insurance plan pays"
$20.00 "customer co-pay"
$180.00 "not covered"
$0.00 "you owe"
I had to look up the difference between "insurance plan discount" and "not covered": the former is "treatments for which the insurance company has agreed to pay a little bit," while the latter is "treatments for which the insurance company has agreed to pay nothing," but the effect is the same: nobody is paying it. So why do they bother billing for it in the first place? Do they hope to actually get the whole $790 from uninsured patients, while getting only $129.60 (about 1/6 of the total) for an insured patient?
The second one-hour visit adds up to only $540, because it doesn't involve an initial exam. The other therapies cost exactly the same amount as before, despite presumably taking longer (because there's no initial exam). This time it's broken down into
$464.46 "insurance plan discount"
$55.54 "insurance plan pays"
$20.00 "customer co-pay"
$180.00 "not covered"
$0.00 "you owe"
This time the provider is getting less than 14% of their claimed total from us. If 95% of their customers have insurance, and our insurance company is neither better nor worse at negotiating discounts than the average company, then the average reimbursement they actually get for this sort of visit is $98.76, which means their actual costs for this sort of visit must be somewhere below that. So why not just bill everybody the same $99 rather than loading 27% of the costs onto what are probably the poorest 5% of the customers?
When you buy a gallon of milk, there's a price tag on the shelf. You can see the price before you decide whether to buy it, and everybody pays the same price (although some may do it with food stamps). I could imagine charging less (for necessities like milk and health care) to the people least able to pay, but what kind of cockamamie scheme charges MORE to the people least able to pay?
