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Started By
Message
re: Why is medical billing the way that it is?
Posted on 1/9/26 at 1:55 pm to jlovel7
Posted on 1/9/26 at 1:55 pm to jlovel7
quote:
Same procedure same plan same provider insurance denied this latter one and now my provider wants the full $600.
WTF?
The test was deemed unnecessary
Your provider ordered it as "preventative", but your insurer didnt agree. Provider still wants his money
Had the same thing happen to me. Provider wanted to do a scan, and my insurer sent me a letter stating that I could take the test, but they arent guaranteeing payment. Well, the results were all negative, and the insurer said, you didnt really need the test. Sorry. Negotiate with your provider
1
Posted on 1/9/26 at 2:17 pm to RobbBobb
We need more insurance agents who better understand medical procedures conditions etc
I deal with writing appeals to these managed Medicare companies because they have no problems covering medication but if you break your hip you’re lucky to get two weeks of therapy
I deal with writing appeals to these managed Medicare companies because they have no problems covering medication but if you break your hip you’re lucky to get two weeks of therapy
Posted on 1/9/26 at 2:23 pm to jbgleason
Yep, this sounds like you people
Posted on 1/9/26 at 2:58 pm to jlovel7
A medical bill is a made up number, with no relation to what the procedure costs or, more importantly, what the doctor is willing to take to do the procedure.
The insurance company never pays the list bill because the provider, in order to be "in network," agrees to take the "UCR" (usual, reasonable, and customary) price, which is a lot less.
In your case, the doctor knows there is no chance you would be willing to pay the list price. In my experience, they (except for anesthesiologists) are almost always willing to heavily discount the list price for a cash payment.
The insurance company never pays the list bill because the provider, in order to be "in network," agrees to take the "UCR" (usual, reasonable, and customary) price, which is a lot less.
In your case, the doctor knows there is no chance you would be willing to pay the list price. In my experience, they (except for anesthesiologists) are almost always willing to heavily discount the list price for a cash payment.
Posted on 1/9/26 at 3:11 pm to Mingo Was His NameO
quote:
LINK
I certainly hope we all can. I wish there were an easier protocol that the one I'm following.
Posted on 1/9/26 at 3:13 pm to Mingo Was His NameO
I wish there were an easier protocol than the one I'm following.
Posted on 1/9/26 at 3:26 pm to jlovel7
They like to mislead and negotiate. Better tactic for them.
Posted on 1/9/26 at 3:30 pm to Roscoe14
quote:
A medical bill is a made up number, with no relation to what the procedure costs or, more importantly, what the doctor is willing to take to do the procedure. The insurance company never pays the list bill because the provider, in order to be "in network," agrees to take the "UCR" (usual, reasonable, and customary) price, which is a lot less. In your case, the doctor knows there is no chance you would be willing to pay the list price. In my experience, they (except for anesthesiologists) are almost always willing to heavily discount the list price for a cash payment.
Yes, this. If your insurer ever denies coverage, you should always at least ask the provider if they offer a self pay discount.
Insurers have contractual agreements with providers to be in network. These contracts result in them paying far less than the gross charge.
Many of the healthcare businesses I’ve worked with 80+% of charges are written off immediately because of contractual adjustments.
I think a legitimate, pretty straightforward regulation that would help a lot of people is requiring healthcare providers to quote all US citizens a self pay price that is the equivalent of applying the median contractual adjustment between the provider and its insurers.
We usually fully reserve against self pay patients (i.e., assume they aren’t going to pay anything) unless that patient is from a wealthy foreign country, usually Arabs, so this would not materially hurt hospitals financially.
Posted on 1/9/26 at 4:41 pm to jlovel7
The simple answer is the government is involved. Virtually all medical rates and contracts are based on Medicare charging allowances.
Get the government out, medical billing could be like grocery shopping.
Get the government out, medical billing could be like grocery shopping.
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