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Presumably, this is based on ICD10 codes... but there can be 30 different services tied to a code. You still won't know what code is being charged until after t
by kurthr 8y ago
Presumably, this is based on ICD10 codes... but there can be 30 different services tied to a code. You still won't know what code is being charged until after the service is rendered, and if it's rack rate you won't know the actual rate your insurance will be charged, until THEY tell you... because that is proprietary information (just like the reason why your treatment was denied coverage).
Imagine you have diabetes and want to know which provider or insurance company will give you better endocrinology rates... it's the best case treatment knowledge scenario, but you can't figure anything out without knowing the secret negotiated rates for each possible coverage pair.
- Scoundreller 8y agoAre people really billed based on diagnostic codes? If true, it’s not what ICD-10 was designed for. Patient A can recover from the same procedure for the same diagnosis much quicker and with fewer interventions than Patient B. Would insureco get billed the same for both?
- wslack 8y agoThey aren't. Prices are based on the HCPCS codes (CPT for clinical charges). For example, a 99213 is a return office visit.
- kurthr 8y agoProviders often enter ICD-10 codes (required by Epic) and do not know HCPCS or CPT... so how could they tell you what you will be charged? There isn't a way (that even educators know of to get those codes or the pricing)... the prices are handled by billing, which is a separate department and you can't reach them by phone. They will call you back (within 30days), but they do not leave messages. Clinic and hospital in the heart of silicon valley.
- gnopgnip 8y ago>Presumably, this is based on ICD10 codes... but there can be 30 different services tied to a code. You still won't know what code is being charged until after the service is rendered, This is not the case in CA. Chargemasters have already been public since 2011, and they list everything the hospital will charge for.
- deleted 8y ago[deleted]