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It's truly fucked up. Most insurances won't publish their fee schedules. So doctors don't know what they will pay. So what they do is bill insanely high knowin
by bena 1y ago
It's truly fucked up.
Most insurances won't publish their fee schedules. So doctors don't know what they will pay. So what they do is bill insanely high knowing the insurance will come back with "Nah, we only cover $X". They'll collect $X, then write off the remainder. Because the fear is not getting the maximum money possible. If the doctor would bill $100 and the insurance pays up to $200, then the doctor "lost" $100.
Regardless of how much it actually cost the doctor to provide the service.
It's also why the "cash price" is usually much cheaper, because it's closer to what it costs the doctor to provide the service.
- hibikir 1y agoAh, but this has also lead to many private practices getting bought by hospital groups, at which point they have superior pricing power. The doctor makes more money, and the insurance company pays more, as it's harder to strongarm a company that owns 8 hospitals than a 3 doctor practice. Either way, the price goes up.
- nradov 1y agoHealth plans are legally required to publish their rates and they all comply with this now. You can literally just go to any payer web site and download the MRF. There are occasional data errors but overall the numbers are generally accurate. https://www.cms.gov/priorities/healthplan-price-transparency/health-plan-price-transparency https://www.cms.gov/priorities/healthplan-price-transparency... https://github.com/CMSgov/price-transparency-guide https://github.com/CMSgov/price-transparency-guide
- bena 1y agoAs of 2022, that explains it. It’s been a bit since I’ve worked in the field. It’s good that it’s changed