$75,000!!!

[cissy 0]

I had surgery done at a hospital. Here's the breakdown from my insurance claim:

surgeon's cost $15,200.00

room & board $1,265.00

IH Misc. Services (I have no idea what this is) $28,678.28

IH Misc. Services NOT covered $6.45 (I never received a bill for this so I assume they just ate this small amount)

Anesthesia $1,233.00

Total $46,376.28

I paid NOTHING out of pocket for the surgery.

[itsyvonne 0]

What I don't understand is this: Is it legal for a surgeon & hospital (and anesthesiologist - and whomever else gets paid for the surgery) to charge the insurance company more for the surgery than they would charge a self-pay patient?

I know that a certain surgeon started charging the same for fills whether a patient is self-pay or insured, because his lawyer advised him that the insurance companies might take legal action against him otherwise.

Does it make a difference whether the billing is for surgery or for follow-up care?

[cissy 0]

What I don't understand is this: Is it legal for a surgeon & hospital (and anesthesiologist - and whomever else gets paid for the surgery) to charge the insurance company more for the surgery than they would charge a self-pay patient?

I was thinking about this exact same thing. When I looked up my claims earlier to see what the dr & hospital charged my insurance, I looked at my fill too. $600 charged to the insurance co, and they paid a "discounted" rate of $535.58 to dr.

I went for a fill this afternoon and a self-pay patient paid $200 for a fill. $200 vs $600. It doesn't add up!