What a price difference...Insurance question...

[hrtgoeson 19]

I had my surgery on 4/28 and the claims are starting to hit my insurance company. I don't know if all of them are in but the claims are so far over $28,000. Luckily I only have to pay about $750 so far. But, here's what I'm wondering..If cash pay is $15,000 for my surgeon, but so far my insurance claims are $28,000 and climbing, are they just milking the insurance company or is there another explanation? I'm just curious and don't want to ask the surgeon a question like that LOL

[ParrotheadCathy 0]

I believe, but have no proof, that claims to insurance push the upper limits of "normal" for any procedure and when the insurance company writes it down to the "allowable amount" the provider still gets about what they would have gotten from a self-pay patient for any procedure or treatment. I have had providers bill my insurance a thousand dollars for something, but the insurance company only pays a fraction of that, and I still only had my set co-pay. The rest is disallowed under my insurance and the provider has to write that part off.

[hrtgoeson 19]

Ahhhh, maybe one of those hoping they'll pay the full amount but knowing they won't kinda thing? That makes a certain amount of sense. I thought I had heard years ago about writing-off the difference but I couldn't remember for sure.

I noticed the same thing on my claim...The charge is $7,000 but insurance only pays $1080 and my responsibility is only $108. Craziness!

[MacMadame 81]

From what I can tell, self-pay patients actually pay more than the surgeon's get from the insurance companies once the insurance company knocks down the bill. That's why a bunch of them have started charging insurance patients extra fees -- to make up the difference.