r/HealthInsurance • u/Enough-Active-5096 • Aug 06 '25

Plan Benefits Colonoscopy anesthesia bill

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Husband got a pre-approved colonoscopy a few weeks ago and this was the bill from the anesthesiologist? Thank god the insurance is covering/paying but wtf? Did they add an extra zero on accident? This makes me so angry.

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6

u/West_Guidance2167 Aug 07 '25 edited Aug 07 '25

That definitely seems excessive for a colonoscopy, but the entire thing is arbitrary. They know how much the insurance is going to pay so they can put whatever number they want there. Now, if you had to pay 20% of that, then you have a very good point, but it should be covered 100%/

1

u/_Dapper_Dragonfly Aug 07 '25

So much for transparency.

3

u/doubting_el_dandy_18 Aug 07 '25

The EOB is transparent. The amount allowed by the insurance company is $349.91.

2

u/_Dapper_Dragonfly Aug 07 '25

Ok. It does make me wonder if the $21,000 is what they charge everyone, though.

2

u/doubting_el_dandy_18 Aug 07 '25

Typically, a medical practice uses the same gross charge for a CPT code across all insurance companies. The amounts allowed by each insurance company are likely different, so the "plan discount" (contractual adjustments) are used to reduce the charges to the allowed amount.

1

u/mottledmussel Aug 07 '25

And it's usually as simple as Medicare Rate + XX%.

1

u/PraiseTalos66012 Aug 07 '25

Yes, that's the whole point. They have agreed to charge that amount to everyone, then they give "discounts" to insurance companies they partner with.

If you're uninsured they have contractually agreed to charge you that crazy amount, they however have not agreed that they can't negotiate prices. Just call and negotiate and you should get the "discounted" insurance rate or near it.

1

u/keikioaina Aug 07 '25

Excellent point. That's where the arbitrary number system gets dicey.

0

u/bobd607 Aug 07 '25

They don't know what insurance is going to pay - they submit an arbitrary excessive amount to ensure that they get the maximum payout from insurance - this saves them from having to keep track of what they have negotiated with every insurance they accept.

7

u/DefinitelyNotWendi Aug 07 '25

Of course they know what insurance is going to pay. They have a contract that spells it out. The real crime is that they are willing to accept $350 from insurance but will bill you the full 21k without it. And they aren’t losing money at $350.

3

u/West_Guidance2167 Aug 07 '25

They 100% do. In and out of network. The in network ones they’ve already negotiated rates in advance.

2

u/PraiseTalos66012 Aug 07 '25

Providers and insurance have contracts. It says exactly what the payment for everything is. It also says that the providers must give insurance a "discount" aka providers gotta charge everyone this insanely high rate and then "lower" it for insurance.

Nothing is arbitrary, not the billed amount, not the amount payed to the provider. It's all predetermined in the contract.