Colonoscopy anesthesia bill

[u/Enough-Active-5096]

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.

[u/meases]

Doesn’t work out very well for the uninsured. That makes it kind of dirty making up numbers to bill. Billed amounts become much more relevant to people if there is no insurance to pay them.

[u/wwork2021 → u/meases]

I don’t understand why more people don’t grasp this and get outraged by it. Providers, by creating these fantasy billed amounts, wind up making the people least able to afford the cost (the uninsured), pay the highest prices. And yes I know you can negotiate a cash discount, but it’s a discount off of an obscenely high starting point. It’s criminal.

[u/CrumbCakesAndCola → u/wwork2021]

Its a symptom of the providers being beholden to the insurance companies, but people will do the mental gymnastics to tell you it's perfectly reasonable.

[u/wwork2021 → u/CrumbCakesAndCola]

I just don’t think this can be blamed on insurance companies. I’m not a fan of them at all, but the idea that the provider needs to jack up the price 10x so that the insurance company thinks they are getting a 90% off deal just doesn’t hold water. The insurance company knows what a procedure costs and they negotiate by playing providers off each other to see who will give them the best net price. It’s the providers doing this to either milk the uninsured who can and do pay or to demonstrate the level of free care they provide (which in the case of certain facilities then gets reimbursed to some degree by the govt)

[u/operation_waffle → u/wwork2021]

It isn’t so that the insurance thinks they’re getting a discount, it’s because the insurance will negotiate it down to 90% of the total cost anyway so they have to inflate the total cost to get paid at all.

For example, say you have a procedure and it cost the doctors office $10 to do that procedure, and they want to charge $100 for it so that they make $90 in profit (they have to pay providers, overhead, and insurance.) The problem is these insurance companies come in and demand lower and lower payments or they’re not going to cover the services at all (that’s in network vs. Out of network.) In order to still make profit after these silly negotiations, the doctors office inflates the total cost because they already know that insurances are going to demand 90% off the top already. If they still want to make their $100 for that procedure they now have to charge $1000 for it.

This is the same reason many providers no longer accept Medicaid or Medicare. They have pre-negotiated rates that don’t always allow providers to make a profit.

It truly is the insurance companies here that are driving up the cost for uninsured people. Insurance companies are the only reason that the doctors office is now charging $1000 for a procedure that only cost them $10.

Now, it is possible that greed on the part of the medical institution is also at play, but it is nothing in comparison to the greed of the insurance companies. You have to consider as well, these insurance companies want to make being insured the ONLY option. Driving up costs for people without insurance only benefits them in the long run.

[u/wwork2021 → u/operation_waffle]

Do you believe that if provider A bills $4000 for a procedure but agrees to a 95% discount with insurer (so net cost to insurer of $200) that then the insurer will pick them over provider B that bills $1000 for the same procedure but only provides a 90% discount (so net cost to insurer of $100)?

I believe that insurers are generally evil but that they are also pretty darn smart. They pick the lowest cost provider. Provider A wants $200, Provider B wants $100. Thus Provider B will be in network and Provider A will not be. Insurers don’t care about discount off rack rate, they care about net cost.

So I dont buy the argument that insurers drive rack rate.