Ah, Negotiated Medical Benefits

[sweetana3]

I do love the BCBS statements as hard as they are to understand. Lab costs for basic lab work were billed as about $400. BCBS negotiated payment was $56. Nothing more paid or owed by me, the patient. Period. $56 was accepted as full payment.

I know I have read this about private medical bills but this is seriously out of whack. $400 down to $56.

My cat's tests cost more.

[Walt34]

I see that all the time on our BCBS statements. It tells me that whoever makes up those "list prices" (for lack of a better term) is dreaming and/or gouging. The labs aren't going to do the work for less than it costs plus a profit so where do the jack-up prices come from?

Outer space?

[Rich_in_Tampa]

Originally Posted by sweetana3

I do love the BCBS statements as hard as they are to understand. Lab costs for basic lab work were billed as about $400. BCBS negotiated payment was $56. Nothing more paid or owed by me, the patient. Period. $56 was accepted as full payment.

I know I have read this about private medical bills but this is seriously out of whack. $400 down to $56.

My cat's tests cost more.

Yes, it's a psychotic system.

Don't forget it goes something like this in the background:
Price $400
Cost to provider $150
Negotiated reimbursement $56
Net to you $0
Net loss to provider $94

That money has to come from somewhere which, in turn, leads to over-use of other services that are reimbursed more rationally, or aggressive billing practices, or niche medicine (veins only, cosmetics, concierge), or $85 Tylenol tablets in the hospital, etc. etc.

I'm a strong believer in capitalism and free markets but IMHO health care and free-market capitalism don't mix well, for lots of reason. But I'll settle for universal coverage as a first step.

[Alan]

My theory is that it is gamesmanship by the hospitals to try and maximize the increases negotiated each year with the insurance companies. Also while the actual cost of a $400 test is really $56 the hospitals are trying to claw back money for their own badly managed beaurocracy and all the uninsured patients they treat

[FUEGO]

lab tests/radiology/ultrasound seem to have the highest markup. Seeing the negotiated rate paying only 10-20% of the list price seems to be very common in my experience.

However, I have seen the insurance company pay $12 for two extra strength advil and $10 for a $1 tube of diaper rash cream. And that was the negotiated rate, not the list price!