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Ah, Negotiated Medical Benefits
Old 06-06-2008, 09:27 AM   #1
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Ah, Negotiated Medical Benefits

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.
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Old 06-06-2008, 09:35 AM   #2
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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?
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Old 06-06-2008, 09:41 AM   #3
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Quote:
Originally Posted by sweetana3 View Post
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.
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As if you didn't know..If the above message contains medical content, it's NOT intended as advice, and may not be accurate, applicable or sufficient. Don't rely on it for any purpose. Consult your own doctor for all medical advice.
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Old 06-06-2008, 09:47 AM   #4
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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
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Old 06-06-2008, 10:10 AM   #5
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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!
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