Health Insurance Guys - Is This Shady? (1 Viewer)

[Andrew74]

I'll try to make a long story short. I had to have an MRI this year. Place I've been to before for other imaging advertises MRIs for $700. "Guaranteed Prices Regardless of Insurance." I have a 20% copay. I get my bill and I owe $160.80. Math does not check out. I go to my insurance website and pull up the EOB. They charged the insurance company $804, hence my copay amount. The insurance company paid them $643.20. On my statement they list a charge of $700, an insurance payment of $439.20 and an "Adjustment" of $100, with me owing $160.80.

I don't get the subterfuge.

 

[TLEF316]

All insurance companies basically haggle with medical bill providers to cut the end cost. It's a whole big runaround

 

[Terminalxylem]

All insurance companies basically haggle with medical bill providers to cut the end cost. It's a whole big runaround

This. The system is opaque, and intentionally confusing, when you attempt to look behind the curtain to determine actual pricing.

I wouldn’t be too bent over 20 bucks though. There’s a good chance MRI wasn’t needed in the first place.

 

[Andrew74]

It’s not the insurance company. It’s the medical provider that’s being fishy. They advertise $700 and their bill says it’s $700, but they really charged $806 and are trying to collect $806. I’ve never seen a company basically lie about the billing on a statement before.

ETA: The insurance company didn’t haggle or shave anything. Company billed and insurance paid their 80%.

 

[Mitchie]

have you called the medical provider? maybe there's a reasonable explanation or maybe it's an error.

btw, i've read there's an absurd amount of mistakes on medical bills, a lot of time just due to incompetence although could be intentional

 

[CletiusMaximus]

It’s not the insurance company. It’s the medical provider that’s being fishy. They advertise $700 and their bill says it’s $700, but they really charged $806 and are trying to collect $806. I’ve never seen a company basically lie about the billing on a statement before.

ETA: The insurance company didn’t haggle or shave anything. Company billed and insurance paid their 80%.

Yeah I think you should call them out on this. They probably won't give in to you but I'd like to see them squirm. I know this is commonplace, but when they aggressively advertise a price like that I would think someone should try to hold them to it as they are getting paid in full with you chipping in $57.

 

[CletiusMaximus]

All insurance companies basically haggle with medical bill providers to cut the end cost. It's a whole big runaround

This. The system is opaque, and intentionally confusing, when you attempt to look behind the curtain to determine actual pricing.

I wouldn’t be too bent over 20 bucks though. There’s a good chance MRI wasn’t needed in the first place.

I think its more like $100 difference in this case to the OP, and of course there's the principle of it all. We all know one benefit of insurance is that these companies are able to negotiate favorable rates from providers. As someone who has paid premiums to become a beneficiary of that insurance coverage, should OP not get the benefit of his insurer's negotiated rate for this service? The provider in this case has an advertised price for an MRI and has accepted payment from the patient's insurance for this service.

 

[the moops]

I think its more like $100 difference in this case to the OP,

He was expecting to pay 20% of the $700. He ended up paying $160.80 instead of the expected $140

 

[kupcho1]

They charged the insurance company $804

My bet is that the MRI provider had a separate agreement whereby the insurer paid the provider $700 (or less). Say it was $700. You get an EOB claiming a higher cost and they split the proceeds.
Something defintely fishy going on here.

 

[CletiusMaximus]

I think its more like $100 difference in this case to the OP,

He was expecting to pay 20% of the $700. He ended up paying $160.80 instead of the expected $140

Yes understood, but I think you could also say the advertised cost of the service is $700 and they've received $643.20. There's a decent argument that his copay obligation should be $56.80.

 

[CletiusMaximus]

They charged the insurance company $804

My bet is that the MRI provider had a separate agreement whereby the insurer paid the provider $700 (or less). Say it was $700. You get an EOB claiming a higher cost and they split the proceeds.
Something defintely fishy going on here.

I think its extremely common. Fishy yes, but I think most people understand the $700 advertised price comes with some fine print limiting that deal for patients without insurance coverage. The paperwork OP signed or agreed to as part of the service undoubtedly notes somewhere in the fine print that they can bill insurance at different (higher) rates.

 

[Andrew74]

They charged the insurance company $804

My bet is that the MRI provider had a separate agreement whereby the insurer paid the provider $700 (or less). Say it was $700. You get an EOB claiming a higher cost and they split the proceeds.
Something defintely fishy going on here.

I think its extremely common. Fishy yes, but I think most people understand the $700 advertised price comes with some fine print limiting that deal for patients without insurance coverage. The paperwork OP signed or agreed to as part of the service undoubtedly notes somewhere in the fine print that they can bill insurance at different (higher) rates.

I’ll have to look at the fine print but they claim $700 “regardless of insurance.”

 

[CletiusMaximus]

They charged the insurance company $804

My bet is that the MRI provider had a separate agreement whereby the insurer paid the provider $700 (or less). Say it was $700. You get an EOB claiming a higher cost and they split the proceeds.
Something defintely fishy going on here.

I think its extremely common. Fishy yes, but I think most people understand the $700 advertised price comes with some fine print limiting that deal for patients without insurance coverage. The paperwork OP signed or agreed to as part of the service undoubtedly notes somewhere in the fine print that they can bill insurance at different (higher) rates.

I’ll have to look at the fine print but they claim $700 “regardless of insurance.”

Im probably missing something but it seems to me you have a strong position in this one just based on the info presented here.

 

[Terminalxylem]

I think its more like $100 difference in this case to the OP,

He was expecting to pay 20% of the $700. He ended up paying $160.80 instead of the expected $140

Yes understood, but I think you could also say the advertised cost of the service is $700 and they've received $643.20. There's a decent argument that his copay obligation should be $56.80.

No, they received $439 from the insurer, $160 from the OP, and $100 evaporated into an "adjustment". But since they initially billed the insurer $804, not sure why the adjustment doesn't reflect that pricing.

Agree the principle is weaselly though. They should advertise $700 "cash" price, rather than "regardless of insurance".

 

[CletiusMaximus]

I think its more like $100 difference in this case to the OP,

He was expecting to pay 20% of the $700. He ended up paying $160.80 instead of the expected $140

Yes understood, but I think you could also say the advertised cost of the service is $700 and they've received $643.20. There's a decent argument that his copay obligation should be $56.80.

No, they received $439 from the insurer, $160 from the OP, and $100 evaporated into an "adjustment". But since they initially billed the insurer $804, not sure why the adjustment doesn't reflect that pricing.

Agree the principle is weaselly though. They should advertise $700 "cash" price, rather than "regardless of insurance".

How do you interpret the OPs comment, “The insurance company paid them $643.20“? I read that to mean the insurance company paid them $643.20.

 

[Andrew74]

The EOB shows the insurance company paid $643.20, $804 x 80%.

The statement I received from the medical provider claimed they received $439.20 from insurance.

 

[Terminalxylem]

I think its more like $100 difference in this case to the OP,

He was expecting to pay 20% of the $700. He ended up paying $160.80 instead of the expected $140

Yes understood, but I think you could also say the advertised cost of the service is $700 and they've received $643.20. There's a decent argument that his copay obligation should be $56.80.

No, they received $439 from the insurer, $160 from the OP, and $100 evaporated into an "adjustment". But since they initially billed the insurer $804, not sure why the adjustment doesn't reflect that pricing.

Agree the principle is weaselly though. They should advertise $700 "cash" price, rather than "regardless of insurance".

How do you interpret the OPs comment, “The insurance company paid them $643.20“? I read that to mean the insurance company paid them $643.20.

Not sure, because he also said:

On my statement they list a charge of $700, an insurance payment of $439.20 and an "Adjustment" of $100, with me owing $160.80.

I have no idea what the facility actually received from the insurer. But the system is stupid regardless, and one of many reasons we should change to single payor.

 

[jobarules]

The $700 is probably for those uninsured

 

[Andrew74]

I checked the pricing schedule I picked up the day I was there and it has no fine print making a distinction between insured vs non-insured. I just looked at their website and all it has is MRI is $700.

I wouldn’t care if there was a difference in pricing, but none of their materials say there is. And if there is, why are they claiming on the statement that the procedure only cost $700.