I believe you are confusing terms. Do you mean quote or listed?
One can list a price, but if we negotiate a better price than the one listed, the price charged is the price that is expected to be paid and it has nothing to do with charged.
There is good reason to list the actual price one will pay, since many of our employees now shop for services. Another major pricing differential in our area is colonoscopy. It is $3200 less 60 miles from our area and now that employees understand that they should be more responsible in their health care, more are making better decisions. This is work in progress...
No, I'm not confusing terms.
The "price charged" is always the same, by law. That is the gross charge for a procedure or service. If a payor negotiates a lower price, at the time a claim is adjudicated, it is subject to an "adjustment" down to the payor's "allowable". For example, if the charge is $1,800, but the insurer only "allows" $800, there would be an adjustment (if the provider is in-network) of $1,000, leaving a balance of $800. The insurer may pay $500 of that leaving a patient balance of $300, or perhaps they will pay nothing (e.g., if there is a deductible) leaving the patient with a balance of $800.
Fees are ALWAYS (or SHOULD be) set higher than any insurance will pay. But you cannot just adjust your base fee schedule depending on who is paying the bill. You can, however, make adjustments for allowables based on negotiated rates, so it works out the same.
No one should pay $3200 for a colonoscopy. There are generally two components -- the gastroenterology fee and the outpatient surgery facility charge. There may be other charges such as pathology or complications (e.g., in the case of a perforation). If you had complications it could easily run more than $3200 -- but in the usual case, you would have a 45383-4-5 for which the payment is usually around $350, but can be more in a non-fac setting. The payments for outpatient facility costs average around $650-700, making the total about $1000 or so, on average. Pathology, if there is any, doesn't add much.
The uninsured get screwed on everything because they don't get the adjustments insurance companies get. That's one reason everyone ought to have the good sense to have insurance. But some choose not to, and they have to pay the price for that decision. We have a neighbor, a fine man who came here from Mexico 30 years ago, but he believes that health insurance is a ripoff and has raised 4 kids without ever having insurance. And he's done well -- until now; his wife now has breast cancer, and it is destroying him financially. All the savings from not having insurance over the years is likely gone by now. |
