Archive for July 6th, 2007


Stupid Health Care Costs

I’m used to having to scratch my head when I review the explanation of benefits statement that arrives after one of us has received some type of medical service. I’ll admit that I’m sorta hazy on when we are supposed to make a co-pay and when we are not, when the amount applies to the deductable or not, etc. I’ve gotten used to seeing the column that shows what charges the provider submitted and what the plan “allows” for that charge. The allowed amount is usually much lower and there is usually a blurb about the negotiated rate. Folks, for the first time in my 20+ years in dealling with PPO’s and HMO’s, the number in the plan allowance column is higher than the provider submitted charge. WTF???

625–Our negotiated discounts with this provider are usually lower than the submitted charges (providers actual charges). However, in some cases, our negotiated amount is higher than the allowable charge (provider’s actual claim less any noncovered charges). Although our payment on this claim is based on the higher negotiated amount, any apllicable coinsurance is calculated on the lower amount (our allowable charges). You are not responsible for the difference between our negotiated amount and our allowable charge.

So, to paraphrase, we think the hospital should be getting more than what they charged for the test. We’re going to pay them more and you don’t owe anything. Have a nice day.