I love how the price goes up and it gets a little worse everytime. I got kicked off my wife's insurance through Huntsville hospital because my work offers me insurance. Now we pay more and my insurance sucks upside hers.

Let me give you an idea of why doctors and medical facilities bill the amounts they do. On May 22 this year I had a massive heart attack. This is what has been billed so far and the amounts paid by my insurance. All of these claims have been closed. Hospital stay was 4 days.

Ambulance Service.......$715...Ins. paid $425....My Co-Pay $20
1st Emergency Room.....$4897...Ins. paid $571....My Co-Pay $0
MedFlight............$28,883...Ins. paid $5649...My Co-Pay $0
2nd Emergency Room.....$938....Ins. paid $0.....My Co-Pay $0
Treatment & Hospital..$49,292..Ins. paid $10,276.My Co-Pay.$25
Totals........$84,725......Ins. paid $16,921.....My Co-Pay $45

Just got a bill for an emergency room visit I had Memorial Day. Needed stitches in my foot. The bill was the doctor and the PA. The doctor only walks by to check my stitches and sign my release. Total bill was $1478 for 5 stitches. Hospital bill is separate. Have not seen it yet.

BCBS paid them $197 and they wrote off the rest with the exception of $35 they want me to pay. That is crazy. It is almost like they have to overcharge to get paid anything at all by the insurance company.

Had the same happen at my job with spousal carve-out. My wife is a teacher and she had to roll off of mine and get her own which is not as good and more expensive. After a year of it they allowed her back on mine. I don't know why but I didn't ask questions.

We have a winner

Does your wife teach at a public school? If so, you must have some incredible insurance at work to beat PEHIP.

Actually that's not one bit accurate.

It's not far off, BirminghamBuck. Insurance companies are going to negotiate a lower rate than you or I could get on our own. It's called economies of scale, and it's like that in every industry. If you were going to buy 1,000 Chevrolet Trucks, you'd pay less than the $45,000 they charge Joe Schmoe at the dealership. That's just reality.

No, the reality is that the provider contract that the doctor and the health insurance company agree to is what sets the price and covered services.

That sets the price for the insurance company, but not for Joe off the street. If Joe were getting that rate, the insurance company would then rightfully negotiate and even lower price.

She is public school. Mine is $5 a week for family coverage, BCBS. $25 copays.

Review Old Grunt's post above and you'll see what is wrong with the system. They reimburse based on a standard cost system not what your treatment actually cost the facility at the time of your visit.

It is like going to the car dealership to have your car fixed. Take it in in the morning and pick it up at lunch with an 8 hour bill for labor and them tell you that's what the "book" says the labor hours are on the service they performed.

Same kind of billing methodology.

I wasn't responding to Joe off the street. I was responding to the following:
"It is almost like they have to overcharge to get paid anything at all by the insurance company."

They actually do charge a lot more than they have too to make up for the loss of free care.

Dixie, my FIL is a General Practitioner and he stopped taking Medicaid patients because their reimbursement rate didn't even cover his expenses.

Mark that is what I am. Our office still takes medicaid but you are right it is becoming quite taxing to know you are not going to get pain. Ultimately it is not my decision to make but I feel it is going to be common from here on out.

PEEHIP is not what it once was and going downhill every year. Of course, I think that can be said of every coverage.

Charged amount has no bearing on reimbursement amount. That is all I was saying. If you charge $100 or $1 million for a service, the insurance company will still pay the contracted amount.

I agree

You just shut down half of the hospitals in America in certain areas! The working class will always bear the majority of the burden of those of the no insurance class whether a hospital calls itself a non-profit or for profit. Then when we need care we will get that fat bill and that big multi-deductible so they can get more out of us until we die!