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Moderatus Puisne
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Discussion Starter · #1 ·
I told you all about my new optometry Rx.

Last time I did this, about 3 years ago, I was paying out of pocket, so I went to Costco for a contact lens exam. I think it set me back $75?

This time, I had vision insurance, so I went to the provider my insurance recommended in my area. It only cost me a copay, but, I got the billing statement that shows what they're billing my insurance: Just over $300. $80 for the "contact fitting fee," and $120 for the basic exam, plus another $100 for something I didn't understand.

Really?

I have -1.75 in both eyes, only nearsighted, and the tiniest cylinder correction on the books. No other issues. I had my old contacts, size remained the same.

I was there for perhaps 30 minutes.

Are these kind of charges normal? Does anyone pay them? Is this just the kind of deal they put on the bill to make your insurance look worthwhile, and then they negotiate paying far less?

FWIW, I also looked at new glasses there, the most entry-level of which cost perhaps $125 fully assembled. I got a pair from a (fairly local) e-vendor for $50, including anti-scratch and anti-glare coatings.
 

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Fini les ecrase-"manets"!
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You will probably also get a statement from your insurance showing what they REALLY paid the eye doctor.

That's what I see all the time from my insurance. The doctors charge these ridiculous fees, so that a single office visit where I don't even get blood drawn is hundreds of dollars, and the insurance company will only pay them about $75-100. The rest they disallow under the idea that the charges are not "reasonable and customary."

It's how the game is played, apparently. Doctors all ask for the moon, in hopes of driving up the insurance companies' idea of what's a reasonable and customary amount, and the insurance companies pay a fraction of it. And then we pay (in our premiums) for all the paper shuffling that goes on.
 

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Fat'r + Slow'r than TMB
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What they bill out and what they get from the insurance company are 2 completely different things. Trust me I know.
 

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Frog Whisperer
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I wonder if the med. professionals can write the difference of what they were paid vs what they were billed as a loss? Just a thought.
 

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Steaming piles of opinion
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Dunno how this thread stays out of PO, but...


Welcome to lesson 1 of why healthcare costs so much.

Next week's lesson: Doctor consortiums that buy MRI studios, and subsequently 'need' high-res images of every canker sore that comes across the exam table.
 

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Moderatus Puisne
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Discussion Starter · #6 ·
I believe you...

jupiterrn said:
What they bill out and what they get from the insurance company are 2 completely different things. Trust me I know.
Got any idea of the ratio?
 

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Discussion Starter · #7 ·
It may get moved, but

danl1 said:
Dunno how this thread stays out of PO, but...

Welcome to lesson 1 of why healthcare costs so much.

Next week's lesson: Doctor consortiums that buy MRI studios, and subsequently 'need' high-res images of every canker sore that comes across the exam table.
Every time I post in PO, it's either talking in circles or asking why it's politics!

You're absolutely right about the equipment, though. They had some kinda fancypants machine that took a digital retinal image. I had to sign two wavers saying that I did not mind if my eyes exploded, I could've saved them for $49.95.
 

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Fat'r + Slow'r than TMB
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danl1 said:
Dunno how this thread stays out of PO, but...


Welcome to lesson 1 of why healthcare costs so much.

Next week's lesson: Doctor consortiums that buy MRI studios, and subsequently 'need' high-res images of every canker sore that comes across the exam table.
There are laws against that in a lot of states. Not saying there aren't ways around it but there are some penalties if caught.
 

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Fat'r + Slow'r than TMB
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Argentius said:
Got any idea of the ratio?
Depends on the procedure and the insurance company but here at our urgent care we may if we are lucky get about 1/3 of what we actually bill. Quite a few patients go outta here at a loss for us.
 

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Failboat Captian
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And this is what really screws the person without insurance. If you pay out of pocket, good luck being able to pay what the ins companies pay.
 

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Palm trees & sunshine!
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jupiterrn said:
Depends on the procedure and the insurance company but here at our urgent care we may if we are lucky get about 1/3 of what we actually bill. Quite a few patients go outta here at a loss for us.

How do you determine P&L for procedures? I mean, I'm sure there's a quick calculation but, I'm more interested in the finer details that goes into a routine visit. For example, if I come in with a simple broken arm, how do you break down the actual, true costs of the procedure?
 

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Fat'r + Slow'r than TMB
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KenB said:
How do you determine P&L for procedures? I mean, I'm sure there's a quick calculation but, I'm more interested in the finer details that goes into a routine visit. For example, if I come in with a simple broken arm, how do you break down the actual, true costs of the procedure?
We have contracts with each individual insurance company. There is an algorithm that is done to determine complexity of the patient, this is done with our electronic patient software. Level 1, 2, 3 and so forth. Certain insurance companies we can bill on the number of individual procedures done. In your example for a broken arm/wrist. We charge for an office visit + xray + spint = total bill. We can not charge for supplies used, we do not get reimbursed. Another example would be if we had a simple ankle fracture, Xray+Splint+Crutches (not reimbursed)= and we quickly start making a lot less money. Medicare is a completely different animal but we bill using their billing system. Now understand I am a nurse and TRY to stay out of the billing aspect as much as possible but that is the way I understand it in our specific office.
 

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waterproof*
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KenB are you asking some one with practice mgmt experience to answer that? Cause I don't have that... but that never stopped me before... isn't there a somewhat standard (very large) list of services and costs, for example Medicare's list of procedures? Similar to the standard labor rate manuals in auto service and LBS service too?

I suspect from that starting point, it has more to do with negotiated outcomes than with any actual costing.
 

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Frog Whisperer
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last time I broke an arm it was free.....at least it didn't cost ME anything to break it....getting it fixed, on the other hand, was about 13 grand with the surgery, anesthetic and steel pins. At least from what I gather, we don't get to see all the bills. It may have been more than that. THANK the gods for great health insurance.
 

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Palm trees & sunshine!
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Creakyknees said:
KenB are you asking some one with practice mgmt experience to answer that? Cause I don't have that... but that never stopped me before... isn't there a somewhat standard (very large) list of services and costs, for example Medicare's list of procedures? Similar to the standard labor rate manuals in auto service and LBS service too?

I suspect from that starting point, it has more to do with negotiated outcomes than with any actual costing.


Yeah, I'm trying to understand the true costs when you break it down to supplies, labor (real labor costs, not billing rates), admin overhead, lights and pipes, etc and how that factors into the P&L for a practice and how that translates down to costing out specific procedures.
 

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Fat'r + Slow'r than TMB
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KenB said:
Yeah, I'm trying to understand the true costs when you break it down to supplies, labor (real labor costs, not billing rates), admin overhead, lights and pipes, etc and how that factors into the P&L for a practice and how that translates down to costing out specific procedures.
Wow, that would be a big list. I could do a little of it but I would be talking about things that I usually don't give over the internet and are just cost specific to my facility in a very upscale part of the country.
 

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Steaming piles of opinion
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Touch0Gray said:
last time I broke an arm it was free.....at least it didn't cost ME anything to break it....getting it fixed, on the other hand, was about 13 grand with the surgery, anesthetic and steel pins. At least from what I gather, we don't get to see all the bills. It may have been more than that. THANK the gods for great health insurance.
Or, not. It's not as if it's free. Just because you didn't sign a check doesn't mean you didn't pay. Or won't, soon.
 

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Palm trees & sunshine!
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jupiterrn said:
Wow, that would be a big list. I could do a little of it but I would be talking about things that I usually don't give over the internet and are just cost specific to my facility in a very upscale part of the country.

Not worth getting in trouble over. I'm just curious. :)
 

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Registered
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Yup just got a statement from eyemd saying they paid $160 to my optometrist for my eye exam last month. The $160 charge includes $40 extra for contact lenses fitting. I been going to his guy for about eight years now and he seems like a fairly honest guy. Just trying to say the $300+ your optometrist charged your insurance co is a bit outrageous or maybe even fradulent. Unless you live in beverly hills or some very affluent neighborhood where merchants double charge everything.
 
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