re: No wonder medical cost or so high...

quote:

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It's absolutely ridiculous to be able to charge a price, then have someone else say- "That's too much, you can only charge half that- or we can just send our customer base somewhere else"

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This isn't really how it works. When physicians sign on with an insurance company, that company provides them with their reimbursement rates for office visits, procedures, tests, etc. Physicians are not allowed to charge people different amounts because of insurance differences, so they have to set one fee schedule. In order to not leave any money on the table, physicians set their fees at a much higher rate than insurance companies will reimburse, sometimes up to 75%-100% more, so that their fee will be higher than any insurance company's reimbursement. For instance, if I charge $50 for an office visit, one insurance company might allow $40 while another allows $60 for the same visit. If I submit $50 to company B, then I'm leaving $10 on the table. So, in order to avoid leaving money on the table with any insurance company, my fee schedule will probably list that office visit at $100 knowing that I won't collect 50% of that.

For cash paying patients, significant discounts are factored in to offset these "inflated" fee schedules.