re: Big price difference between 2 medical service providers for same procedure - acceptable?

Let me give you a better example:

Let’s say you need an MRI. This is what the following plans will pay the orthopedic clinic:

Blue cross - $400
United - $200
Medicare $300
Medicaid - $150

A clinic is trying to run its billing department with as few people as possible because overhead expenses are crazy.

So instead of a biller having to check the fee for each plan before they bill it, they bill a number way above any possible plan’s fee. Then the insurance company adjusts it down on their end.

So the clinic will bill all MRIs at $600. It’s just an arbitrary number. To you it looks like they are 3x what Medicaid would pay. But at the end of the day Medicaid only pays them $200 for the MRI.

The hospital may have better billing resources and are comfortable billing closer to the actual fees.

These fees also change on a yearly basis. So instead of constantly having to keep up with the changing prices you just bill way more than anyone would possibly pay.

You don’t want your biller submitting a $200 bill to blue cross when they would pay $400.