re: What in the hell is wrong with medical billing?

quote:

---

Everyone gets charged the same rate regardless of your insurance plan. Each insurance plan reimburses according to the contract that the physician and/or hospital signed. If you're in network, then the physician cannot collect the difference in the charged amount and the reimbursed amount.

---

I see the difference, though it amounts to the same thing in terms of what the provider gets paid for each service being different for each patient. This being the case, if a doctor had a posted “price list”, this would not be the cost to you but the maximum possible cost to you as a patient.

quote:

---

If you are out of network, then you may owe the difference(this is called balance billing).

---

Here is where the confusion lies. A patient goes to a doctor that is in network, expecting everything that is done via that doctor to be in network. What they don’t realize is that the lab, the radiology, and any other services ordered by that same doctor might be out of network. I’m sure this has been covered already in this thread.

quote:

---

Some types of practices do now operate on a cash based system.

---

Decreasing the overhead on the practice should in theory decrease costs. But the fact that they are all out of network would then raise costs and there is the added uncertainty of being reimbursed at all. Are most of these practices things like cosmetic or anti-aging treatment type places?