re: Health Insurance Question

This is what's happening to you: Medicare and Medicaid have the legal right to the lowest reimbursement possible to physicians so what happens is other insurance companies try to pin their reimbursement prices close to Medicare and Medicaid. It doesn't matter if the doctor bills Medicare or Medicaid or another insurance company for $1000000 they're only going to pay x amount and that's the customary and standard amount that that doctor agreed to when they signed up with the insurance company. So what the doctor is trying to do is defray the rest of the bill on to you to cover whatever they think is the cost of providing care. However the cost of providing care is a highly subjective issue especially if the care provided is questionable in the first place or the care process itself is questionable. It's poor form to try to reccover x amount of money from patients who are already paying premiums for insurance out-of-pocket co-pays and other out-of-pocket expenses and Doctors should know this and try to find a more affordable way of providing care. For example, lots of doctors like to order MRIs right off the bat just because of the billable amount, but in a lot of cases that's not the best exam for a number of reasons including diagnostic criteria and financial cost.

It's even more than that though because if a doctor bills Medicare Medicaid or private insurance and they recover 100% of the bill without any kind of rejection or fight the assumption is that they were previously billing to little and now they're going to raise their price. It's all about recovering as much money as you can all the time. If you worried about getting good care though what you don't want to do is start arguing with doctors because that is the most Surefire way to either get yourself dropped as a patient or just get shity care for the rest of the time you're with that physician. There's a fine line you know.

I would contact my insurance company and my doctor and get an itemized list of what's covered by Insurance versus what's billed for by the doctors and that will give you somewhere to start because if it's a b******* bill you can legitimately say I'm not paying this and here's why. You would not even believe how many times the same medical codes for diagnosis or procedure double or triple billed.

By the way, I'm a licesned physician who is a private patient advocate.

There might be some punctuation errors in here. Voice to text while I'm running around working.