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Hippo
jwg

The riduculousness of our medical system pricing system

In november I had my annual eye exam with my doctor at Harvard Vanguard, an HMO. I paid the $15 co-pay at the time.

Today I got a not-a-bill From Eye Med Vision Care.

This document showed a submitted charge of $186 with an allowed amount of $67.40 and evidence that $52.40 was paid by Tufts Health Plan Medicare my insurer. AThe bill indicated that Eye Med is administered by First American Administrators.

Four organizations are involved in this transaction - not counting me, my credit card company, and my bank.

This document said the submitted charge was $186, but only $67 was allowed - that is 36% of the submission.

$186 would yield $744 / hour assuming 15 minute appointments which is what I think they do. I wonder if anyone every pays $186.

I also wonder how many different prices get charged for the same service at this HMO. And how automated is this billing process and how many people had to do something in the process.
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Well, yes, some people do pay the $186: the ones who don't have insurance.

The reason is that the insurance plans negotiate rates that are high enough to yield profits for them and their intermediaries, but resulting in lower proceeds to the providers than they need. To make up the difference, they charge inflated rates to the smaller percentage that are uninsured and don't have companies bullying the price down for them.

...which is why single-payer works.

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