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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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Yeah, when I was in Canada, hospitals said about 80% of the work of their billing departments was dealing with the insurance companies of folks from the States. My mother had heart-attack-like symptoms (happily not a heart attack) when she visited me and we went to an ER, the total bill (including an EKG & blood work with cardiologist consult) came to about C$600, which would have been about US$425 then.

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