Portal Login:
  • Clients
  • Providers
  • Skip to primary navigation
  • Skip to content
  • Skip to primary sidebar
  • Skip to footer
    Portal Login:
  • Clients
  • Providers
  • About MCN
  • Careers
  • MCNTalk
  • Contact Us

MCN | Medical Consultants Network

The Power of a Second Look

  • Services
    • Independent Medical Examinations
    • Medical Peer Reviews
    • Bill Review Services
    • Utilization Reviews
  • Expertise
    • Short and Long-Term Disability
    • Workers’ Compensation
    • Auto/PIP/Casualty/Liability
    • Independent Review Organization Services
  • For Clients
  • For Providers
  • Your Exam
    • About Your Exam
    • About Your External Review
    • Contact & Scheduling
  • Schedule Now
  • About MCN
  • MCNTalk
  • Careers
  • Contact Us

MCNTalk
News, Insights & Opinions

Home / MCNTalk / Adventures in Healthcare – a Short Chapter

November 26, 2013

Adventures in Healthcare – a Short Chapter

I opened the mail to find a medical bill for some lab studies on a family member. Total billings from “Laboratory Corporation of America” for 8 line items of services was $568.50. The adjustments by our insurance carrier, United Healthcare, were a total of $495.56, leaving a remaining balance of $72.94 on which the carrier paid $58.35, leaving a balance payable by us of $14.49.

What does this mean to those who don’t spend much time thinking about this? It is quite simple. The lab, a large national company, billed $568.50, the retail price that they decided to charge, which had we lacked insurance, we would have been expected to pay. The discount was 87% of charges, which means that the carrier used some sort of fee schedule, which is acceptable to the lab as a member of their network, to determine what was likely “usual and customary.” I sampled one of the line items that was charged at $219.00, and while my carrier permitted $21.71, the maximum that Medicare would permit was $16.99. So my carrier is generous compared to Medicare, paying about 27% more.

Why does the lab charge so much relative to what they get from carriers? Because they can. They can make up any number they wish, but clearly are thriving and surviving on actual payments that are 15% or less of what they charge. The small number of uninsured or underinsured, those least able to pay, are getting billed six times or more what their insured neighbors or retired relatives on Medicare are expected to pay.

What if the person in the check-out line buying the same basket of groceries was asked to pay 6 times more than the person in the next aisle because of where they work, or because they are younger, older, or for any other reason? Would we stand for this? Why do we permit this?

That the real prices differ from billed is a given in health care. I am accustomed to seeing discounts of 40% or so. But 87% is a new one that reflects, to my view, flagrant behavior that must be called out and must be stopped.

Share this:

  • Twitter
  • Email
  • More
  • Facebook
  • Reddit
  • Print

Tagged: Clinical Issues, Cost Containment, Government Policy, Health Policy, The Practice of Medicine 1 Comment

Previous Post
Next Post

Reader Interactions

Comments

  1. Lyn Carlsen says

    December 6, 2013 at 10:32 am

    In California, there was a case of a man w/o insurance having an aneurysm repaired. The hospital billed 140K. He second-mortgaged his house to pay, then sued. Since the hospital wd settle for 20K from its largest insurance contract, he argued that the hospital shd be willing to accept that amt in cash from him for the same services. It resulted in a law being passed to force hospitals to do exactly that. If more states’ (or federal) law were changed in this way, it wd be an improvement in the payment systems for those w/o coverage. Not perfect, mind you, but an improvement.

    Reply

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

Primary Sidebar

Recent Posts

  • The Quality Divide: What Makes a Quality IME Physician?
  • The Quality Divide: Is Your Vendor Driving IME Excellence?
  • The Quality Divide: When and How to Request an IME?
  • April Clinic Calendars Are Available
  • MCN’s Client Portal Login Page is Changing

Archives

Footer


  • Twitter
  • LinkedIn

Quick Links

  • Services
  • Expertise
  • About MCN
  • Careers

Division Headquarters

MCN
1200 5th Ave., Ste. 650
Seattle, WA 98101

See all offices

Email Us

General Inquiries: info@mcn.com
Sales & Marketing: marketing@mcn.com

Call Us

206.343.6100
800.248.6269

© Copyright 2023 Mitchell International, Inc. All Rights Reserved.

  • Privacy Policy
  • Sitemap