Your bill will be calculated using simple natural logarithms and multivariate gamma functions
My receptionist was seen at an Urgent Care Center for an injury. She got the bill this week. She was tracking it through Anthem’s website and learned she would be responsible for $54.71. She received the bill from the Urgent Care Center and it was totally bewildering. There were a series of different charges interspersed with a series of “discounts” and “insurance credits,” combined with additional charges and “recalculations.” There were a lot of lines with numbers and unrevealing explanations. Ultimately the bill for her portion was $58.90.
She called the Urgent Care billing department. They couldn’t figure it out. We even contacted our billing company to see if they could make sense of the bill. They couldn’t. Her plan is to contact Anthem for an explanation.
Granted, $54.71 is not much different than $58.90, but these two numbers ARE NOT THE SAME! What aren’t they the same?!?
Bottom line, insurance reimbursement is like calculating your taxes. Five different accountants or insurance reviewers will give you five different numbers. The system is, of course, designed like this. It’s easier to rip you off if you don’t understand how much you owe.
Yes, this is the part where the blog moderator steps in and says: “Hey! That’s why you need Direct Primary Care!” The problem is most Urgent Care’s don’t use such a model and the hospital absolutely will never use such a model.
“The system is, of course, designed like this. It’s easier to rip you off if you don’t understand how much you owe”
This is also the theory behind “value-based payment” – it’s easier to rip off the physicians if they don’t understand how much they should be paid.