Originally Posted by Sawbonz
I did it for a living for a long time. Even though I have retired from the business I still have some connections and yes, narrow networks are a thing, but not too many docs get to bill the “rack rate” because very, very few would pay it. And THAT’S only if that rate was somewhat reasonable. Insurers typically pay a percentage of Medicare. In my area it was only a very miserable 80-90%, but that stated bill of $200k plus would be probably 40-50 TIMES any Medicare allowable. If the insurer didn’t have a contract
with that doctor and paid some “usual and customary” number they bought from somewhere else the patient is still liable for the difference. I can see no reason why they wouldn’t have pursued that if due.
The claim in question was for an in-network physician. Nothing was due beyond the plan deductible and co-insurance. Just an example ( I could give many) of the insane price
of care in the US. I have been giving talks to the medical
students and newly minted Dr's at a University near me regarding healthcare reform and the state of the US system. Even they are shocked at some of these costs. They are even more shocked when I show then that a procedure reimbursed at $22,000 procedure under commercial insurance
is paid at $1900 under Medicare. They are not so keen on single
payer after that. One girl cried.