Blue Cross Blue Shield Expert?
The benefit summary states service dates, amt. bill, amt. allowed, deductible, copay, coins, amt. pd., you owe, remarks.
The amount paid never equals the amount billed, does this mean my doctor / provider is not getting paid ? Recently, billed was $30,000, paid was $4,000, copay was $200. What is going on with this ? Sooner or later my doctor tires of not getting paid !
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The earlier answers about "contracted rate" are correct. As long as you are using an "in network" doctor, physician, labs etc the provider can NOT balance bill.
When paying your bills - keep the following in mind.
1) The document you are looking at is called an Explaination of Benefits (EOB). You never pay a hospital, doctor, lab (etc) bill unless the bill matches your EOB. This way you know you are getting the contracted rate.
2) Match your EOB's and Bills up by date of service - then by procedure. If you stay on top of this process it will make your life easier when it comes to paying the bills.
On my insurance a lot of doctors are considered 'in network', when they are in network they agree to give the insurance company a discount or only charge a certain amount. In the same terms if a doctor accepts Blue Cross they will only charge the insurance an agreed upon fee. They are getting paid but not as much as the would normally charge an out of pocket patient. For example on one of my insurance bills-
Total charge- $200 ( amt. Dr. normal fee )
Network discount $100-
Amt Allowed $ 100 ( amt insurance will pay for xyz service )
Co-Pay $0
Deductible $0
Not Covered $0
% Paid by Plan 100%
If the doctor doesn't agree to the terms of your insurance company- then they would/will not accept that insurance anymore.
The amount billed will never be what the insurance company pays. You have to look for the "amount allowed" column. The amount allowed is the amount that a health service provider has to charge for that particular service. It's a discount applied because you have health insurance. If you didn't have health insurance, you would be responsible for the "amount billed." So, given your example, the amount billed was $30,000 but look for the amount allowed and see what that says. You'll notice that it's substantially lower and probably around $4200.....good luck!
This is very common. The price the doctor charges is always higher that what the insurance company feels the procedure is worth (normally called Usual and Reasonable Charges - URC). All the doctors know this and accept what the insurance company says the the accepted amount. Most doctors also have contract with the insurance companies and know ahead of time how much they are actually going to get.
I went by way of this myself for various scientific scientific care and it became Blue shield. They continually deny each and every thing hoping you will no longer combat it. prepare an charm letter pointing out the justifications why it is so mandatory and supply a solid argument against their reasons for denying. Get Drs to jot down letters to attach to charm. additionally connect any analyze that have been achieved to coach that the scientific care works. I did this and it became authorized very immediately whilst they have been given my charm. it truly is on a med that expenses $1200 a month for existence.
The provider's are being reimbursed based on their contract rates. The difference is a discount/write-off. They don't get paid the difference, you aren't billed for it either.