The Medical Bill

My latest medical bill arrived. This was a follow-up to the doctor’s office. On that day, I was weighed and then peed in a cup connected to a computer to measure my flow and output. Then a nurse asked me some questions about how I was doing, before the doctor came in, read the reports, and made some follow-up actions. Including waiting — they were overbooked and I waited twenty minutes to see him — peeing, and talking, I was out of there in about forty minutes.

Before going further, I want to say that I’m amazed and grateful that my military retirement gives me health benefits. I can’t say that enough. That’s not what this is about. This is about a neophyte in the healthcare’s billing process.

The bill began as a total of $277.10. That’s not bad, I thought. Insurance covered $59.36. Cool. Then, total adjustments and discounts were $180.84. Of that, $4.10 was a discount given to me for the prompt payment of previous bills. The other $176.74 was an insurance adjustment. The total due for me to pay is $36.90.

I’m not complaining so much as stating my surprise and confusion. What in the world is that insurance adjustment that reduces the bill by sixty-three percent? Is it a volume thing between Tricare and Asante? Makes me wonder about the original bill and its legitimacy.

I don’t know. The discount wasn’t explained. I suppose I could do an Internet search, but, well, I’d rather just note it and press on, at least for today.

8 thoughts on “The Medical Bill

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  1. Again, my gratitude for living in a country with government subsidized health care. We may have longer waits, but we have smaller bills, and are only billed for non-essential services.

    Liked by 1 person

  2. It’s the negotiated discount the insurance company has with the healthcare provider. Adjustments are typically reductions related to maximum allowed charges between the healthcare provider and the insurance company.

    So, if you went it for a routine exam, and the maximum agreed to is $200, and the clinic charged $280, you would see the $280 charged, “adjusted” down to $200.

    There can then be a discount on the $200. A 40% discount is not unheard of. So, the $200 becomes $120.

    This $120 is now where any payments from the insurance company begin. So, if you are in an 80/20 split, the insurance company covers $96, leaving the remaining $24 to you.

    This is one of the reasons not having insurance at all is so difficult. With insurance, even if you haven’t hit the deductible, you are paying $120. Without insurance, the same visit would be $280.

    Liked by 1 person

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