Check your logic at the door...
Insurances pay an 'allowable amount' for each service that you bill. But they don't tell you what their allowable is.
So if the allowable for service X is 100$ and the provider bills 50$... They pay 50$. If the Provider bills 300$ then you get paid the full 100$. Add to this a complicated dance of refiling and demanding money and insurance denying things randomly (but purposefully) and you have these ridiculous charges and payments. We actually had a charge that was rare for us that we were charging 30$ for due to our system note being reset and the insurance would pay 200$. We lost several thousand in revenue before it was notice. To that effect, we usually set our charges at 5x over what we anticipate the allowable to be.
This is why you have to argue about every single charge on a medical bill though, because if something is denied, then you will get a bill for the inflated amount. Most providers will cut this value down to size, but you may have to argue it. The allowables and charges are all over the place and some (as above) are absolutely insanely inflated. If you are uninsured, step 1 is to ask/demand for the bill to reflect what insurance pays... It can mean a multiple.
The 'facility fee' is for hospitals to charge to cover the costs of the building that the services take place in. As a private practice physicians, my group can't charge this. It is why hospitals are eager to buy up every doc in the world. One day you are paying your PCP a 20$ copay, and the next day they are adding on a 100$ facility fee, regardless of the building being old and paid off or brand new. It comes as a shock to the patients for sure. I've seen this happen with Huntsville and Crestwood buying up practices and then everyone blames the docs involved! But they don't see that money.
In the last 20 years the nickel and dime approach by (usually in the hundreds of dollars) insurance companies has made traditional coverage very spotty indeed.
Insurances pay an 'allowable amount' for each service that you bill. But they don't tell you what their allowable is.
So if the allowable for service X is 100$ and the provider bills 50$... They pay 50$. If the Provider bills 300$ then you get paid the full 100$. Add to this a complicated dance of refiling and demanding money and insurance denying things randomly (but purposefully) and you have these ridiculous charges and payments. We actually had a charge that was rare for us that we were charging 30$ for due to our system note being reset and the insurance would pay 200$. We lost several thousand in revenue before it was notice. To that effect, we usually set our charges at 5x over what we anticipate the allowable to be.
This is why you have to argue about every single charge on a medical bill though, because if something is denied, then you will get a bill for the inflated amount. Most providers will cut this value down to size, but you may have to argue it. The allowables and charges are all over the place and some (as above) are absolutely insanely inflated. If you are uninsured, step 1 is to ask/demand for the bill to reflect what insurance pays... It can mean a multiple.
The 'facility fee' is for hospitals to charge to cover the costs of the building that the services take place in. As a private practice physicians, my group can't charge this. It is why hospitals are eager to buy up every doc in the world. One day you are paying your PCP a 20$ copay, and the next day they are adding on a 100$ facility fee, regardless of the building being old and paid off or brand new. It comes as a shock to the patients for sure. I've seen this happen with Huntsville and Crestwood buying up practices and then everyone blames the docs involved! But they don't see that money.
In the last 20 years the nickel and dime approach by (usually in the hundreds of dollars) insurance companies has made traditional coverage very spotty indeed.
