I have never had insurance before so I am not sure how things are billed. Last month I went to Urgent Care & they prefer that you pay & then they will reimburse once the insurance pays. I didn't have a problem with that, but I just got the statement from the insurance company. I was charged $72.00, but they the insurance company $95.00, is that common practice?

By Ginny~moderator on Monday, February 20, 2006 - 06:18 am:

Emily, your last sentence got a little blurry, so I don't understand. Did the provider tell the insurance company the bill was $95, but only billed you $72?

If that's what happened, I'd first call the provider and ask them if this was an error and, if it was not, why the difference.

By Emily7 on Monday, February 20, 2006 - 10:54 am:

Yes, I paid $72.00 & the bill they sent the insurance company a bill for $95.00. The insurance company didn't pay because I haven't met my deductible yet.

By Karen~moderator on Monday, February 20, 2006 - 11:09 am:

I'd definitely question why they billed different amounts.

By Ginny~moderator on Monday, February 20, 2006 - 11:55 am:

Definitely ask the provider to explain the difference. That's an almost 25% difference.

By Reeciecup on Monday, February 20, 2006 - 12:04 pm:

Emily it could be that the $23 was the difference between the actual cost and the contracted cap the Urgent Care was allowed to bill you. Often doctors, etc. contract with the insurance company to only charge xx amount. So the bill to the insurance co is the actual cost but then so much is automatically subtracted to the contracted amount which you are then billed. I forget the name for this, maybe someone in the insurance business here would know. I hope that makes sense.

By Tayjar on Monday, February 20, 2006 - 01:08 pm:

This is a common practice. I used to process employee medical claims for my employer. Typically, if you go to one of the preferred providers, you only have to pay the agreed discounted amount. In your case, $72.

Then, the medical provider sends the entire bill to your insurance company, $95. The medical processor will enter the bill into the computer system as $95 and it will recognize it as a preferred provider and do the repricing automatically. That's where the $72 comes in.

The downside to that is only $72 will go to your deductibe, not the $95. I've seen bills discounted by as much as 50% for using a preferred provider.

Your provider is honest. Some providers would have made you pay the $95 hoping you will never realize the mistake.

By Emily7 on Tuesday, February 21, 2006 - 06:34 pm:

The entire $95.00 has gone towards my deductible, which is why I noticed it in the first place.
Thank you all for your thoughts, I think I will call the provider & ask why the difference.

By Ginny~moderator on Tuesday, February 21, 2006 - 06:55 pm:

Sounds to me like Tayjar has some good information. It also sounds like your provider billed the insurance carrier the "full price", but charged you what they would have received from the carrier at the contracted (discount) price.

If it were me, I wouldn't call the doctor's office, but would, the next time I'm in there, just quietly mention it and say something like - I'm curious about how you work this, because of the difference. I'm not complaining, but I don't really understand how this works and I'd like to. That keeps it real low key and unofficial, which I think is better for you.

Sounds to me like you got the best of both worlds (if one can say that abouot health insurance and doctor bills these days). You got a discounted rate but got credit for the full rate towards your deductible. That's a boat I wouldn't want to rock.