Another example of the insanity of “pricing” in the US health care “system”

July 16, 2013 in health care costs, Health Insurance, Insurance Bills

A family member had some lab work done by Quest Diagnostics, which is under contract with Harvard Pilgrim Health Care, our health insurer.  Because we have a high deductible plan, we were expecting a bill.  No problem.  The bill comes and it lists each test’s CPT Code along with a description – although admittedly I have no idea what these tests are – as well as the “charge” the “insurance discount” and a column that indicates “patient owes,” among others.

Here’s what was listed on the laboratory invoice:

Date CPT Code Test Description

Charge

Insurance Discount

Insurance Paid

Medicare/ Medicaid Paid

Patient Paid

Patient Owes

05/29/13 86036 ANA SCREEN, IFA

78.00

05/29/13 82784 GAMMAGLOBULIN

$56.15

05/29/13 83516 TISSUE TRANSGLUTAMIN

$157.04

05/29/13 83516 GLIADIN (DEAMIDATED)

$227.76

05/29/13 86039 ANA TITIER

$44.72

06/26/13 ADJUSTMENT

($483.20)

$563.68

(438.20)

$0.00

$0.00

$0.00

$80.48

 

I called Quest to get an explanation about the invoice.  In particular, I didn’t understand what they meant by “Insurance Discount” vis-à-vis the “Charge.”  After some back and forth, it was explained that the insurance discount is the difference between what Quest charges someone without insurance – i.e., their “list” price – and the amount that Harvard Pilgrim pays them for the test.  In my instance, it’s the difference between what I would pay if I didn’t have insurance and the amount that I owed because we’re covered through Harvard Pilgrim.

Their so-called charge for these services – the amount that they would charge me if I were to walk in off the street and get some routine blood work done – is more than SEVEN times the amount that they charge my insurance company. I understand the concept of contracting with providers to obtain a better price, but this seems to me to be a tad bizarre.   Perhaps the contracting staff at Harvard Pilgrim is like William Shatner, the Priceline Negotiator…but I doubt it.

So I asked the customer service rep from Quest if they ever collect the “Charge” amount.

The answer: “Yes, from people who don’t have insurance.”

What a country…

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