What happens to the rest of the money?

[UncleLeo]

Needless to say, I have crappy insurance. I just received both the bill and EOB for my sleep study. Here's how it breaks down...

Billed amount: $2456
Allowed amount: $1350
My co-pay/deductable: $1035

What happened to the other $1106 between the billed amount and the allowed amount? Was it just "forgotten? Written off?

What's the purpose of even having a billed amount if they've already agreed to not take more than the allowed amount beforehand?

[dnelms]

They take the difference as a "loss" come tax time.

[tomjax]

Providers contract with insurance for a SET figure for PAP and get the same, whether for CPAP or APAP.

They can BILL anything they like, but will only get the contracted amt.
Many people here simply cannot grasp this elementary fact.

Some wil attempt to bill the patient for the DIFFERENCE!!
This works with SOME patients who do not know the facts and are not sophisticated to question them.

You are left with a copay that is almost twice what you can get one for cash from this site.
You shold never have to pay this price.
Get informed and do not pay this amt.
tomjax

[bookwrm63]

Tom,

You are correct in saying that the patient is not responsible to pay more than the allowed amount. However, he/she is talking about an overnight sleep study...not a mask. Not something that can be purchased on cpap.com..lol..although, the possibilities could be endless....


Mary

[oldgearhead]

If your talking about the $371.00, its just the "write-off" credit given to
your insurance group. You may pay it if you like.

[UncleLeo]

They take the difference as a "loss" come tax time.

I guess that means I(/we) end up subsidizing the difference through tax dollars, anyway.

[tomjax]

Damn, I was thinking that was a bit high for a cpap.

You are right, it was the STUDY.

My lyxdesia is acting up again.

note to self:

"SELF, pay attention"

But I am distracted by the ANS court hearing. I am obsessed and must not have a real life.
Sometimes I worry about me.
tomjax

[Snoredog]

Needless to say, I have crappy insurance. I just received both the bill and EOB for my sleep study. Here's how it breaks down...

Billed amount: $2456
Allowed amount: $1350
My co-pay/deductable: $1035

What happened to the other $1106 between the billed amount and the allowed amount? Was it just "forgotten? Written off?

What's the purpose of even having a billed amount if they've already agreed to not take more than the allowed amount beforehand?

Well if that was DME charges (I know it is a PSG), the DME would be telling you how hard it is to survive and "that is set by the insurance company and NOT us..." yeah right.

They charge $2456 to the poor sucker that doesn't have insurance and walks in off the street. Insurance has caught on to the sleep medicine ripoff "racket" so that is shown in line 2, the $1350 figure.

Now the question becomes, if insurance is only going to pay $1350 and the doctor/lab has to jump through hoops to get that amount billed to insurance then wait another 90-120 days before they ever see their money. Then why in the hell can't they cut a person without insurance a break like $1200 who comes in and pays cash and they get their money right away?

However, missing from that $2456 figure is the PSG "interpretation". Doctors charge seperately upwards of $570 for that process alone (bet most come here to find out what it really says). So the actual charge is $2456+$570=$3026 for the PSG and someone to tell you what it says, not including $65 or so for office visits.

[Slinky]

Say what? My sleep lab didn't charge any extra for analyzing the data collected during the sleep study! I was given a copy of the full data not just the dictated final report at no extra charge when I asked for it too. Now my sleep doctor DOES bill Medicare $150 for an office visit to see him, BUT I then pay ONLY my co-pay of 20% of the ALLOWED (not billed) amount.

I'll have to go check mymedicare to see just what the billed, allowed and paid amounts for my sleep study and titration study were.

[Slinky]

Keep in mind that Medicare is my primary and that I also have a secondary that does NOT pay anything towards an office call.

Okay: my initial office call to see my sleep pulmo to determine whether he thought I might even need a sleep study was as follows:

Billed amount: $175.00
Allowed amount: $164.14
Paid: $32.11
Total Applied To Deductible: $124.00

Mind you, this initial office call was in January when I hadn't met my deductible yet.

The following is for my sleep evaluation study, including the analyzed results and dictated report (including a copy of the full data report - some 5-6 pages long):

Billed: $1500.00
Allowed: $779.55
Paid: $623.64
My secondary paid $155.91

My follow-up appointments with my sleep pulmo are as follows:

Billed amount: $110.00
Allowed: $88.03
Paid: $70.42
I paid: $17.61 (remember, my secondary insurance does NOT cover office calls)

The following is for my TWO sleep titration studies cost (the first was insufficient - only 42 minutes of sleep - not that the second was much better - only 98 minutes sleep). Medicare requires a minimum of 2 hours sleep out of at least 6 hours of lights out in bed. (My 42 minutes and 98 minutes sleep in the two titration studes combined barely qualified). The charges include both dictated results AND the full data reports from both titration studies.

Billed amount: $3300.00
Allowed amount: $1700.54
Paid: $1360.44
My secondary insurance paid $340.10

Also keep in mind that Medicare allowances can vary by region and state.

[dataq1]

Uncle Leo, In reference to your question ... what happens to the rest of the money?

So, again using our BCBS example - they have set our price at $815 for a complete CPAP setup.
However, they also only pay 40% of whatever claim we submit to them. So in order for us to hit thier price of $815 we actually have to submit a claim for $2037.
That's what is referred to as the 'Submitted' (2037) and 'Allowed' (815) amounts.

I sure hope that no one is taking a tax loss on fictious pricing like this.
Cheers,

[onecoknower]

Just for comparison - my first sleep study in December
billed around $3700
allowed about $2500
my part - after deductible $450

Second sleep study (titration study) in 2007
billed $4200
allowed $3000ish
my part $2450.00 - I have a $3000 deductible. I maxed the whole deductible 1/14/07.

I haven't seen my dme charges for the machine/mask yet.
Oneco

[tomjax]

I can just imagine the DME watching this 2450.00 they got from you evaporate to ZERO if the doc simply sent you home with an apap for a week and got a much better value for your pressure.

Then imagine them having a stroke if you were prescribed and APAP and esssntially had a sleep study every night for free.

Your money, your choice.

[Gerald]

Then why in the hell can't they cut a person without insurance a break like $1200 who comes in and pays cash and they get their money right away?

Snoredog....I asked myself that same question.....and came to the conclusion that to perpetuate their con they have to set unrealistic "list" prices.....so that they can give "discounts" to the insurance companies......and still come out with a reasonable return for their services.

The schmuck who just walks in without "insurance" (prepayment) has to pay list....because they can't get caught giving him a discount.

I've always been self-insured.....and a couple of years ago, I was about to schedule a sigmoidoscopy at my local hospital's outpatient facility. I offered to pay in advance....and the nice lady in the business office told me that my cost would be $1,850. I had already paid my doctor $350.00 in advance for the job........so, the hospital charge was only for "scope and table rent".

A total of over $2,000.00 for something as routine and simple as a sigmoidoscopy seemed to be excessive. I checked the internet and found that most clinics charged around $450.00 for the procedure.

I went back to the hospital and asked if they had made some sort of mistake.....and the nice lady said that they hadn't.

I then told the "nice lady" that I could understand the high charge for scope and table rent.......provided they were going to have a group of nurses dressed in togas.....handing out hors'dervs......while a 6-man band played for our entertainment during the procedure.....and everyone took turns "looking thru the tube". But since I didn't expect a band or nurses in togas, the charge was too high....and that I'd take my business elsewhere.

I went to the doctor's office....told him the same thing....and requested my money back...less the cost of the initial visit and consultation. He paid me.

I then went to a specialist....he did the procedure in his office....and charged me $375.00.

The medical business is so full of fraud and misrepresentation that it's just a matter of time before it all changes. The internet is allowing better communication between the "victims" (patients).......and we're able to warn each other......just as we do on this forum.

The world is rapidly changing.

Gerald