The Texas Department of Insurance offers a link to consumer information on health care pricing. So we checked what the average cost allowed by insurance companies for a routine office visit in the Lower Rio Grande Valley of Texas.
Below you will find the pricing information. Does not seem right but if it is, and a plan has an office co-pay of $25, guess who is really paying for the office visit? Hint: It’s not the plan paying.
Medical Specialty: Office Visits – Rates
Procedure Description: Office or Outpatient Visit, Established Patient, Level 1, 5 minutes
GeoZIP: 78520
Region: Rio Grande Valley
Average Rates For Selected Region
| Network | Total Billed | Total Allowed | |
| Total | IN | $48 | $23 |
| Total | OUT | $47 | $23 |
Average Rates Statewide
| Network | Total Billed | Total Allowed | |
| Total | IN | $44 | $20 |
| Total | OUT | $59 | $19 |
Billing Definitions
Total Billed Definition
| Total Billed |
| The dollar amount physicians or hospitals bill to health plans for medical care. |
Total Allowed Definition
Table – Texas Healthcare Costs
