Food Insurance PPO Network

Excerpt from an email received yesterday:
This morning I had some tests run at Valley Diagnostic Clinic in Harlingen, Upon finishing the tests, I was directed to go to the cashier to settle my bill.
The clerk said “Mr. XXXXXX, I have already checked with your insurance company and you have a $10,000 deductible! Therefore I am going to have to ask you for your payment now please.”
I said “well, why don’t we wait to see what my PPO allows for these charges, so go ahead and file the claim, then I will return and pay you the discounted rates your clinic has negotiated with my insurance company.”
“Oh, Mr. XXXXX, that won’t be necessary. I can reprice your charges right now on my computer!”
That really surprised me. So I inquired “can you re-price claims through all the PPO networks that your patients use?”
“Of course, Mr. XXXXX! We are fully automated!”
“Are all services priced the same for all patients, or is there pricing differentials among PPO networks?’, I innocently asked.
“Oh no Mr. XXXXX, prices vary from one PPO to the next.”
So the nice little clerk entered the data into her computer, and a total came out, which I promptly paid.
Upon driving home, I reflected upon this interchange with the insurance clerk, and I thought;
This is like buying donuts at HEB. Ten different people go to HEB and buy the same dozen donuts but each is charged a different amount based on their Food Insurance PPO network. This is an amazing way to conduct business.

Editor’s Note: HEB is a large chain of grocery stores in South Texas

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