By Chris Barakat on Linkedin
This afternoon, Geetinder Goyal was advocating for one of his patients. The facility is a huge branded facility in Houston.
The need for the visit was for an initial encounter and a blood test…
Her quote from the facility was $2,500 Out-of-pocket.
unbelievable…
So, he asked for the cash price.. They said $4,700.
Thanks to Yuzu Health and their RBP calculator, we calculated the rates appended to Medicare. Guess what the rate was… $250 at 100% of Medicare.
Dr Goyal asked, how do you justify billing the member $2,500 and then charging the plan another $1,500, for a service you accept $250 for under Medicare?
The billing person said oh this must be a mistake, we will rectify it and confirm the new rate with you tomorrow.
Moral of the story:
– Members, if you don’t have someone to advocate for you, tell your employer to find someone.
– Employers, if you rely on your health plan “negotiated network rates” and you don’t have someone looking out for your plan, you and your employees will be taken advantage of
– Brokers, if you have a plan design that will eliminate copays, coinsurance and deductibles for members by allowing steerage in your health plan, we can avoid members and employers from being exploited by the health system
UPDATE: THE RATE THE FACILITY CAME BACK WITH WAS……… $55.
