Outpatient CBC Test – Billed Charges +1,800% of RBRVS 2010

A blood draw, performed by a nurse, with results in ten minutes. All in-house. Of course insurance covered the bill. A month later the patient gets an Explanation of Benefits  (EOB) from his insurance company which provides an accounting.

But, there were two EOB’s each with two ledger items. Total billed charges on EOB #1 was $153.00. Total billed charges on EOB #2 was 52.00 for a total billed charge of $205.00 for a blood draw.

The insurance company allowed $55.14, a significant discount of 73% off billed charges.

Medicare 2010 would have paid $11.14.

Insurance company paid about +500% of Medicare.

The insurance company is a major health insurance company, one of among only a few left in the business of providing health insurance for Americans.

Editor’s Note: Does Medicare pay too little or does insurance pay too much? The answer depends upon who you ask. With third party intermediaries paying claims consumers don’t really care. “Hey Doc, before you run that test, tell me how much it costs please – I don’t want my insurance premiums to increase too much.”


Bill, the clinic has agreed to pricing with the insurance company. In this case they agreed to accept $55.14. Why do they bill $205 when they know they agreed to accept $55.14? Is it because they are trying to inflate their U&C profile or to show a “loss?” Or maybe someone is getting a percentage of the “discount” as a fee? Any number of possibilities it seems. This makes no sense but I am sure there is a logical explanation. Maybe it was a clerical error? Please enlighten me!