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Old 10-27-2007, 02:02 PM
876 posts, read 3,481,355 times
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Originally Posted by FLtoNC View Post
This is not true. If you go to a doctor that is participating with your insurance plan, they can bill anything they want, but will only get paid the "allowed amount", which is an amount that is a reasonable and customary charge which they have agreed to accept from the insurance company. For instance, let's say they bill $850 for a procedure, but the allowed amount is only $225. The insurance will pay the $225, and depending on your plan, you will pay a co-pay or co-insurance. If you choose to go to an an out of network doctor, than you may be responsible for the balance of the bill the insurance did not cover (in this case $625). This doesn't affect the insurance company - it affects you. One of the reasons rates go up if you have insurance coverage through your employer is the amount of usage. If you work for a small company, and you have one or two families/people that have excessive medical bills, it can affect the whole group. Employers are not privy to the information of who is racking up the medical bills, but in many cases, it may be obvious.
you are 110% correct. Insurance companies will not pay "whatever the doctor says." They pay an allowed amount and thats all. If the doctor wants more, good luck.
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Old 10-27-2007, 08:49 PM
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It is even expensive through a job. We thought it would be less when we came here from NY but Dh's job said that everyone pays the same in the company no matter where you work. That kind of shocked us as salaries are so different. But it is something we have to have so we pay it.
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