Re:Girl’s $143k bill for snakebite treatment reveals antiven...
by 378fho on Wednesday May 01, 2019 @12:51PM
(#19799022)
It's simple fraud in many cases.
Patient has a 20% copay. The provider bills $100,000. The provider "pays" $80,000. The patient pays $20,000.
Provider then pays a $70k kickback disguised as a discount on other charges, fees for participation in the system, etc. (or never even pays the EOB amount). In fact a total of $30k is paid for the services, and 66% of that comes from the patient.
Insurance gets away paying $10k instead of $24k (80% of $30k). Provider gets the business by being on insurer's provider list. Patient thinks "I'm glad I paid $20k for Insurance. My health-care-spend ended up being $40k instead of $100k." In fact, they'd have been better off without insurance, which would have only cost $30k.
Patient has a 20% copay. The provider bills $100,000. The provider "pays" $80,000. The patient pays $20,000.
Provider then pays a $70k kickback disguised as a discount on other charges, fees for participation in the system, etc. (or never even pays the EOB amount). In fact a total of $30k is paid for the services, and 66% of that comes from the patient.
Insurance gets away paying $10k instead of $24k (80% of $30k). Provider gets the business by being on insurer's provider list. Patient thinks "I'm glad I paid $20k for Insurance. My health-care-spend ended up being $40k instead of $100k." In fact, they'd have been better off without insurance, which would have only cost $30k.