Actual Bills:
| Direct Primary Care | Dermatologist (after contractual insurance-adjustment) | |
|---|---|---|
| Skin lesion shave biopsy procedure plus visit | $40 | $240 |
| Skin lesion pathology bill | $45-154 | $154 |
| Visit to discuss pathology results | $0 | $65 |
| Total out-of-pocket | $85-194 | $459 |
| One DPC Office In Virginia “account bill” the doctor | Hospital Lab Initial Charge To Insurance | Self-Pay run by Hospital Lab but drawn by DPC doctor | |
|---|---|---|---|
| CBC | |||
| CMP | |||
| ESR | |||
| SARS Antibody | |||
| Blood draw charge | |||
| Total | $90 | $721 | $432 |
Imaging Plus Biopsy (a different regional hospital in 2024)
| MD Save self-pay on-line paid ahead of time | Hospital Out-Patient Facility Self-Pay 50% Discount (mention HITECH Act to become self-pay rather than going through your insurance this one time) | Hospital Out-Patient Facility Insurance-Pay | |
| image-guided biopsy (excludes pathologist’s fee) | |||
| initial charge | $3,337 | $3,968.14 | $3,968.14 |
| insurance-contractual discount since $2,000 deductible for year was already met | – $1413.07 | ||
| equals | $3,337 | $3,968.14 | $2,555.07 |
| 50% discount if self-pay | – $1,984.07 | ||
| 10% discount if paid in full same day | – $198.407, if additional discount allowed | – $255.507 | |
| equals | $3,337 | $1,785.663 | $2,299.563 |
| after two days of phone calls by patient starting right after the procedure, inquiring about self-pay options, the hospital re-ran estimate with insurance, issued 10% prompt payment discount to patient, charging this price | Patient paid $1,536.52 Insurance owes the rest | ||
| Insurance EOB statement on-line ten days after procedure: | Patient owes $1,412.09 Insurance paid $2,495.99 (from a total due to hospital of $3,908.08) | ||
| total spent by patient with prompt pay | $3,337 | $1,785.66 | $1,412.09 (vs without having met deductible: up to $3,412) |
| Additional (late) hospital charges for radiologist reading imaging and performing procedure | unknown/zero? | not offered/not permitted | $353.92 |
So the hospital facility had to refund the patient $265.64 for overpayment plus the 10% discount.
It only reimbursed $124.43 and did not honor the 10% upfront discount.
Because the patient used health insurance, the hospital earned $3,908.08.
The hospital would have only collected $1,785.66 straight from the patient if he/she had chosen to be self-pay.
Those calculations exclude the add-on specialist fees of $353.92.
Hospitals and their staff do need to earn something, but insurance premiums and maximum out-of-pockets are outrageously high.
Healthcare in the U.S. has several parties contributing to the high cost.
Sometimes it saves to shop around for self-pay discounts.
When scheduling or pre-registering with specialists or for imaging or procedures, make sure to ask the facility for transparent pricing, with both a self-pay quote and an insurance quote, plus an itemized list including the cpt codes. You have that right.