[ProtectOurFreedom]

“sticker price”

Thanks for the explanation. I got more out of your explanation than anything the DME or insurance company explained.

So the “bill rate” is entirely fictitious like “sticker price” on so many products?

[Bernard]

No, sometimes the bill rate is what is actually paid, but not very often. Most of the time, it exists as a starting point for price negotiations.

Before my time, but I think the disconnect between the bill rate and normal provider pricing expectations all started back in the 1960's, when Medicare first came into existence. Then private insurance got involved and things just got more and more complicated.

[steve86]

The medical billing sticker price is also called the “Paymaster” rate according to a long Fortune article I read several years ago. Fortunately there is no “adjusted market value” markup like at the car lots.

[Bernard]

One more thing - the bill rate is also referred to as the ‘Charge Rate”, depending on the organization. Whatever the org calls it, it resembles the sticker price.