[Vermont Lt]

I can answer that.

There is the retail price. That’s the $300.

Then there is the Medicare contract price. That is the price that Medicare tells providers it will pay. Honestly, that is the basis for most hospital based healthcare costs.

The insurance companies will look at the Medicare contract price and determine what their base will bear—that is, what do their customers need and what can they pay to insure a profit for the insurance company.

This is the price the insurance company will contract with your provider. That is the $100 price.

Since you haven’t hit your deductible or out of pocket, they will pay the 85% of their contract price. You owe the $16.

Think of the first price as the un-discounted suggested retail price. And no one pays retail.

In a lot of cases its the few thousand before the deductible that end up as bad debt for the hospitals. Unfortunately…it’s THAT money that ends up paying for the hospitals uncovered expenses.

[ProtectOurFreedom]

Thanks, LT. I logged onto my insurance account yesterday and was astounded to see the total value of services provided to me this year was over $11,000. I’ve been to the doctor once, to Urgent Care once (COVID), had some routine lab work done, got the CPAP machine, and had a retina specialist examine my right eye. I couldn’t believe the total to-date is $11k.