I went to the doctor one day last week after a few weeks of feeling ill. My doctor is a very nice man. HIs nurse put me in an examining room and measured my weight, temperature and pulse. Then 20 minutes later or so he came along and looked into my throat and nose and listened to my chest. Then he gave me an antibiotic. They had my insurance card on file and so I left without paying anything.
A few days later I received an email link to the billing at my health insurance company.
He billed $140 for “office visit”.
He billed $135 “lab services”.
He billed $480 for “office surgery”.
I was initially appalled at a total of $755 for a fairly routine visit, grateful as I was for the help. I was especially appalled at the billing for an “office visit” since it seemed to be double counting with the rest of the treatment.
Then I looked more closely at what the insurance company had paid out, and felt better.
They disallowed the office visit, saying quite correctly that this service was included in other procedures performed on the same date of service.
They allowed $40.17 for the lab services, which I take to be the nurse’s treatment.
They allowed $208.72 for the office surgery, which I assume is what the doctor did to me.
The total they allowed was $248.89 and they paid 80% of that, which came to $199.12. I may be responsible for the mismatch, $49.77.
The end result is an arguably unsurprising charge for a routine visit to a doctor of your choice in Manhattan. I don’t understand why he had to bill $755 to get paid a third of that. And I wonder if he would have billed me the same amount if I didn’t have insurance.