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So I get this statement from Blue Cross for lab work done at my Dr's office.

Posted by CovingtonCat May 18 '10, 15:31

I had blood drawn for one test. I don't have a co-pay for lab work. The Dr (part of a large regional practice) submits a charge for $73. Blue Cross pays them $9. That's a pretty big difference. Does the test really only cost $9? If so, how does the Dr get away with charging $73 to someone who doesn't have insurance? And if the Dr knows his contract with Blue Cross only pays $9 why even submit the higher charge? Do they think Blue Cross might goof up and pay the higher amount?

I don't get it.

Responses:

it's a negotiated rate thing. - b. May 18, 16:16
This is extremely common. Ask Trish for the details but all doctors do this. $73 is not the cash price for the test, if you are a private patient you - James Bond (aka Igor) May 18, 15:35 4
- If they tried charging just 9 then insurance would probably try to only pay 3. -- nm - Ender May 18, 15:36
- I think that if you charge the insurance $9, they will pay even less. -- nm - James Bond (aka Igor) May 18, 15:36 2
  - But the practice signs an agreement with the insurer, right? - CovingtonCat May 18, 15:39 1
    - They do sign an agreement. And yes they know how much they will get. But still you need to maintain your prices. It is just something everyone does. - James Bond (aka Igor) May 18, 15:41
Not necessarily, but probably closer to the $9 than the $73. Good question. For consistency. No. -- nm - TFox May 18, 15:34

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So I get this statement from Blue Cross for lab work done at my Dr's office.

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