It’s not the first time medical bills in my family have seemed really confusing.
Take a look at these two bills, for the same procedure, performed not long ago. The top one is from the provider for the actual test, a blood test at a lab. The charge was $401, the mysterious “adjustment” $376.20, leaving a $24.80 total charge, which remains my responsibility because I haven’t met the deductible yet.
The bottom one is from the insurance company, their “explanation of benefits,” which to my mind just confuses matters. The amount charged is different, but the “patient pays” portion is the same.
One of my friends points out that prices have been completely decoupled from each other in the marketplace: the price charged is not related to the cost of providing the procedure. The reimbursement rate from the insurance company also seems unrelated. And in this case, the insurer and the provider actually recorded different charges, but they both arrived in the same place: for a procedure priced at $401, the payment is $24.80.
Do you have a puzzling bill? Anonymize it, scan or copy, and send to email@example.com. or mail to ClearHealthCosts, P.O. Box 8124, Pelham, N.Y. 10803.
Jeanne Pinder is the founder and CEO of ClearHealthCosts. She worked at The New York Times for almost 25 years as a reporter, editor and human resources executive, then volunteered for a buyout and founded ClearHealthCosts.
She was previously a fellow at the Tow Center for Digital Journalism at the Columbia University School of Journalism. ClearHealthCosts has won grants from the Tow-Knight Center for Entrepreneurial Journalism at the Craig Newmark Graduate School of Journalism at the City University of New York; the International Women’s Media Foundation; the John S. and James L. Knight Foundation with KQED public radio in San Francisco and KPCC in Los Angeles; the Lenfest Foundation in Philadelphia for a partnership with The Philadelphia Inquirer; and the New York State Health Foundation for a partnership with WNYC public radio/Gothamist in New York; and other honors.
Her TED talk about fixing health costs has surpassed 2 million views.