Test charges: $401 = $24.80

Filed Under: Costs, Health plans, Patients

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 info@clearhealthcosts.com. or mail to ClearHealthCosts, P.O. Box 8124, Pelham, N.Y. 10803.