Adjustments to Medical Bills

I once wrote a story about a mistake that my medical insurance CIGNA made. They had a typo in the year of the end date of my insurance coverage in their system. As a result of this error, they mistakenly thought they had paid my doctors after my insurance had expired and tried to get their money back. While I was trying to correct all this mess, an interesting thing happened.

To help me explain, check out the following portion of my bill. (If it looks a bit funny, it’s because I cut out some details including the doctor’s name).

My Medical Bill

On the bill you can see that I had a mammography for which I was charged $493.00, but CIGNA paid only $295.80. The remaining $197.20 was removed from the bill as an adjustment, as frequently happens because of certain agreements between doctors and insurance companies. A year later when CIGNA made their mistake, they requested that the payment be returned. You can see on the bill that once the payment was reversed, my doctors reversed the adjustment too.

When CIGNA fixed the typo, they repaid the doctors, but the adjustment stayed on the bill, which the doctors then wanted me to pay. And that was only one of many such bills. It took me a year of phone calls to get the adjustments taken off, but this is not what I am writing about today.

If not for this mistake, I would have never seen these bills and the revealing information on the different amounts doctors charge to different parties, and how much they really expect to receive. As you can see my doctors wanted 67% more for my mammogram than they later agreed to.

The difference in numbers for my blood test was even more impressive. I was charged $173.00, and the insurance company paid $30.28 — almost six times less.

If I ever need a doctor and I don’t have insurance, I will take these bills with me to support my request for a discount. I do not mind if you use this article for the same purpose.

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2 Comments

  1. Mike Buchanan:

    Too bad you didn’t see medication prices! I think California demands hospitals publish prices to some office. But on to what you can do. Visit hospitals and describe how your psychic told you to prepare for a simple fracture in your left arm due to falling into a manhole. You can also see how they laugh if you suggest paying the same rate that Medicare does. Or maybe one of your friends has gone on to work at a medical software company and can give you some assistance.

  2. Tanya Khovanova’s Math Blog » Blog Archive » Infinite Deductible:

    […] I have an even better idea. For an extra fee, I will negotiate with doctors so that you will pay the same amount as medical insurance companies pay to them, which is often three times less than you would pay on your own. […]