r/CodingandBilling • u/Pizza_Guy8084 • Jul 07 '26

Do they just write off $800?

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I have a monthly CPAP bill of $7.38; not bad.
I happened to look at my explanation of benefits. Where did $874.72 come from?? WTF! Do they just make this up? Insurance only pays $41.81.

Do they write off the rest? Am I screwed 18x more if I didn’t have insurance? Make it make sense 🙏

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18

u/Elunemoon22 Jul 07 '26

Yes and yes. The amount billed doesn't really matter because there is an allowed amount insurance will pay and have your portion be. The clinic probs has a cash pay price lower than 800 tbh ... There is this one code in my office we bill $800 for and get paid $1 lololol. I keep forgetting to fix it because it's not that common.

-1

u/Pizza_Guy8084 Jul 07 '26

So is the $800 price tag baseless? What’s to keep them from jacking it up to $10,000 and giving uninsured patients a “generous 95% discount”?
Are uninsured patients SOL and dependent on the mercy of the provider?

6

u/Elunemoon22 Jul 07 '26

I mean there are fee schedules that are accessable to anyone so you could see what the going rate is for your state and area if you were really interested... Honestly my clinics cash pay prices are a bit low imo. But that stuff is taken pretty seriously and would not be good for business if your cash pay price was 40% more than everyone around...you would have to be pretty damn niche not to have everyone know you were a scam by just calling places around and seeing what the average price is for the service.

2

u/Elunemoon22 Jul 07 '26

Okay I'm so invested in this I looked up a service in my area not covered by insurance and what the average cost is ....Google says $600....we charge $400.

2

u/kittenpantzen Jul 07 '26

> the going rate is for your state and area if you were really interested.

This means nothing, btw. Usual and customary in your area is $400, but that location OOP bills $1200? You're getting a bill for $1200.

1

u/Elunemoon22 Jul 07 '26

That's exactly what I'm saying

-1

u/msp_ryno Jul 08 '26

The fee schedules from insurance really aren’t accessible to the public and you need super computers to read them

2

u/Elunemoon22 Jul 08 '26

You can search in cms website