I've had a few physio (physical therapy) sessions now for my tennis elbow problem, and they've provided some temporary relief at least. Today I received a "THIS IS NOT A BILL" statement from our medical insurance company, aka an "Explanation of Benefits".
These "Explanations" leave me a bit baffled. There's a list of figures that the clinic has submitted to the insurer as a bill, then the figure that the insurance actually covers. Subtracted from the latter is my standard, pre-determined co-payment of $15 per session. For one session the clinic claimed $185, and the insurer paid $27.60 - but apparently that's ok.
The implication seems to be that a medical provider puts in a claim for any random figure, with the expectation of being paid just a fraction of it. How does that work? And if you don't have insurance, if it's just you, the patient faced with that big bill - can you get away with paying only what you feel you can afford? I suspect not.
I wonder if any well-informed reader can help me out on this one?
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