I was snipped last month, and I’ve been getting a steady stream of explanation of benefits (EOB). EOBs are the listing of what the medical provider did, what they charge, what the insurance company has as a contract rate, what the insurance company pays, and what the individual member who received the service is responsible for. For the actual surgeon and anethesiologist, I was expecting to see a 70% to 80% reduction in charges from what the provider asked for and what the contract rate was. And that was the basic discount. The pathologist saw an 87% discount.
And then today, I received the facility charge explanation of benefits. The entire ask for a five hour hospital stay was the equivilent of a new subcompact. The contracted rate was the sales price of a 1984 Toyota Tercel that could not go over 66 miles an hour downhill with a favorable wind nor go in reverse (if you want cheap birth control, buying every 17 year old kid this car would work too).
The most eye popping discrepency was the ask for a local topical anesthitic at $194.00 and the pay out of .56 cents. I think I can buy a tube of generic version of the drug at my local mega-drugstore for $1.99. That tube has been good to get Kid #2 through his last 6 teeth that have popped through.
This is asinine, and if the health policy push over the next decade is for people to become more cost concscious, hospital pricing has to be vaguely related to actual payouts.