got a statement from my insurer (BC/BS) that shows that "Biotel" has billed them;
I've posted on the billing situation before, but it's worth repeating -
the $880 is irrelevant to your cost and your insurers cost.
I worked for about 5 years providing telecommunication services to healthcare providers and insurers and as a result had some exposure to claims and revenue cycle.
I assume what you are describing here as a "statement" is your explanation of benefits (EOB) sent to you by your insurer.
Just to be clear for all reading this, the EOB is not a "billing" document from either the provider or the insurer. It does however communicate information (sometimes cryptic) that gives you an idea of what you will probably owe when/if your provider invoices you.
Different insurers vary in how they present info on the EOB. I'll just give you a couple examples from mine (Medica). One example from the Roche era, and one from Biotel
Date of Service: 6/22/2020
Provider: Roche Health Solutions Inc
Description: Professional Service
Status: Approved
Total Charges: $250.00
Discounted Balance: $137.00
Plan Paid $0.00
You Owe: $113.00
Date of Service: 3/21/2021
Provider: Bio Tel Inr LLc
Description: Professional Service
Status: Approved
Total Charges: $880.00
Discounted Balance: $767.00
Plan Paid $0.00
You Owe: $113.00
Status: This gives you an idea whether the claim is final or has some other action. Medica uses the term "Approved" Other statuses I've seen are reversal, re-submission, denied, etc. You might see the same claim submitted multiple times each with different status. There might also be some codes and footnotes explaining further.
Total Charges: This is the "Chargemaster" price. Think of it as a list price, MSRP, etc. Again - different insurers use different terms.
- The insurance company
never pays this price.
- Patients
with insurance for covered services don't pay this price. There may be exceptions where a patient will get a service that the insurance does not deem required/covered in their situation. Generally you can negotiate (preferably in advance) to the insured contract price or even less. It's surprising the discounts you can get by simply calling the provider billing department.
- Patients
without insurance (or an uncovered service) only pay this price if they have sufficient wealth (i.e. not qualified for a poverty situation or unable to pay for some other reason), and have terrible/non-existent negotiation skills.
Providers and Insurers have contracts that specify the price for each service. I don't know for sure why the insurance company shows the Chargemaster price, but just speculating that they want to show you how much money they are "saving" you. Unfortunately, I think it leads to more confusion than clarity.
Discounted Balance: This is the difference between the Total Charges(Chargemaster) and the contract price.
6/22/20 claim from Roche: $137. I can back into the contract price as follows: 250-
137=113.
3/21/21 claim from Biotel: $767. Contract price: 880-
767=113.
Insurers I used in the past would use the term "Plan Cost" (contract price) and show the $113 rather than the difference between Chargemaster and Contract price. My insurer does the opposite, but it's easy to calculate contract price as shown above. The $113 is what will be paid to the provider in total between the insurer and the patient.
Plan Paid: This is the portion of the contract price that the insurer paid. This is dependent on the particular coverage the patient has. The deductible balance as of the service date, the copay or co-insurance amount, etc. In my case, the cost of strips is my obligation until I fulfill the deductible. If I had fulfilled the deductible, then I would pay 50% co-insurance of the $113 and the plan would pay 50%. ($56.5 each). Of course this amount will vary considerable depending on your plan and your deductible situation.
You Owe: This is what the patient owes. In my case - the full $
113 contract price since I still have a deductible balance.
In summary, the $880 chargemaster price under Biotel did not change what the insurance contract price is for the test strips/meter. This is over two calendar years so far. No way to predict the future contract price, but generally it depends on the size of the insurer's patient population that are likely to use each service. The more usage an insurer brings to the provider for a given service, the lower price they can get for that service.
And BC/BS DENIED every single one of them saying that the claims were submitted after the filing limit!!!!
There are claim submission time limits in some contracts. There are also some jurisdictions that have billing timeline statutes. In other words, if the provider did not bill within the defined legal timeframe, then they can't bill and collect from the patient. I don't know how your situation will play out in the end, but
@slipkid it looks like you got free strips!
In my case, I have been billed slowly, but consistently by Biotel for each shipment since they acquired the service (and since they were in turn acquired by Philips), but I never received a bill from Roche for the 6/22/20 shipment. Maybe I never will!
Anyway all of that was a rather long explanation for why you should ignore the $880 "Chargemaster" price. Neither you or Blue Cross will pay that.
