Read This: After Surgery, Surprise $117,000 Medical Bill From Doctor He Didn’t Know

[still_one]

52. What isn't clear is exactly what is the contracted rate that the insurance company pays. It is

NEVER or very rarely the bill sent to the consumer. That is the price if the person did NOT have insurance. It is also padded, but the actual contracted rate the insurance company pays out is considerably less.

That is the game that is played. Perhaps I read it wrong, but if they wanted full disclosure it would be nice to see the following:

The Total out of pocket expenses from the Patient
The Total payment from the insurance, that is excepted as payment in full

The actual bill for an insured person means very little.

A perfect example is Medicare. For those hospitals that take Medicare payment in full, people receive statements from the healthcare facilities which represent huge bills, and yet the patient doesn't pay those, and Medicare gets a negotiated price.

That is the game.

A perfect example is out of network and in network providers. The consumer will pay less going to an in network provider than an out of network provider because of the negotiated contract the insurance company has

In this case he needs to appeal it. His insurance company should also work with him.