Negotiated Fee Rate

is the amount of payment that an Insurance Company has negotiated with the Participating Provider as the maximum they can charge both the Insurance Company and YOU!

Excerpt from Blue Shield Explanation
Excerpt from Blue Shield Explanation

It’s the  secret number the insurance company and the provider have worked into their contract. The industry often calls that number the “adjusted rate” or the “negotiated rate.” NPR.org

View an actual Specimen Policy Explanation – Page 42 Blue Cross EOC  & 167

More explanation calhealth.net– Can MD’s charge more? Uninsured?

How do I know that the amount I’m being billed is the correct amount?

Once your insurance carrier pays their portion of the bill, they will send you an explanation of benefits (EOB) to show how the claim was paid. You can compare your EOB to the statement sent by the hospital. How the carrier paid the claim is based on their contract with us and their contract with you. If you feel the insurance company should have paid a higher amount, please contact them directly for resolution.

Learn More ===> Scripts.org Patient Billing FAQ’s

True Cost of Health Care.net

Todd Friedman, Esq. can help if debt collectors are harassing you when you don’t owe the $$$

Might it be better to pay cash? 

LA Times 6.10.2016

Child Pages

 

2 comments on “Negotiated Rates – Itemized Bill

  1. After contacting my providers, it isn’t going to make much difference to them what I am on – Grandfathered or ACA Obamacare, because, unbelievably to me, my present Grandfathered costly plan reimburses them less than Medicare does!

    This is a complete reversal of the 90s when my husband’s health insurance switched from private individual market to Medicare. After the switchover to Medicare, I had to fight for his treatment and doctors saw him as a one payment body in a bed. You wouldn’t believe how bad it was, all due to the difference in insurance..

    Now I am hearing just the opposite — Medicare has less restrictions on authorizations and better reimbursement than private health insurance! Unfortunately for us seniors the anticipated cuts to Medicare due to the newly passed tax bill could put us right back to the 90s Medicare scenario.

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