We just got the EOB for cataract surgery in one eye. The replacement lens was a basic single vision replacement so basically the "standard" option and the procedure went well with no complications nor other issues.. The patient is on a Medicare Advantage program through their Government Retiree/pension plan. The surgery was performed in a hospital outpatient clinic by a Ophthalmologist that has their own practice. All were in-network for the Medicare Advantage plan.
The total gross billings including hospital and physicians was $32,000! The amount approved by the insurer was roughly $3,200 (but not exactly 10%) with the patient's portion being the plan's standard 20% co-pay of roughly $640.
I've seen large insurance discounts before but never anything that reduces to by 90% for such a large billing. With the possible exception of some medical tests originally billed at several hundred dollars.
So my question is why to providers bill such high amounts when they know they'll be reduced so dramatically. Especially in this case where $32,000 for basic cataract surgery is outrageous. A quick google search shows the average cost is $3,500. Since $3,500 is average, I can't see any individual nor insurance paying anything remotely close to the $32,000 gross billing.
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