- Joined
- Oct 17, 2011
- Messages
- 2,753
- Reaction score
- 6,253
Hospital Fee Schedule Price for
99203 - >$4000
99212 - $450ish
Negotiated rate from Insurance - 99203 first, 99212 second
Aetna - $2551 --- N/A
Aetna MA - $127 --- N/A
BCBS HMO - $1721 --- N/A
BCBS PPO - $1715 --- N/A
ChampVA - $127 --- N/A
Cigna HMO - $1926 --- $294
Cigna PPO - $2782 --- $294
Humana - $1566 --- $166
United - $930 --- $296
N/A - the system wouldn't provide data for these plans
Not sure if anyone had ever seen anything like this before, but hospitals theoretically are supposed to post their fee schedules online lest they be trivially fined. The data is also supposed to contain information about their contracts with major insurance chains though usually it does not. This is from a large hospital in my town which is part of a system spread across essentially the southwest-western aspect of the US. My experience exploring these is that usually systems are unusable (contain no codes or often can't give you a specific estimate). They essentially confirm what everyone already knows - the hospitals prices are enormously high. However, these values for outpatient visits blew me away. These are theoretically low level visits ie. an ankle sprain, a minor infection etc. The hospital in question does do some variation of means testing for patients with income near the poverty level/small multipliers of it ultimately receiving Medicare rates, but - damn.
The other thing about these - hospitals are apparently now all looking at what the different insurances pay them and pay their competitors which is resulting in hospitals chains dropping United, dropping Cigna etc when they see other systems receiving much greater payment from those insurance plans.
Last of all - the values reinforce the trash position that it is to be private practice.
99203 - >$4000
99212 - $450ish
Negotiated rate from Insurance - 99203 first, 99212 second
Aetna - $2551 --- N/A
Aetna MA - $127 --- N/A
BCBS HMO - $1721 --- N/A
BCBS PPO - $1715 --- N/A
ChampVA - $127 --- N/A
Cigna HMO - $1926 --- $294
Cigna PPO - $2782 --- $294
Humana - $1566 --- $166
United - $930 --- $296
N/A - the system wouldn't provide data for these plans
Not sure if anyone had ever seen anything like this before, but hospitals theoretically are supposed to post their fee schedules online lest they be trivially fined. The data is also supposed to contain information about their contracts with major insurance chains though usually it does not. This is from a large hospital in my town which is part of a system spread across essentially the southwest-western aspect of the US. My experience exploring these is that usually systems are unusable (contain no codes or often can't give you a specific estimate). They essentially confirm what everyone already knows - the hospitals prices are enormously high. However, these values for outpatient visits blew me away. These are theoretically low level visits ie. an ankle sprain, a minor infection etc. The hospital in question does do some variation of means testing for patients with income near the poverty level/small multipliers of it ultimately receiving Medicare rates, but - damn.
The other thing about these - hospitals are apparently now all looking at what the different insurances pay them and pay their competitors which is resulting in hospitals chains dropping United, dropping Cigna etc when they see other systems receiving much greater payment from those insurance plans.
Last of all - the values reinforce the trash position that it is to be private practice.
