Medical bill and health insurance question

[nychila]

I'm becoming very interested in the healthcare debate, but I'm not as familiar with the everyday medical billing and insurance system as I should be, so I would be very grateful if fellow SDNers can shed some light on some issues:

Do all clinics charge the same fees for the same procedure? Can a private clinic charge as much as they want for a clinic visit or procedure? Can a surgical clinic charge as much as they want for their post-operation beds if it’s decorated like a 5-star hotel?

Does MediCare or private insurance ever decline to cover a patient’s medical bill if it feels that either the procedure is/was necessary or the pricing is/was unreasonably high? Medicare seems to only pay for a portion of the medical bill, in which case does the doctor simply receive less payment for every MediCare patient that he sees, hence enticing some doctors to reject MediCare?

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[LaughingMan]

Do all clinics charge the same fees for the same procedure? No, each clinic chooses its own pricing system.

Can a private clinic charge as much as they want for a clinic visit or procedure? Kind of--you'll see why below.

Does MediCare or private insurance ever decline to cover a patient's medical bill if it feels that either the procedure is/was necessary or the pricing is/was unreasonably high? Here's where the pricing changes. Looking at one of my fathers bills for example, our provider charged 200, but the insurance had an allowable amount of 120 for that procedure--thus the remaining balance was on us. So they will accept the charge--but will only cover a portion of it.

It also differs on if your in-network or out of network.

If I am wrong--please correct me.

 

[nychila]

Do most clinics more or less charge the same fees for medical consultations/procedures due to supply and demand?

So before a patient approaches a clinic for services, the patient should and usually first find out the pricing of consultations and procedures?

Is it a frequent occurrence that patients have to pay a small portion of their medical bill out of their own pockets, even with MediCare or private insurance?

Why do doctors receive less payment from MediCare patients when they charge everyone the same?

Any help is greatly appreciated. I'm new to the American healthcare system and I couldn't find the above info on SDN nor online.

 

[Tots]

This article from Time yesterday might be of interest for you: http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/print/

It's long(and not perfect) but answers a lot of the questions you are asking.