Therapist charged $260 for one hour session, BCBS “discounted” the rate so that I owe $153. Next session, the office charges me $150 even and BCBS didn’t cover any of it because it didn’t meet the “threshold” – so I’m effectively paying more using insurance than if I didn’t have any???

This is in Nebraska, btw: So, I’m in premarital counseling and our first session was billed $260 with what the office described as a BCBS discounted rate of $153. I asked why this was so high and my provider basically said “yeah, that doesn’t seem right, I only charged $150/hr for couples.” So the next bill was for $150 and my insurance didn’t cover any of it because apparently the contract they have with BCBS only discounts rates over that $153. Talked to the office about it and in summary, “we overcharged insurance based on the Medicaid average to maximize provider profit while keeping it affordable.” So if I had no insurance, I’d be charged $150/hr but since I have insurance…..I actually owe $3 more?! I thought the whole point of having insurance was to cover these types of expenses at least somewhat. Should I keep pushing back or just pay the bill?

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  1. Cash pay is cheaper than insurance a lot of the times because they don’t have to deal with billing insurance and waiting for payment. The downside is it doesn’t go towards your deductible.

  2. If you stay in network, what they bill is irrelevant. You only pay the contracted negotiated rate.

    Yours is within $3 of the cash rate. That’s pretty unusual so I’d be pretty happy about it.

    It’s pretty common that cash rates are usually lower than insurance rates.

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  4. Better question – if the provider charges $150 to uninsured people, why do they think it’s appropriate to charge insurance companies more for the same treatment?

    It sounds like $153 is the going rate in your area. Take it up with your doctor’s office.

  5. I have had that here in the mid-atlantic area. Cost if covered by insurance is $ 1085, with a co-pay on me for $ 225. Cost if self-insured was like $ 185.

    The whole system is broken, but depends upon insurance companies paying 4 time the cost of the service.

    I’m not blaming this on doctors, because I don’t know the whole story, but the system is clearly screwed up.

  6. Make sure they’re still going through insurance so that anything you pay counts towards the deductible.

  7. This is slightly off-point but it’s also correct that you can sometimes get a prescription that costs $7.50 cash but if your prescription co-pay is $15, you will pay $15. Sometimes it can be cheaper to use GoodRx and you’re within your rights to do so.

  8. Therapists very often charge a lot more for the first visit.

    Some of this is because of bureaucratic to-do’s, but often they highly inflate the cost because they know a lot of first meetings end without a person wanting to return.

    Typical U.S. healthcare scam type stuff. You know. FREEDUMMMZZZ.

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