Content starts here

Medical Billing Insanity and who can fix it?

So, I got a bill for wearing a heart monitor for 7 days. $3,500!  Insurance paid $228.  The medical company then adjusted by $ -3,237. I owned only $35.  


While I'm eternally grateful the bill was so greatly reduced, it is also disturbing and begs many questions:

- Is $3,500 the "real" cost?

- If I didn't have insurance, would I have to pay $3,500 OR would their bill be reduced to $228?  The uninsured person is the least likely able to pay this bill.

- If the real cost is $228, then why wasn't that the billed amount? 

- Does the medical facility just take a loss?  Or, do they get the difference elsewhere? 

- Does the medical facility start high because different insurance companies pay different amounts?


I've gotten worse medical bills where I couldn't even get the numbers to add up.  

I'll be asking how much a medical procedure will cost (out of my pocket) in advance.  Hopefully, I'll be able to get this information.


Lastly, what organizations are working to improve this whole medical billing process?  I'd like to 

be kept in the loop of their progress and to help where I can.

0 Kudos
Social Butterfly


Who provided the heart monitor, your doctor, a hospital or other? After the insurance pays what is agreed between them and your provider it's up to your provider to decide what the final charges to you will be, if any.


If I visit my doctor or other doctors that accept my insurance, if they must do something other than my normal checkups, they provide me with the cost up front.


Example: I recently had my six-month dental cleaning and after the cleaning I was asked if I wanted the fluoride treatment for my teeth and the cost would be $19.00 to be paid by me because my insurance would not cover it.


Thank about how much you pay for your insurance each month that helps keep your out-of-pocket costs down?



0 Kudos
Honored Social Butterfly

Is this the 1st time you have had health insurance?


A very short, simple as I can make it, explanation -  

EACH Insurance company or program (public or private) negotiates with selected medical providers for the cost of good and services.  EACH one that accepts the deal gets a different rate or cost for goods or services based on several factors.  


You, as the beneficiary, get a covered medical good or service and the provider bills the insurance where you have your policy.  Medical goods and services are billed under a national billing code - each good or service has a different code.


The insurance company or program where you have coverage, pays the provider for the good and service relative to the time when you received it and sends them the amount due - leaving any of your part for you to pay - deductible, co-pays or any remaining co-insurance or out of pocket cost that were not covered.


The remainder of the billed cost are adjusted by the provider after all the above are taken into consideration.


Best way to begin learning about it is to read your health insurance policy or about the public program. has a good vocabulary/glossary list of all the terms and words.


There are different types of health insurance and each one has uniquenesses.’

Maybe this will help



Good Luck



It's Always Something . . . . Roseanna Roseannadanna
0 Kudos
Showing results for 
Show  only  | Search instead for 
Did you mean: 
Need to Know

"I downloaded AARP Perks to assist in staying connected and never missing out on a discount!" -LeeshaD341679

AARP Perks

More From AARP