Our insurance costs so much because the insurance company pays way more than you or I would pay.
I recently went to see a chiropractor.
I was informed that the chiropractor’s appointment would be $45 if I paid in cash. The sign on the door said a massage was $70. (The doctor prescribed the massage.) Or they could bill my insurance company and they could not guarantee the prices in that case. Thinking I’d save some paperwork, I said please bill my insurance company. They billed my insurance company $144.60 for that chiropractor’s appointment (321% more than they were willing to accept in cash) and $180 for the massage! Who in the world would pay $180 for an hour massage??
Of course, the insurance company didn’t pay that, they paid their agreed up on rate of $65.12 for the chiropractor and $113.92 for the massage. The massage was actually billed as “physical therapy” which I think is also wrong. (In case you are curious, my portions of what the insurance company paid were $26.05 and $45.57 respectively.) The going rate around here for an hour massage is $50-60. And my insurance company paid $114!!
| Cash amount | Amount billed to insurance | Insurance Paid | |
| Chiropractor | $45 | $145 | $65 |
| Massage | $60 | $180 | $114 |
So I called the chiropractor’s office to complain that they were overcharging my insurance company and they claimed that the state of Colorado sets those prices. They can charge me whatever they want if I pay cash, but if they charge the insurance company, they have to use the codes and prices set by the State of Colorado. However, the insurance company then pays whatever rate the doctor’s office and the insurance company agreed upon when they signed their initial agreement.
This is just wrong. The doctor’s office is getting $113.92 for a 60 minute massage that they were willing to give to me for $70. I can only assume the insurance company agreed to that amount because they either don’t know any better or they are passing on those costs to me or the company backing my insurance.