Matthew Holt

I participated in the annual physical examination with my doctor Yiyi In December. Well, it’s actually not once a year, because the last time I went was 2 years and 1/2 years ago, but it’s under ACA, my document Andrew Diamond Keep bothering me because I’m old and fat. So I went in.

I took the general exam and had a wonderful chat for about 45 minutes. Then I performed blood tests and laboratory tests (cholesterol, A1C, etc.) and TDAP vaccination, because I have not been vaccinated for more than 10 years.

Today, about a month later, I received an email asking me to pay for One Medical. So as a difficult person, I think I will go through this process to see how much consumers should know how much they should pay.

This is an email from One Medical and it says: “You owe us money.”

When I clicked the “Pay” button, I saw this screen

It told me that I owed $7 and got change, and asked for my credit card. why? who knows?

So I clicked on the “Account Details” button in the corner-suppose it will ask me to log in to One Medical’s website. But instead, it sent me to a screen and asked me to send myself a code. Although it did it in a messy way, saying “null null”

When I clicked “null null”, it did show my phone number and allowed me to select it and send the code to myself. I’m not sure why this step is needed. Safety? Prevent others from paying the bills they have shown me?

It now sends me to an actual page on a website called “Patientops” which contains detailed information. Now it becomes interesting. Or maybe not…

It told me that I was charged for a blood draw (I know this because I can search for venipuncture on Google!). One Medical charges $15 and I owe $7.49.

But what about the billing for all other aspects of access? You will never know from the One Medical website, but of course I can go to my insurance company, which happens to be Blue Cross Blue Shield of Massachusetts.

After some navigation, I found my appointment claim at One Medical. This is a summary

This is classified by service.

It told me that One Medical’s bill was US$975, and BCBS Mass very well agreed to pay them US$781-this is not a significant price reduction! It does tell me that there are 4 different medical services. But I can’t know which is what. Online transparency is so much

But wait. With a little attention and looking around on the website, I can Also Download EOB. You know, the multi-page incomprehensible document issued by the health insurance company says that this is not a bill. So I did.

Below is a snippet of a 6-page PDF from EOB.

Just to confuse you even more, it told me that BCBS Mass allows $882 in the total bill of $1,365-yes, I owe me a deductible of $108, which may be for preventive care that is not prescribed by the ACA Service. (More on this). Since One Medical only charges them US$975, I want to know where the US$390 comes from?

To do this, you need to delve into the 3 page EOB PDF, and then you will eventually get some information. Yes, BCBS Mass bundles all my medical expenses in December, including the laboratory incurred when I visit One Medical and the chiropractor who visits me entirely. (My chiropractor is the best Taylor labez If you are looking for one in San Francisco and its office happens to be located in the next block of One Medical in Embarcadero, I highly recommend you).

Here you can see the details of all the parts visited.

One Medical charged US$660 for office visits and BBCCS Mass paid US$530. (do not worry Andrew Diamond It’s worth it, but they still pay him a pretty good hourly wage! ). My Tdap vaccine charges $160 and BCBS Mass charges $153-it seems a lot Goodrx will provide you with it in the pharmacy for about $55! BCBS Mass paid $90 for “other medical services” for $140-I don’t know what those are, and I didn’t give a CPT code, so I can’t figure it out. In the end, the blood drawn for the laboratory test was $15, for which BCBS Mass received a discount of $7.51, leaving me with a bill of $7.49. I guess laboratory tests and lotteries do not count as “preventive care”, but immunizations. Therefore, this $7.49 allowed me to start the whole mission.

But wait there is more. The poor chiropractor charged $120, but his effort only got a negligible $57 (I paid, of course, because it was under the deductible). Somehow, BCBS discounted it to 50%, and One Medical got 90% of the bill. So my chiro must see 10 times One Medical’s PCP brings the same number of patients in one hour.

Then there are the laboratory tests themselves-although they are arguably the most important part of “preventive” care, they are clearly not included under the ACA. I haven’t received the bill from Labcorp, but now I know what will happen. Their bill was somehow split into 4 different tests. I can’t tell which is which again, but I actually have CBC, lipids, A1C, uric acid, and fecal occult blood (although this is a take-home test that I delivered later, so it may not be on this bill). But the most surprising thing is that their bill was 270 US dollars, but they only got 43 US dollars. So while One Medical got about 90% of the demand and chiro got 50%, the poor small laboratory company (well, not very small) got only about 15%. Yes, when they start charging me, I have to pay them $43.

All this leads me to several conclusions:

1. Six years after Health 2.0 and Mad*Pow challenged ONC, AARP and RWJF called A bill you can understand For most of us, there is still no such thing. I mean, besides a nerdy grumpy person like me, who will go through all the troubles I just did? Even so, there is no information like CPT code to really track what happened.
2. There does not seem to be a relationship between the time spent or the services provided and the payment. Yes, my chiro spent 15 minutes with me and my PCP 45, but what is the logic of the 10x payment difference?
3. There is also no relationship between “fee” and “payment”-I mean this has been known for decades. But why does One Medical get 90% of the fee while LabCorp only gets 15%?
4. There does not seem to be any logic regarding the actual cost of preventive care under the ACA. This is The official list of what is coveredIt includes cholesterol screening, but BCBS Mass believes that I should pay for it, and I also paid for the blood draw-it is hard to imagine that my LDL and others have not been checked! (Sorry, Elizabeth Holmes!). I should get too Free diabetes screeningBut I have to pay for the A1c test. However, the immunizations are on the list, and yes, they have been paid in full.

The only way out seems to be a unified fee schedule. My guess is that we won’t get it anytime soon. But beyond that, consumers basically have no chance to figure out all this. Remember, this not-so-simple billing experience is for routine inspections! God knows how it feels for patients with complicated conditions!

Oh yes, no matter whether I really owe them $7.49 or not, I have to pay One Medical. Given their Recent share priceThey may need it!