Today I Learned (TIL): Insurance - how it's billed makes a big $$ difference!

We're in the midst of open-enrollment for insurance at my company. So I've been digging into records, trying to understand this year's billing to see how next year would work under different plans. I had to call BCBS to understand what happened with my Lupron shots vs. what the benefits state, and found a big surprise!

The key is whether it's billed as an "office visit", or as "outpatient services". Holy moley what a difference.

So Vanderbilt billed a Lupron shot and a same-day visit with my RO as outpatient services, costing my full annual deductible plus coinsurance percentage above the deductible. Total cost $710 between the two charges.

If they'd billed it as an office visit, my charge for Lupron would have only been $135 ("provider administered specialty drug copay). The office visit with a specialist is a $30 copay, for a total cost of $165 between the two charges.

So, with the way they billed, and my lack of understanding, it cost me $545 just because of the method of billing!

Passing it along in case anyone else may have similar insurance provisions.

(Oh, and by the way, the insurance plan I had this year was deemed a "cadillac plan" by the government and thus eliminated by my company to avoid a massive tax penalty. The previous base plan is now our best "gold" plan with premiums increased by 2-1/2 times for next year, with 50% increased deductible, doubled coinsurance, increased copays, and on, and on. Thank you, SO much.)

Cadillac plan must be nice...I believe Ive got the Ford Focus plan...