Tag Archives: Explanation of Benefits

The vultures descend

Here’s a little item that I find amusing. Maybe you will, too.

At yesterday’s meeting of the House Health Care Committee, Rep. Avram Patt (D-Shap’s District) brought up the subject of those long, confusing Explanation Of Benefits forms (EOBs) we get in the mail every time we see a doctor or have a covered service or procedure done. You know, the ones nobody ever reads?

Well, Avram Patt reads ’em. And he had some questions, mainly centered on the lavish “prices” for services beyond the basics. How are those prices arrived at? Do they reflect the cost of the services rendered? Does anyone — covered or not — ever actually pay that?

He had inquired about some of this with his insurer, and been told that if an uninsured person gets a whopping bill and complains, “it’s immediately negotiated down.” And the original fee? That’s an “algorithm” — a calculated starting point for negotiations.

Short answer, in other words: Nobody ever actually pays that price, and it seems to have nothing to do with cost.

The committee wanted more information on these questions and some others, and decided to seek testimony — mainly from Shumlin administration functionaries.

But lo and behold, I look at the revised committee schedule this morning, and at 11:00 a.m. I see a lobbyist clusterf**k. Lobbyists for MVP Healthcare, CIGNA, and Blue Cross Blue Shield will be lined up, one after the other, to explain those EOBs. Presumably in an industry-friendly, “No no, it really makes sense, please don’t ask us to change” sort of way.

That’s all. I just found it amusing that healthcare industry lobbyists were so quickly available on less than 24 hours’ notice, and all at the same time.