List price, realized price … and the plight of doctors.

Have you ever really looked at the EOB (“Explanation of Benefits”) that you’ve gotten from your health insurance company after getting medical care?

I hadn’t … just threw the letters into the file … or wastebasket.

But, the ObamaCare launch has heightened my interest … and recently, unfortunately, I’ve been able to gather some personal empirical data points.




Here’s the first part of my story …


My optometrist told me that I probably needed eye surgery and referred me a surgeon.

So, I went to the eye surgeon for an “initial consultation”.

The initial consultation consisted of about 1-1/2 hours of eye tests and measurements performed by well-trained, experienced technicians (“techs”) using several very sophisticated measurement and imaging machines.

Not your usual: “Can you read this line” routine.

Then, it was showtime with the surgeon … a highly regarded, high patient-load doctor.

After a quick “hi”, he pulled up the digital images on the exam room’s monitor and started pointing and explaining.

Obviously, he had been briefed by the techs and scanned the images before walking into the room.

He diagnosed my condition, laid out the options, delineated his concerns, and referred me to a corneal specialist for a 2nd opinion.

  • Sidenote: Since surgeons rarely (never?) suffer from a lack of confidence, the surgeon’s credibility skyrocketed when when he recommended a 2nd opinion … just to be sure.


OK, now to the point of the story and the pricing lesson.

The surgeon’s bill for the initial consultation was $265 … pretty reasonable, I thought for 2 hours of tests on fancy equipment, a complete set of digital images of my eyes (inside and out), and 1/2 hour of surgeon’s time.


CareFirst Blue Cross /Blue Shield is my health insurance provider.

We’ve been happy with CareFirst … nice network of doctors, good coverage, satisfactory customer service.

Well, CareFirst whacked the $265 down to $69.99 ….  with them paying $39.99 and me co-paying $30.

  • Teaching point: $265 is called “list price” … $69.99 is called “realized price”

I’m fine from my side, but what about the doc?

$69.99 for 2 hours of tests on fancy equipment, a complete set of digital images of my eyes (inside and out), and 1/2 hour of surgeon’s time.

  • Note: All of this is pre-ObamaCare, but CareFirst’s primary customer base consists of Federal workers, so I think their rate structure is an indicator of things to come.

Let’s put that in perspective.

Recently, our refrigerator had a problem.

The repair call cost us $110 just to have the guy show-up (and, to be fair, for the first 1/2 hour of work) … plus $65 per hour for the each hour thereafter.

Total bill for the trip $142.50 plus parts … more than twice as much as the eye surgeon got.


Does that make sense to you?

It doesn’t to me.

Does anybody really think that the health care system is going to be “saved” by squeezing doctors so that they make less than refrigerator repair guys?

I’m betting the under on that one.

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One Response to “List price, realized price … and the plight of doctors.”

  1. Joe Smith Says:

    A brain surgeon called a plumber for a clogged drain. When the plumber finished, he handed the bill to the surgeon who exclaimed, “$130?? You were here only 20 minutes… that’s almost $400 an hour. That’s more than *I* make!!”. To which the plumber replied, “Yeah, back when I was a brain surgeon, I didn’t make $400 an hour either.”

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