List price, realized price … and the war on 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.

Couple of months ago, 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.

Last week, we needed to have our garage door opener repaired ($356),  a faucet replaced ($276), and routine maintenance to my car ($182).


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 … and surprised that the GOP hasn’t highlighted ObamaCare’s “war on doctors”.

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3 Responses to “List price, realized price … and the war on doctors.”

  1. Alex S Says:

    Isn’t the problem, at least partly, about who holds the power in the value chain – especially in, in this case, a value chain in a sector that provides social benefits? No wonder some doctors – especially many excellent ones – are no longer prepared to accept patients with insurance.

    I hear that it’s not so dissimilar in academia. Researchers and instructors (the little guys) are squeezed into tiny salaries, while college presidents and football coaches get the big bucks, after even bigger bucks have been spent on enlarging real-estate infrastructure in the hope of attracting ever-larger student bodies at ever-excessively inflated tuition levels. No wonder the race is on for universities to adapt quickly to the threat of online education solutions, and try to integrate them into their own infrastructure before it’s too late.

  2. jpgoetz Says:

    A neurosurgeon had a plumbing problem, so called a plumber. When the plumber finished the 20 minute job and presented the bill for $200, the surgeon replied, “That’s $600 per hour. I’m a brain surgeon and I don’t get $600 per hour!’
    The plumber replied, “Neither did I when I was a brain surgeon.”

    –My point: anticipate the brain drain to other, more lucrative fields…

  3. Vivoda Says:

    I wonder what you’ll end up paying him for the surgery…

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