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TAOEP TAOEP is offline
Joined: Feb 2017
Posts: 2,400
Senior Member

Joined: Feb 2017
Posts: 2,400
Senior Member
Some answers
Old 12-06-2020, 08:11 PM
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Insurance companies has contracts with hospitals and other providers that govern how much they will pay for various services. The first thing that happens with your bill is that it gets knocked down to that amount. Then you are expected to pay any copay and/or percentage and the insurance pays the rest.

Perhaps the original amount was $10,000. Then, by the agreement $4000. Lucky you, no deductible, but your insurance covers 90% and you have to pay 10%. So the insurance company pays $3600 and you pay $400.

Sometimes there are problems when a doctor (or dentist) charges more than the "usual and customary" amount for a service. Occasionally the patient is liable to pay that excess amount. Other times, the agreement between the insurance company and the provider limits the charges to "usual and customary."

Unless your school district is self-insured and only uses an insurance company to handle the claims and paperwork, I don't think they are entitled to personally identifiable medical cost information (remember HIPAA!). I'm not sure exactly how it would work for a self-insured district. There might be an employee who sees more medical info, but that person would be bound by HIPAA not to share that info.
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