Being a doctor in a small office I’ve had the opportunity to work and learn numerous aspects of running things. Insurance is the primary aspect I hear questions about on a daily basis. It seems as though each day insurance policies are changing. Regardless if you have a brand new policy midyear, or have maintained your current policy, there are a handful of terms you should understand.
All medical offices have a fee schedule. A fee schedule is a list of services and the amount billed to an insurance company. These fee schedules are determined based on location and other aspects which as a patient you could care less about. On a very basic level, paying for insurance gives you the privilege of paying that companies rates.
Medical office rate for exam: $100
Blue Cross Blue Shield Rate for same exam: $80
If you have BCBS insurance, you can only pay up to $80 for that exam. You get the $20 discount.