When does 20% of $753.95 equal $641.60? When $753.95 equals $2,808.
Health systems have contracts with insurers about what the insurer will pay for a given procedure. While the specifics are confidential, Cigna’s contract with Sentara allowed for a “case rate” to be applied. In Dockter’s case, that meant the epidural injection she received was part of a group of outpatient surgeries that were all covered at the case rate of $2,808.
Just one of many examples of the sleazy behavior of our health neglect system. I am trying to document as many as I can.