nancy,

I feel your pain. Here in Idaho, the medical establishment refuses to give out valid information. Try to get a price before a procedure or therapy. They don't know their own prices. They send the coded statement to an outside agency for pricing and billing.

One thing I have found, if I research the CPT codes, you can find out what the procedure is specifically. The itemized description is not always understandable. Then, I research the fee structure for that code. There are tables with Medicaid, MediCare, Work Comp, and other rates. From this you can get information to work with the billing agency.

There is a multiplier from the base rate for different geographical areas. You will need to look up your area. Multiply the base rate by this number to get the rate for your area. Some areas are lower than the base rate. Some others, like metropolitan California, are 20% higher.

Major health plans negotiate discounts of up to 40%, mostly 20-30% off the full rate.

Here are some good links:

https://catalog.ama-assn.org/Catalog/cpt/cpt_search.jsp
http://www.asksam.com/ebooks/cpt/
http://www.cms.hhs.gov/PFSLookup/

There are others if you google "ctp codes" and "medicare reimbursement"

As you struggle with this for your loved one, remember that there are many living on the street because they have not had someone to help them in this area. They end up losing their housing, cars, jobs, everything.

I have given up on keeping a good credit rating because I refuse to pay the gouging over-charges. i.e. Doctor charged $2260. medicare reimburses $1330. Blue Cross reimburses $1600. My out of state health plan paid $1880. The doctor has taken me to collection for the $380 balance.

Said he cannot discount his fees to me because he does not have a contract to discount to my out of state health plan. Said his blue Cross contract states that he can only discount to health plans that have a valid contract.

So, you are in good company.

I think I can say, You have all of our sympathies.