Palm Harbor, FL asked in Insurance Bad Faith and Health Care Law for Florida

Q: Insurance company charging a 1100% markup for wrist braces, anything I can do?

My insurance company is charging a 1100% markup for wrist braces, discounted to 450% for in-network.

First, my doctors office told me the cost for the braces was $10.40 when I asked how much they were. A week later I received a bill for $224 (discounted from $566)

They admitted fault for not telling me the $10.40 was only an estimate, because they based that off my deductible being paid off but hands are tied. They said the insurance company sets the price and agreed that amount was really high. The brace costs them $5.

The bill contains no SKU/part number. It just says "Medical equipment" I found the exact same model and brand brace online at amazon and medical stores for $17-25. I confronted my insurance company and they would not explain why the price was so high. They kept repeating the same response. I asked for a itemized bill including the sku/part number and they said they do not have one. This seems like a scam.

Is there anything I can do or is it too late?

1 Lawyer Answer
Jane Kim
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  • Naples, FL
  • Licensed in Florida

A: American healthcare is unlike any other business of supply and demand. In the healthcare world, the healthcare provider and the health plan agree on prices. You as the consumer (patient) do not dictate, negotiate or drive pricing up or down. You agree to pay the health plan premiums without price transparency.

Keep in mind that you owe the doctor's office, and not the health plan. You owe the health plan monthly premiums only. Since your doctor believes the price is high and unjustified (the price the doctor's office and the plan negotiated), you may try to negotiate with the doctor's office billing department to reduce the price. If this is a large healthcare provider, they may have financial assistance available, if you qualify.

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