Explanation of Benefits

I’m on Medicare and have a supplemental insurance as well. I got an “Explanation of benefits” from the supplemental carrier on an appointment I had with an orthopedic specialist. I was in his office for no more than 20 minutes altogether. My complaint was with pain in my hip. I was given an X-ray. The doctor looked at it, told me there was no sign of arthritis or any bone or joint damage. His best guess was bursitis. He suggested he give me a cortisone shot. I agreed. He gave me the shot. I thanked him and left.

So, now back to the “Explanation of benefits.” It shows that the doctor billed the insurance carriers $775. This was broken down as:

Physician $200
X-Ray $160
Surgery $335
Injections $80

Of this, only $267 was covered by Medicare and the other insurance company. The balance was neither covered nor was I responsible for it since the doctor has agreed to collect only the amount approved by Medicare.

Two things, from my perspective. First, please tell me what surgery was performed. Yes, the other things did happen, but surgery? He got $280 for looking at the X-ray, visiting with me for a few minutes, and giving me a shot. Surgery?

Second, this seems a good illustration of some of the absurdity in our healthcare system where the services I received can be billed at $775 regardless if some of them are denied by insurance companies. Under- or uninsured people? Yikes.