Is there a way to find out how much doctors offices get reimbursed by insurance companies?

Question

Wondering if there is a specific website that lists different insurance companies and what they reimburse doctors offices for certain drugs

Answer 1

No - only if your insurer gives you an EOB that shows it.  Many reimbursement rates for HMO plans are confidential.

Answer 2

Not sure about in general but you can look at your Explanation of Benefits (EOB)  to find out what your insurance company is paying for your visit. It will all be listed on there...what you pay...what the insurance pays.

Answer 3

I wish my advice could be helpful.And here is a good resource.Check it up.

http://insurance.online-assistant.info/i...

Answer 4

What do you mean "what doctor's offices get reimbursed for certain drugs" ?

If you're talking about prescriptions, the insurance company doesn't reimburse the doctor - the payment goes to the pharmacy plan.

Or are you talking about specialty injectibles administered in the doctor's office?  Those are pretty much the only sort of drugs that a doctor is going to be reimbursed for by the insurance company.

If you clarify your question, you may get better responses.

Edit to add:

Okay - we're talking about injectibles.  That makes more sense.  :)

I'm not aware of websites that compile that info for different insurance companies.  Especially since different doctors could be contracted for different rates with any one insurer.  (Depends on how good their contract negotiator is.)  :)

The fee schedules for Medicare and Medicaid are publicly available - if you know the "J code" for the injectible, Medicare and Medicaid would give you a good starting point to get a ballpark estimate of how much to expect.  (Keeping in mind that Medicaid is generally the lowest reimbursement around and any private insurer is going to pay a substantially higher rate than Medicaid.)

You could obviously find out the information from your own insurer, by looking at your Explanation of Benefits.  However, I get the impression that you're looking to "comparison shop" and see what the average rate would be for other insurers.  That information might be a little tough to compile.

Many contracts for pharmaceuticals are based on a markup from AWP (average wholesale price).  For example, one doctor could have a contract for AWP+10% for specialty drugs.  (Meaning that if AWP for your drug was $100, your doctor would get reimbursed $110.)  Again, different doctor's may have different deals...one doctor in your area could be AWP+10%, while another could be AWP+12%, etc.

If you can get ahold of the AWP (average wholesale price) for your injectible, that could also help you come up with a ballpark range of what the reimbursement might be.

(Yes - I know.  It all sounds confusing.  I've gotten used to it because I work with this information every day.  :)  If you need any more explanation of what I've said here, I can try to come closer to putting it in plain English.  lol)