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.
Presumably, while the $753 charge for Dockter’s epidural was only a fraction of the case rate, there are other, more involved procedures that Sentara would bill significantly more for. Regardless, Cigna would pay $2,808 and, in theory, it all comes out in the wash in the long run.
And we wonder why health care costs are so high.