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5:00Health Insurance Plumbing: Networks, Prior Auth, and Adjudication
Your $1,000 hospital bill is mostly fiction. Before you owe a cent, three hidden machines decide what the visit "really" cost, whether it was even allowed, and how the leftover is split between you and the plan.
A US medical bill passes through three pieces of plumbing before you owe anything: the network, prior authorization, and claims adjudication. Understanding them explains why two people with "the same" insurance can pay wildly different amounts for the identical procedure.
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