I just want to clarify that the $4K is not the original “price” from my audi. The original price is actually $6,200 from my audi to me, which is used as the basis to calculate the 5% of co-pay I’d have to pay out of pocket, which is $310.
I have 95% insurance coverage (and 5% co-pay out of my pocket) if I use an in-network provider. Or 70% coverage with 30% co-pay if I use an out of network provider. My audi is not an in-network provider, so I would not have done business with her but instead would have gone with an in-network provider in the first place. So in order to win my business, she agreed to charge me only 5% out of pocket for co-pay, as if she were in-network from my perspective. She would then bill my insurance as an out-of-network provider for 70% of the rest. So in a way, she’s willing to discount 25% of the $6,200 price in order to win my business. So the discounted price would have been $6,200 * .75 = $4,650 ($4,340 from insurance and $310 from me).
But then audi billed my insurance company not $6,200, but $7,200. I guess she hoped to see if they would bite on the higher price. But of course they balked at this $7,200 price and negotiated down and in the end paid her $3680. I guess another way to look at this is that the insurance agrees to a price of $5,257 (of which 70% coverage is $3680).
So as you can see, the actual pricing was actually all over the place to begin with. Originally, the price was $6,200 quoted to me and used as a basis for my 5% co-pay. Then it was $7,200 billed to my insurance, which was negotiated down to $5,257 by my insurance to the audi and used as the basis from which 70% of insurance payment was made. In terms of the discounted price in order to compete with an in-network provider and win my business, the original “discounted price” was $4,650, which was negotiated down to finally end up at $4K, which is the final “revenue” to my audi.
So I guess that at $4K/pair of OPN1s, my audi still probably makes enough money to cover her overhead costs even with the discount. And although it may not be as much profit as she’d like, I hope still enough profit for her. At least it’s still better than letting me walk away and lose my business to an in-network provider.