And as for my insurance, if the doctor doesn't charge as much as he can, am I going to get any of my money back that I lay out every month? Or if I don't use any insurance for a month will the insurance company apply what I paid to next month? Probably not, so I'm content to allow my doc to run as high a bill as they'd like in hopes that it means they're interested in having the newest and best treatments in their office for me.
Here's the thing that most (including above) don't realize about insurance billing from doctor (doesnt matter what kind). Doesnt matter if you bill out $1,000 for a procedure. If the insurance company feels that the reasonable and customary fee for that charge is $100...thats the most you will get. Some peoples plan call for copays, then there is the matter of co-insurance....so look at it this way:
Lets take an MRI - $1200 is what MRI company charges the insurance company. Insurance company says, umm..we feel that $800 is reasonable and customary. Patients plan calls for 80% reimbursement. MRI company gets paid only $640 for that MRI. Guess whos responsibility the remaining $560 is? Patient.
In addition, offices like a chiro or physical therapist dont have carte' blanche to bill $10,000+...a lot of plans have limitations on the number of modalities per visit, maximal amount of reimbursement per service (manipulation, physical medicine), or even the amount of visits a patient can receive. I am continually confused when a patient comes back and asked why they have a bill (of various amounts) when "they have insurance, why isnt it paying for this"
In addition, there are many times that the insurance provider will request records during the treatment period. If they feel that the patient isnt progressing like they think they should (no matter if subjectively and/or objectively the patient improves), they will deem further care not medically necessary.
Oh, and regarding the unused benefits question....its just like your car....you pay every year....if you dont get into an accident, your benefits just start right over the next year.