On medical billing and payments

The below is a a recent EOB (Explanation of Benefits) Financial Summary for a minor procedure I had during my annual physical:

• Billed - $858.36

• Insurance Covered - $653.53

• You Paid - $172.90

• Your Balance - $31.93

So here is the question: When we hear "The US has the most expensive healthcare among OECD countries," which number are they using to determine that? Lets look at what each of the above actually means.

• Billed - the amount that my provider submitted to the insurance company.

• Insurance covered - the amount the the insurance company deducted off the bill because my provider is “in network.”

• You paid - the amount the insurance company paid on my behalf to my provider. Please not this is NOT what I paid out of pocket. It is the amount my provider collected and put in their bank account.

• Your balance - the amount I need to pay my provider from my HSA.

In total my provider will receive cash payments in the amount of $204.83. This 24 percent of the amount billed. The $653.53 (76 percent of the total) is an accounting fiction. It doesn’t really exist and never did. So once again my question: When we hear "The US has the most expensive healthcare among OECD countries," which number are they using to determine that?

In my conversations with those involved in medicine and public policy I have not been able to ascertain a straightforward answer to my question, but I know that it is certainly not just the amount I paid directly ($31.93) and I suspect it is not the amount my provide actually received in cash ($204.83), but rather the amount of the total bill ($858.36), the one that is mostly (76 percent) an accounting fiction.

If anyone knows more about this, comment here or on Facebook.