What happens if I manually submit a "cash pay" claim to my health insurance provider?
I was referred by my doctor to get an MRI. He gave me two places to go to, one of which he said has a cash price of $175 and another one right around the corner that he knows accepts my insurance. I made my appointment with the second place. They told me that since I did not meet my deductible I would be responsible to pay the negotiated rate of $348. I obtained the procedure billing code and call my insurer to confirm it. The price for that procedure was indeed $348. The agent also told me that all providers in my area that take my insurance are bound by my negotiated rate. I asked if the first place with the cash discount was in network and asked how much they would charge to do that same procedure code. The price was indeed $348, which is more expensive than the cash price!
This means that if I don’t keep my mouth shut and tell them I have insurance I will end up paying $348! The agent said they are required to charge me that. My question is that if I pay the cash price and then submit the receipt with the claim form to the insurer what will happen. The scenarios are:
1) The insurance company will credit $175 to my deductible and I owe nothing
2) The insurance company will credit $348 to my deductible and I owe nothing
3) The insurance company will credit $348 to the deductible and I will owe ($348—$175)
The agent said I would be billed and it would count toward my deductible. He did not seem too knowledgeable so I am not sure. If number three is indeed true that is kind of sad that you pay for insurance then are forced to pay more because you are paying for insurance…
A second question I have is the $175 MRI place said they regularly charge $1500 for the procedure and the $175 is a “discount”. Is this inflated price a sneaky way to write off losses as in “We normally charge $1500 but the insurance company only paid us $348”
This question is in the General Section. Responses must be helpful and on-topic.