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josie's avatar

Will you negotiate a cash payment for your next medical bill? .

Asked by josie (30926points) June 8th, 2012
Great article and a big revelation. I think I will try this if I ever need an expensive test. The only people who would not would be those who never intend to pay anything anyway. And then we will all know who they are. Doesn’t everybody win?

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10 Answers

ragingloli's avatar

public insurance here.

YARNLADY's avatar

We belong to a managed care group, Kaiser, and the prices are already negotiated.

Mariah's avatar

Okay, reduced cost is cool and everything if you just need one scan. Try being chronically ill and needing tests done constantly. It’s still just not doable, even at a reduced cost. But nice to know you think the chronically ill are free loaders.

JLeslie's avatar

I have examples all over fluther. My husband’s head CT cost me much more through insurance than self pay, and they received money from my insurance company in addition. I negotiated dow a couple hundred dollars, was treated like shit by the billing people, told if I try to lie about not having insurance they would find out and come after me (the test was done, they were billing me my portion negotiated by my insurance company, how would I hide it?). I asked my husband if it is against the law to self pay if he has insurance, which seems ridiculous to me. I know it must not be because another doctor lets me self pay or go through my insurance. I still paid more for those tests, because my husbans did not want to fight it and he gets defensive that his company’s insurance might suck at times. My treatment for my ectopic years ago was much much higher than self pay. I self paid.

The problem is the system makes it almost impossible to deal with all of it timewise or emotionally. Like in a sitiation like @Mariah‘s the burden of questioning every test and bill is a nightmare. Or, when I was brought into emergency after my accident, I had tests done I did not realize were being done and then billed for it, and I was conscious and able to communicate the whole time.

@YARNLADY Your missing it. Sometimes the self pay amount is cheaper than the portion you would pay for the price your insurer negotiates.

wundayatta's avatar

I am not clear on what is being discussed here. Are we talking about the coinsurance? Or are we talking about the insurer’s negotiated rate? Are we saying that the coinsurance on the insurer’s negotiated rate is higher than the self-pay rate? If so, then insurance is shit, isn’t it? What do you pay all those premiums for if they make you pay all the bills anyway?

My copay for a doctor’s visit is ten dollars. Insurance pays the rest. I never pay any more for tests. I’ve also never seen a copay for any hospital bills. For this, perhaps I am being foolish. My employer tells me I am paying $18,000 or so a year for family coverage. It’s all paid in pretax dollars, so it would probably be worth close to thirty thousand to me in taxable dollars. Am I stupid to take this plan instead of forgoing insurance and paying out of pocket? I don’t have much choice. If I decline coverage, it’s not like my employer is going to pay me that cash.

Anyway, I understand the cost shifting that is going on. We who are fully insured have to pay more to make up for those people who can’t pay for their health care. The cost to charge ratio just shows how absurd the whole system is. But just look at how much of the economy goes to health care, and you can see that we, as a society, love the stuff. It’s getting close to one in five dollars spent in the economy goes to health care. Just look at who the big, expanding employers are. Just look at where all the building is in my town: it’s where all the hospitals are. That’s where the jobs are. That’s what people want: to live forever.

I don’t know how you can get the self-pay price if you are insured. I guess if you do it and they catch you, you could get into trouble. So go for it, @josie. Let us know how it works out.

YARNLADY's avatar

@wundayatta I guess I was wondering the same thing. Our plan is similar to yours. Our yearly premiums cost $3400 and when we get service, we pay $30 per visit, or $40 for emergency, and nothing more, except a minimal payment for prescriptions.

JLeslie's avatar

@YARNLADY @wundayatta For me it’s both issues. If the insurance company paid more to the doctor than what I would have been charged self pay, then that means my insurance is paying too much, which means premiums go up. If there is no copay this can happen, and if there is a copay it can happen. My husband’s CT, the diagnostic center made over $2k between the insurance company and the $1k I paid, when I could have self paid somewhere between $550 and $750 depending on the clinic. Even if my copay had been zero, $20, $30, instead of the $1,000 because I was satisfying my deductible I still would be pissed about it. I notice the dishonesty in billing probably more than you, because my deductable is $2,500. But, even before when I had coverage similar to yours I would find out at times insurance paid more than what I would be charged. My antennas are up to hate the system, becauee I have been gouged by it, and I almost lose sleep at night at the seeming lack of integrity in it, so I ask more questions about pricing to my doctors.

It is sort of a Republican thing, if we bring politics into it, that the consumer knowing what they are paying will help bring prices down, but then the republicans protect the insurance companies. Most people have no idea what the doctor is paid for services and how much tests cost, because they never look at their EOB, because there was just $20 for them, or free. But, premiums go up and up, and that is because the insurers sometimes pay the doctor’s too much, and insurance companies line their own pockets too. It’s both.

If it were totally socialized, then all this would probably be better to at least some extent, because doctors would be paid whatever they are paid, and there would not me wild fluctuations in fees from one insurance company to another and compared to self pay. Well, I guess we could still habe a different price for self pay, but I don’t think there should be.

elbanditoroso's avatar

Yes, i did about a year ago. Saved about $150.00

wundayatta's avatar

So there’s a deductible involved? That explains some of it.

To understand how medical finance works, it is necessary to understand that there are a mix of payers who all pay different rates for the same services. Typically, the government pays the lowest rates, and they force hospitals accept these rates as a condition for being in business. Private insurers pay the highest rates, because someone has to make up for the cut rate government payments, and private insurance is it.

Private payers usually pay the highest rates, since they have to pay actual charges instead of a negotiated rate. But it sounds like in some places they are getting a lower rate. This is unusual. Perhaps it is mandated by law in some places. But usually the uninsured get shafted the most.

On average, hospitals get paid what they need and most of them make a profit. Some don’t. Hospitals that serve sicker people get to charge the government more. I forget the name of this payment now, but the Medicaid reimbursement rate changes based on how sick patients are in an area, and also based on what state you are in.

The point is that this is how hospitals get paid, and they try to maximize their payments from all these different sources. It’s even more complicated when you think about which insurers have contracts with which hospitals. Also which insurers are private and which ones are blue crosses. If you force hospitals to accept the lowest payment from private payers, they will go out of business, or at some point, the other payers will start paying more.

The only way to fix this is with a single payer system. Then the payer gets to set the rates and gets to set the amount of health care that will be consumed. Americans think there should be competition in the system, but the only way for that to happen is for the government to stop paying for health care and to outlaw insurance. We’d have to all pay out of pocket. Then we could have a system like South Africa’s or Burma’s or Rwanda’s.

JLeslie's avatar

@wundayatta I agree with your last paragraph 100%. This middle of nowhere system we have will eventually, slowly emplode like the real estate market did I figure. It will be horrific and finally someone will pull the trigger and put in a national health care system. I figure the very people who are dead against it will be going right alin eventually.

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