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boomp said:   Read this for good info on cash vs insurance:
http://www.fatwallet.com/forums/finance/1195281/

I found out by accident that the cash price is always lower for me. I wanted to pay cash for a Dr. exam by a specialist after the exam. They said it was $700 but they had to bill my insurance. I said no it's a high deductible and they won't pay you or me a dime so I'll pay today. It was less than $400 for cash.
Another time I got a blood test bill from my local hospital. It was $150 and I called for the cash discount. She asked if I still had the same (high deductible) insurance . I said "no I have no insurance" even though I did. I paid $80, it would have been $150 if I had said I have insurance.
I think hospitals and clinics do charge more to bill insurance, wait to get turned down, then bill and hope to get paid.

Now I always get prices in advance as a cash paying patient and shop around. If it exceeds the $5,000 deductible I'll give my insurance info, so far it never has.

You have no idea if you are saving money by paying cash. The 'list prices' are no where near the insurance network prices.
Even though the bills will not meet your high deductible plan, the plan is supposed to get you access to their network rates.
I routinely have bills (particularly from labwork) where the cost was billed at $200 and my insurance says $30 is the in network rate. Had I negotiated for 50% off as you did ($100 in my example), I would have greatly overpaid. If I haven't met my deductible, I would have only had to pay $30.

Dus10 said:   Al3xK said:   ...And it says right on the box not to stick those in your ear.

The things are designed to be stuck in your ears... that crap is on the box for the same reason a Snickers bar says "may contain peanuts"... They are just covering their rears because some idiot is going to cram the thing way down there and bust his eardrum.


I was kidding

biomedeng said:   
Even though the bills will not meet your high deductible plan, the plan is supposed to get you access to their network rates.


Well the prices I'm supposed to get access to are not as cheap as the cash rate. I may talk to my states insurance regulator again on this. They are the only non biased source I have for prices on this stuff.

boomp said:   biomedeng said:   
Even though the bills will not meet your high deductible plan, the plan is supposed to get you access to their network rates.


Well the prices I'm supposed to get access to are not as cheap as the cash rate. I may talk to my states insurance regulator again on this. They are the only non biased source I have for prices on this stuff.


I read your previous post just to make sure that you didn't actually have the information you claim you do. The price negotiated by an insurance company with the physician's office is vastly different from the amount the physician's office will try to bill for. The prices the front-desk people gave you in both of your examples were what they were going to bill, not what they had agreed to accept from your particular insurance company. Look at your EOB next time to see what I mean.

MissCrabette said:   

I read your previous post just to make sure that you didn't actually have the information you claim you do. The price negotiated by an insurance company with the physician's office is vastly different from the amount the physician's office will try to bill for. The prices the front-desk people gave you in both of your examples were what they were going to bill, not what they had agreed to accept from your particular insurance company. Look at your EOB next time to see what I mean.


If one demands to get the low price negotiated by an insurance company do you get it? The prices I was paying when I believed my insurance helped were higher. Remember I have 5K deductible per diagnosis not 5k per year.

Does anyone know if there's a way to get the insurer to price stuff in real time? Can you just call and say how much is a level 2 office visit plus blood text X. Here are the codes they'll be submitting.

boomp said:   MissCrabette said:   

I read your previous post just to make sure that you didn't actually have the information you claim you do. The price negotiated by an insurance company with the physician's office is vastly different from the amount the physician's office will try to bill for. The prices the front-desk people gave you in both of your examples were what they were going to bill, not what they had agreed to accept from your particular insurance company. Look at your EOB next time to see what I mean.


If one demands to get the low price negotiated by an insurance company do you get it? The prices I was paying when I believed my insurance helped were higher. Remember I have 5K deductible per diagnosis not 5k per year.


Typically the insurance negotiated rate will be lower than a cash only rate (even with a massive deductible)- example
CT scan billed at 2k
Insurance adjusts bill to 500- if you have a high deductible you pay 100% of negotiated insurance rate of $500.
If you have NO insurance, you pay 2k.
If you negotiate a cash only price, you might pay 1k.

Unitl proven otherwise, I would assume the insurance negotiated rate (even if you pay 100%) is less than a cash rate.

TravelerMSY said:   Does anyone know if there's a way to get the insurer to price stuff in real time? Can you just call and say how much is a level 2 office visit plus blood text X. Here are the codes they'll be submitting.

Yes, if you tell them EXACTLY what the billing codes will be, and EXACTLY where the bill is- they can tell you. But if you are off, even slightly, all bets are off.

boomp said:   biomedeng said:   
Even though the bills will not meet your high deductible plan, the plan is supposed to get you access to their network rates.


Well the prices I'm supposed to get access to are not as cheap as the cash rate. I may talk to my states insurance regulator again on this. They are the only non biased source I have for prices on this stuff.

The state regulator likely does not have access to the in network contract rates between a major medical insurer and a medical provider. In fact, I believe insurance companies and providers deliberately try to keep contract rates somewhat secret (at least they don't publish them publicly). Think about it, if hospital A gets $500 per MRI, but hospital B is only getting $300 per MRI, don't you think B would use this information to negotiate a higher reimbursement? If you knew hospital B took 300 for an MRI, wouldn't you as a cash paying patient demand the same price?
The only rates I am aware that are publicly available are medicare and medicaid rates. Medicaid reimbursement is very low, perhaps below what any major insurer would reimburse, and this is why medicaid is often not accepted. So if one were able to get a cash rate that was similar to the medicaid rate, I would say this is a good deal, most likely better than the rate with insurance.

some clinics/doctors can still find a way to double charge you even though they claim through your insurance company. There were 2 such dr visits we had. They were both annual check-up, less than 15 minutes routine ones. Only basic stuff were discussed. But later I got charged for 2 office-visit for each. The reason? The doctor claimed they provided the consultation to specific conditions. There might be one sentence in each visit regarding that specific condition ever been said. If I knew I got to pay that much for that single sentence, I'd let the doctors shut their mouth. We don't have to hear that.
Ridiculous.

Called the clinic. Called my insurance company. The insurance company said they gotta no way to help. The only thing I could do is to submit a complain, which I did, and then the complain was dropped by the insurance company because of no proof.

I thought this was an interesting article on hospital billing practices: http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bi...

Can't any people in the medical profession give us info as to whether we can get a better price trying to get a cash price versus paying the insurance rate (on a high deductible health plan)? Or, perhaps there is some way for us to figure out what the insurance rate is as a basis of comparison?

Silverthunder said:   Can't any people in the medical profession give us info as to whether we can get a better price trying to get a cash price versus paying the insurance rate (on a high deductible health plan)? Or, perhaps there is some way for us to figure out what the insurance rate is as a basis of comparison?



This MD's website has some good info-- http://www.kevinmd.com/blog/2012/06/hide-health-insurance-status...

He say's:

First, to get the discounted prices, patients would have to withhold insurance information from hospitals. If you tell them you have insurance, they will be bound to charge you the insurance company’s negotiated rate. Those are the up to 89% higher fees documented in the previous paragraph.

However, if you don’t tell them your insurance and pay cash instead, the cash payments don’t apply to your annual out-of-pocket spending limits.

For a 89% discount, I am pretty sure there are times it would be worth it to keep your little secret. If you are healthy and only need an occasional visit to the doctor you now get to make the judgment call on cash discount vs. paying five times as much and applying it to your deductible.

Hospital executives say they don’t like to charge insured patients more, calling it a result of the country’s broken healthcare system. “We end up being forced to charge a premium to health plans to make the books balance,” said John Bishop, the hospital’s finance chief of Long Beach (CA)Memorial Medical Center. “It’s a backdoor tax on employers and consumers.”

rmf1981 said:   Have your form all filled out to the best of your ability and know precisely what information you need from me. Probably 75% of people don't mention the form until the end of the visit when I'm walking out the door - at which time they present a four page form they haven't even looked at and say "hey I need this in 2 days." That person is definitely getting the fee.

OMG, YES! A large number of patients that want paperwork filled out check in at the front desk ~12-15 minutes into their 20-minute appointment slot. The reason for the visit is quite often listed simply as "follow up" or "I don't know". They want their 3-5 "acute" (I use the term loosely, since more often than not, it is something that has been ongoing for years) issues to be addressed immediately and wonder why you are running behind. Hint: it's because the previous person also showed up halfway into their scheduled appointment time, needs an interpreter, and also has several 'acute' issues (one of which is the chest pain they've had on and off for a year that began after they started smoking cocaine). When I finally complete history/exam/counseling, they suddenly remember that the main reason they came in to see me was to get their SSI (disability)/FMLA/etc paperwork filled out. By tomorrow. Because it was due last week. Not that they have filled anything out on the form.

Which reminds me...just last week I had a patient come in upset at me because she did not receive her disability benefits - "you didn't fill out my paperwork correctly". Upon looking at a copy of the document, it turned out that she had mailed it off with only the information I had filled out completed. There was no name, address, or anything else. She facepalmed and left, coming back the following week to drop off a copy of the form for me to fill out again.

(To anyone offended: sorry for the broad, sweeping generalization, but these things happen more often than not)

Direstraits66 said:   No reason why doctors can't charge by the minute or in block of 20-30 minutes for outpatient visits. I would rather go to a doctor who will charge me 250 for a 30 min consultation when i know the cost of my visit before the visit. A competing doctor may charge me 100 and I may choose to go see him instead. Market and skill-set will set the price. And i would push back when my school wants some frivolous form signed cause it will cost me 200.

And your expertise is valued over the other, i will be ready to pay a higher rate. You've no paperwork to file and you get to schedule your time productively.
And you're not forced to care for anyone walking in like a hospital is required to.

Yes there is. While intensivists (ICU staff) bill like that, you can't bill insurance companies like that in an outpatient setting. Like another poster mentions, the only people you can bill like that are patients that are looking to pay cash. Additionally, what is your position on all the other things that aren't currently billed for (the time for documentation, test/imaging interpretation, phone calls, etc.)? Would you want to be billed for all that, too? It's not uncommon for that stuff to take up more time than the visit itself.



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