Just got a bill from the hospital for lab work. We had switched out insurers and they had gone to the wrong one for reimbursement. That’s being fixed, so all is good.
What did bother me were the numbers on the bill. It was a a goodly sum, but it was half of the total charges.
So if they’re cutting the total charge in half – even though, as far as they knew, it wasn’t eligible for insurance – why wasn’t the base charge half of what they put on the bill? Who pays full price?
You have hit on a nerve that bothers civil defendants in injuries cases. They are responsible for paying the reasonable cost of medial care, and generally don’t get credit for insurance discounts, etc. (CA did away with that rule, but it does still apply many places)
They argue the reasonable cost is what people pay, not the base pay that no one pays. We have a lot of fights over this. In a recent deposition of a major hospital’s billing director, he testified that yes, some people do pay the full charge (or are expected to anyway) and some insurance companies without a negotiated “deal” with the hospital have to pay the full amount.
ETA Since they automatically offered you a “no insurance discount” then the full price must have been for the second scenario I mentioned. Or something else completely.
I pay full price until my $3000 deductible is met. Just paid $1638 for a 90 day supply of Jardiance. One more of my other meds, and I’m set for the year. But of course I get some back from my HSA account, but not everyone has one.
I have a HDDP with HSA but I still get an insurance discount. Are you sure you don’t? Example, my insurance company stayed the same but Jan 1 they changed the underlying RX program so all my stuff run on the old card got rejected. One RX for my wife was $235 retail then knocked down to $25 ish. A med I take for bph and usually pay $4.50/mo was rung up as $75 then went down to $6 when they ran the new card. Having a (high) deductible and “paying full price” aren’t the same thing. Usually one of the benefits of having coverage is the insurance discount, regardless of how high your deductible is. Other examples: had a surgery last year and the bill was well over 10 grand, insurance discount came to a little over 2. I paid all 2 because I had $0 charges for the year at that point. Had a Dr visit with labs billed at over $500. Was charged $0 even though I wasn’t close to deductible, because insurance was required to fully cover as preventative. If you are paying full price for something with insurance, it sounds like your insurance isn’t covering it (your insurance “covers” eligible services regardless of deductible).
I’m not entirely clear what’s going on with your bill, but back when I was without insurance a long time ago many places routinely chops “retail” prices in half for those with no insurance at all. So… maybe they thought you were uninsured? As I’ve had insurance for the better part of two decades now I’m uncertain how things like that are handled these days. And it might have been something else.
Insurance companies demand discounts, often deep ones. Facilities inflate “retail” prices to compensate. Medical billing is murky as hell in the US, just one more jacked-up detail of our so-called medical “system”.
I’m sure they thought I was uninsured. We did give them out new insurance cards, but they had our old insurance on file and probably didn’t update. Our old insurance told them we weren’t covered by them, so we’d come back as uninsured.
I just didn’t understand why they automatically cut the price in half.
I changed my insurance this year to a BCBS HSA plan with a low monthly charge (1/10 of what I paid last year) and a high deductible ($3000). Since I do take a lot of meds it works out for me, but they match nothing until I spend $3000. That’s why my Jardience was so damn expensive. While I will get reimbursed from my HSA account once I have it funded, that’s actually just my money that I set aside before tax, so I will see a tax savings on my script by the end of the year. The pharmacist even told me, you recall your paying full price until the deductible is paid, and I said oh yeah that’s right. Still the low premiums along with the HSA made sense for me in my case.
I’m on Medicare with a robust BCBS supplement. This summer Imhad a cardiac ablation. The hospital charges were $103k. They accepted the Medicare assignment of $20k and I owed nothing. So why price it at $103K if they will accept $20k? Having worked for said hospital system for over 20 years, I know it’s all down to the negotiations between hospital and insurance companies.
Correct. All of which occus out of view and with little to no tranparency. It’s in the same league as airline ticket pricing.
I remember reading on some doctor’s blog that the reason for this is that if they bill $20K , then no one will pay more than $20K including the insurance company that would have paid $30K if the bill was $100K. So they set the “price” higher than any insurer will pay and give a discount to people who self-pay.
Yes, except Medicare doesn’t “negotiate.” They set the rates they’ll pay. Usually much less than private insurance Companys pay.
I’ve had hospital administrators testify that they would go bankrupt if everyone paid the Medicare rate.
Everything I’ve read about hospital pricing indicates that they themselves don’t have the slightest clue what any of their services actually cost. They simply cannot put a credible number on any procedure at all, or even what a single Tylenol costs to dispense to a patient. They have been fixing the numbers for so long (to account for differing payments from Medicare, private insurance, cash patients, etc.) that they’ve ruined their ability to actually track costs at all.
And yet Medicare (until recently) can’t negotiate drug prices.
Which leads to hideously high list prices for various drugs, along with “premium support plans” which make them more affordable to people who are uninsured or on an insurance plan which covers them only partially.
Of course, such plans are not available to people who are on government medical insurance, so the Feds play full price. And will continue to do so, until the drug in question comes up on the schedule to be negotiated; perhaps by the time the patent expires…
That’s cute. My family deductible is $15k, with $7500 for any individual before they start getting coverage. And my premium is 1400 per month. This is a marketplace plan. The $7.750 I can put in the HSA covers a little over half of our deductible.
Why do people put up with this? Why aren’t you organizing and demanding reform?
We did. Back in 2010 - it is called the Affordable Care Act, but some key provisions were watered down or removed altogether in order get get juuuust enough congress-critters to support it. Since then it has been gradually weakened. I know, how come other civilized countries can get this right, but the United States cannot.
This is what it looks like to me, too. It seems to involve funny money and a charade to get whatever they can get, on the part of everybody in the system that has enough real money to write laws.
The system has to work well enough for patients to keep returning to care providers, but that’s not much of a framework for making the pricing sensible.
This is true, and it’s one reason why Medigap policies exist.
Medicare (and Medicaid, for that matter) pay less than cost; at my old hospital, the rate was about 80% of what it cost to treat patients. Private pay, insurance, and Medigap policies made up the rest.
I don’t understand this. Medigap policies pay the part of a bill that regular Medicare doesn’t pay. As I understand it, Medicare and Medigap together pay up to the Medicare allowable charges. That’s what my Medicare statements say. So, if the allowable Medicare charges are lower than the cost to the hospital, Medigap won’t make up for it.
My step brother, a shrink for the rich, complained all the time about Medicare not paying enough to support his house in La Jolla.
The big issue is that drug companies and hospitals make big profits and give the money to politicians to vote their way.
Also, many people don’t think about it untill they get a bill.