What kind of scam is this?-re health insurance and hospital bill

[TexasProgresive]

I have very good health insurance thanks to my union contract. Recently I had surgery and got a statement from the insurance company. It lists the amount billed, a discount and the amount the insurance company pays.

It is a whopping 83% discount. this discount is enough to by a car and not a sub compact. So if someone did not have insurance would they be billed the full amount?

[newfie11]

1. yes they would.

[csziggy]

2. Yep, uninsured pay the full amount unless the doctor and hospital take pity

And give some kind of discount. Even the the discount is not as big as insurance companies and Medicare get.

[HereSince1628]

3. Yes, they would be billed for that.

[spanone]

4. that's how it works...they negotiate a price with the hospitals so...

if you don't have insurance you are double screwed.....

my knee surgery with insurance was 14,000 dollars.....without about 30,000. go figure.

[uppityperson]

5. Yes. However, most hospitals have a discount program, either based on

paying cash and/or sliding scale based on income. Yes, it really sucks and I don't understand how this is legal.

[bemildred]

6. Why yes, yes they would, and it would be collected if the money could be found.

And this is justified on the basis that other patients would not be able to pay those same high prices.

[cbayer]

7. Hospitals routinely have charge masters that are 3 times or more than what they

actually collect from the government or insurance companies.

There have been multiple, successful lawsuits challenging hospitals who charge private pay patients more than they get from insurance companies.

All patients who receive bills should check the charges against what the acceptable medicare payment is and negotiate with the hospital to pay no more than this rate.

Hospitals are aware of the legal implications of using their charge masters for private pay patients and will readily make a deal.

If at all possible (non-emergency), private pay patients should negotiate these rates up front. A hospital is very likely to agree to the charges they would normally pay to Medicare or an insurance company.

[LiberalAndProud]

8. I wonder if Medicare or Medicaid would be billed at 100% for the surgery

[uppityperson]

9. Medicare typically pays a small % of what is charged so I think so.

Not sure about medicaid though

[cbayer]

11. Even smaller, for the most part

[Freddie Stubbs]

12. No, they pay even less than private insurance companies do

[begin_within]

10. My doctor charges less than his regular price for patients with no insurance.

Because he only gets a part of what they bill the insurance company, and because they don't have the costs of billing them either (they use a billing service and it costs them about $10 just to get the bill submitted to the insurance company). Since he saves that cost, and he doesn't get the full amount from the insurance company, he charges less to patients who pay directly at time the service is rendered. And from my standpoint, charge for follow-up visits are actually cheaper than what my co-pay was for an office visit with the insurance. For simple, day-to-day, primary care stuff, I'd like to get the insurance companies out of that completely. All they do is just suck money out of the whole process.

[dixiegrrrrl]

13. True story:

Mr d had a sudden lung collapse. ( He has had it happen a couple of times before in his life, so he knew what it was)

Off we go to ER, Sat am , for less than 1 hour, then he is admitted to Crisis Unit, where they inflated the lung
( painful procedure, be warned)
Stays in ICU from Sat. noon to Monday noon, twice daily they take chest x-ray to see if lung is reflating.
I know about the treatment/procedure, all is done as it should have been done.

The ER visit, again remember he was there less than an hour,
is considered an outpatient visit, even tho it is IN the hospital.
We do not have outpatient insurance.
Er is run and billed by a private consortium of docs.
total: 743.00

The 3 day hospital bill, INPATIENT, we have insurance for.
The bill:5,000.00.....paid by insurance
Our copay:( annual deductible)
1100.00

The Dr. IN the hospital bill, for ramming a sharp stick into Mr. D's chest, taping a tube there to blow air into the lung, and visiting once in am and once in pm, is 800.00. For all 3 days total.

Twice daily x-rays are 25.00 per, times 2.5 days.( outpatient billing, who knew?)

Total bill out of pocket:

743.00 for 45 minutes of uninsured ER ( Medicare would have paid 114.00, if we had it)
1100.00 for 3 days for hospital
800.00 for 3 days of doctor coming in for 5 minutes twice a day, and for initial chest tube insertion
150.00 for all total x-rays.

Good news:
hospital dr bill and hospital bill, they said we could make low monthly payments with NO interest.We did, for a year.
X-ray lab and ER: they demanded their money ALL in one payment.

[TexYellowDogDem]

14. My last hospital bill was $575,000

The negotiated rate that the insurance company paid was $106,000! About 82% discount.

[RagAss]

15. This is the structure to kill off the uninsured.

Get the surgery and lose your home....your choice.