then the hospital bills the patient for the unpaid balance the insurance does not pay...Ive seen that plenty of times too.
Catastrophic insurance, along with direct payment is becoming popular because its cheaper often. I have used a direct pay outfit for xrays and saved hundreds of dollars instead of using my ####cross.
From what I have seen, the hospital/facility bills the insurance company. The agreement with the insurance company/hospital sets the agreed upon reimbursement. If the patient has not met their deductible for the year, the hospital/facility bills the patient for THAT amount - not whatever their original billing amount was. That has always been the reason to stay within your plan’s network of physicians/hospitals/facilities. They agree the accept the insurance amount, whichever one of you pays it.
If the hospital is in the patient’s network, the only money the hospital can legally collect is the difference between the approved network rate and the amount the insurance company paid.
Several problem issues raise their ugly head and the patient doesn’t inquire about them. Although the hospital chosen may be in the patient’s network, none of the professionals providing service may be in their network and they end up receiving a slug of very expensive bills once they are out of the hospital. Or the insurance doesn’t cover any ancillary services, only a basic per day/bed charge.
More and more doctors and health professionals are dropping all network participation because insurance carriers keep cutting the reimbursement rate.
More and more individuals do not understand how insurance pays/processes a claim, what their policy really covers or how they can advocate for themselves with carriers. Individuals who work for insurance carriers rarely know anything about a policy other than the very general information they read on their screen and have never actually worked in a doctor’s office or hospital. HR people make recommendations on coverage without sufficient knowledge as to what their employees need. And then you throw in politicians who set standards in an area they know little to nothing about.
It’s just a mess from top to bottom.