So the question I have is who is making that decision?
Is it the hospital/doctor, or is it the insurance company?
Why wouldn’t insurance companies leverage their market share fight the bills for their customers?
It seems like they are fine to sit around and pay out rediculously inflated healthcare invoices!
In any business, the number one way (in a competitive marketplace) to increase your margins is to reduce your costs. Raising prices (premiums) causes you to lose customers and revenue.
The number one way is to lay off employees and offshore the work.
Every hospital has a local monopoly on emergency care.
This is enforced by federal law that requires the ambulance to take you to the nearest hospital, not one a half mile further away that would be 30% cheaper.
Hospitals financially need to zing the middle class so Medicaid and EMTALA care can be subsidized.
To get access to emergency care for their insureds, insurance companies have to go along with the system.
To introduce competition, each hospital might be split ~50/50 between two hospital network systems.
You’re paying for a lot of middle men. It’s the difference between retail and wholesale.
“It seems like they are fine to sit around and pay out rediculously inflated healthcare invoices!”
Blue Cross was created by Baylor Hospital to help ensure its bills got paid. Other hospitals soon wanted into the system.
In my youth, the Blue Cross system still existed to support hospitals.
In the video, the agent on the phone says that California passed a law saying that hospitals give discounts to the uninsured. But there's also the broader problem beyond law.
If someone else pays the cost of your decision, you're okay with it being an expensive decision. It doesn't matter if the "someone else" is insurance or govt. So if you, the patient, decide to undergo a scan or procedure, you're okay with there being a higher cost unless you're the one footing the bill. States allow hospitals charge insurance more so they can get money that they know they'll get (insurance co's have bigger pockets) as long as they charge the cash payers less (patients = voters).
You must be new here.
We have been told repeatedly that their customers and the people that they must serve are their shareholders. They are at the top. Which means it is all about profit margins. And you make better profit margins by raising rates and not paying. Especially when you are a product that people must, by law, buy.
You can't lose.
I do believe it is made based on negotiations and what the law allows. You can (I think) opt to not file insurance and tell a facility you want to do self-pay. They may not give you the same discount as someone who is uninsured but you can certainly negotiate when you get the bill. A good starting point is finding out what Medicare allows for the same procedure (It should be available.) and starting with that figure. Medicare would have you pay 20% of the allowable. NOT 20% of the bill. Then go off that asking for a further discount if you pay cash within a certain time frame.
If a bill is high enough you might just want to let it go to a collection agency. Usually they will accept a steep discount if you pay cash within a certain number of days.
Just remember your living expenses (the necessary ones) do not need and should not get shunted aside to line the pockets of HCA executives. So keep that in mind when presented with medical expenses that are way disproportionate to your income.
The insurance companies. They never pay the bill handed to them. So the doctors have to increase the bill to get the money they want. Not to mention hiring people who have mastered the various insurance companies’ insanity to try to maximize what they get there. It’s all a ridiculous high low game they play with each other that would go away if the insurance companies didn’t go out of their way to keep the game going.
I’ve been saying for years. Insurance is a scam.
Had a friend who was in his 20’s and twisted his ankle playing beach volleyball, he went to an urgent care facility for an x-ray and and splints. He had just left his job and had no insurance and they charged him less than $200. So he was curious whether he should get insurance so he asked how much it would be to get insurance and they told him his deductible would have been 400 dollars. He was incredulous, “So I pay more if I have insurance?”. Insurance companies and medical facilities get together and inflate the price of services to make it look like they are saving you money. But with people who have no insurance they charge market prices.
As far as I know, it’s the doctor.
Some will accept the insurance payment as paid in full; others won’t.