My wife is a controller/accountant in a rural hospital and TennCare nearly destroyed them. Getting paid .50 cents on the dollar. She told me they had figured for example how much it cost the hospital to xray for a broken arm and these figures are by no means correct. With the xray machine, techs, radiologist, maintenance etc... $100 and they recoup their overhead and make a respectable profit.
In comes Medicare and they say you will accept $35 for this xray period. So right off the bat any profit is gone and they are not even meeting overhead. Medicaid pays even worse! So they have to charge the patients with insurance and paying out of pocket even more to try and recoup losses from the government Medicare/Medicaid.
And that may well be but I have private insurance and they also don’t pay the full amount even though it appears the doctors office/hospital way overcharges. The insurance company apparently has a “negotiated price” so who is paying the full amount? People without insurance? The office/hospital never gets paid the full amount?
I used to have a very different type insurance, a high deductible plan with a health savings account. The doctors would give me a 10% discount for cash but it appears I was getting screwed because having private insurance they pay way less than a 10% discount.
The whole thing is screwy.