Posted on 01/18/2022 4:38:32 AM PST by Kaslin
Most people using hospital services must sign a form indicating that they will pay whatever their health insurance doesn’t. Federal transparency rules can help defend us against the consequence of that signature.
Federal price transparency rules require hospitals to post all negotiated rates, including cash prices for the uninsured, every single commercial insurance plan that they’ve contracted with, and even rates for government programs such as Medicare, Medicaid, Tricare and the Veterans Administration.
Those rules require hospitals to display:
Ignoring these rules is a bullying tactic to make you think you’re contractually bound to pay whatever the hospital charges. Unless the hospital makes its pricing accessible, the form you signed is what courts would find an “open price” contract, meaning a seller (hospital) may only expect the buyer (you, the patient) to pay if a court would find the price to be a fair market rate.
Most hospitals are not complying with federal transparency rules. If yours is not complying, you can make the case that you should not pay a dollar more than fair market price. Here’s how:
Step 1: Next time you go to the hospital, instead of signing your name on that form, write “I did not read this.” The clerk taking the forms probably won’t notice. It won’t disrupt an electronic registration process. When you’re billed, ask to see the form with your signature.
Step 2: If you did not sign the form, skip to Step 3. If you did, check the hospital website to see if the pricing information is posted and is in compliance with federal price transparency requirements. If it is, steps 3-6 below will help. If it isn’t, you can argue you were charged unfair market pricing and you’re only bound by an open price contract. Be prepared to argue for lower charges.
Step 3: Determine fair market rates. If you have health insurance, hospitals charge an average markup of 150% above their “cost,” which is benchmarked to the Medicare rate (Medicare=100%). Without insurance, the average markup is 317%. You can multiply your billed charges by a “fair market multiplier” and get a price that allows a “mere” 50% markup:
Step 4: Pay your fair market rate. If you have insurance, check the Explanation of Benefits from your insurance plan—it’s possible that the insurance company already paid more than the fair market rate is (in which case, you owe nothing). If not, pay the difference between the insurance payment and the fair-market rate. Use the instructions on your bill. Keep a screenshot of your online payment confirmation or take a photo of your check or payment stub before you mail it. Pay this amount on time!
Step 5: Send a letter like this one to the hospital’s registered agent demanding your balance be zeroed out. Explain you are in an open price contract because of the hospital’s non-compliance. Explain how you arrived at the fair price. Provide a screenshot or photo proving you paid that fair price (or a screenshot of your Explanation of Benefits showing that your insurance company already paid the fair price), and demand that your balance be zeroed out. You can find the agent by searching your state’s Secretary of State site.
Step 6: Check your patient portal to ensure the hospital zeroes out your balance. Be prepared to dispute bills if the hospital continues to send notices. Call the number on the bill or the patient billing office number from the hospital’s website promptly and have it recorded in your file that 1) you are disputing the bill, 2) you called to demand a response to your letter, and 3) that you are not obligated to pay anything beyond what you already paid. Insist the hospital commit not to sending your account to collections while the dispute is being resolved and have this noted in your file.
Just don’t give in and pay an unfair bill!
Didn’t Trump do this already?
Before CoupFlu hit, I was calling around trying to get prices for specific tests and treatments for someone should was uninsured.
None of the health systems I called was willing to provide the info.
All of them stated that the patient would have to speak to a financial counselor, their title, before the patient could learn the price.
I finally got done one to admit that prices were dependent on income level.
So for the same exact test, treatment, service cash pricing would vary according to income.
And there were no discounts available for patients paying cash.
That’s not healthcare.
It’s a racket.
Trump did.
But health systems are refusing to comply.
And Deep State is refusing to make them do it.
Question, now that the hospitals have free labor from the National Guard, shouldn’t they reduce prices to reflect the cost savings?
they are covering up getting PAID to murder,
to commit genocide KNOWINGLY
by failing to provide therapy.
the penalty should INCLUDE loss of clinic license,
LOSS of their medical (if any) licenses, and
LOSS of their pensions, homes and Freedom.
“If you have insurance, multiply your billed charges by 0.60.”
My understanding and experience are that if you have insurance, you are only required to pay the amount your insurance company indicates on the EOB. That is if the hospital / doctor is in network of your insurance company.
In Network is a negotiated contract between you Insurance company and the hospital/doctor. If you stay In Network, you cost should not total more than your deductible and out of pocket.
I have learned this over the last five years with a couple of million dollars in health insurance bills. We only pay our deductible and out of pocket each year. Where they get you is the approval of medicine for off label.
I had an urgent care office demand payment before seeing me. I was still waiting on the EOB. I just went to a different care provider when that happened. Don’t let them push you around, they will try to get money that you do not owe.
Don’t get stressed out over the Hospital / Doctor billing apartment, it will work out in the end. Keep good records.
Contractual agreements between large entities, e.g., the biller and insurer.
Jessie James’ agreements where you get robbed by the hospital or doctor if you don’t have insurance.
Stop mandating hospitals care for illegal aliens and mandate citizen’s care as before; charge only double as penality for not having insurance rather than 4X.
Prices are bad enough but we need another deep dive into the 5 W’s for covid and ventilator kickbacks - since we the taxpayer are on the hook once again!!!
Most of the time, they don’t know their cost (what the government and hospitals call “cost” is a fiction), and they don’t really have a “price” but rather a position they take with regard to every “payer” and the government.
To understand any of this, you have to have a deep understanding of the status quo prior to 1986, when Medicare began “prospective payment” by Diagnosis Related Group (DRG), or even better before 1965 when Medicare invented the formula “Price (P) = Usual, Customary, and Reasonable (UCR)”.
There is almost no one setting a budget or sending a bill that was working, or even alive, in 1965 (I was 15 years old). 56 years of centrally administered “prices” has done its work and I don’t have much hope that legislation such as the one you describe here has much chance of setting things right.
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