Why do people w/out insurance have to pay the highest rates?

[duid12]

Why, if I have insurance and get a procedure done, does the hospital get paid $xx dollars, but if I don't have insurance, and I have the same procedure done they charge a lot more for the same?

Shouldn't people w/out insurance get charged at least the same as those with? Why do they gouge people that are least able to afford it?

[Abe Linkman]

1. It's the way the procedure works

You must be referring to the greatest healthcare system on the planet:
The United States of America. It could only happen here.

[bearfan454]

2. I noticed that too because

recently I had a colonoscopy and and endonoscopy done. Without insurance it would have been 1500. But they "contracted" with the insurance and it was only 400. My copay is 86. Fucked up huh ? But I am happy with an 86 copay.

[sirshack]

3. Because....

Why, if I have insurance and get a procedure done, does the hospital get paid $xx dollars, but if I don't have insurance, and I have the same procedure done they charge a lot more for the same?

Because your insurance is picking up the rest of the cost. That's why you have it, presumably.

Shouldn't people w/out insurance get charged at least the same as those with? Why do they gouge people that are least able to afford it?

They probably do. The difference is they're basically going it alone if they don't have insurance to pick up some of the tab. For instance, my friend recently had to get a prescription for some medicine after having a procedure done. His insurnace picked up the cost of the medicine because it's part of his policy. He paid for it out of his pocket, and sent the insurance company the bill. He got reimbursed a week later or so.

Now, if you don't have insurance, obviously you have no one to send the bill too.....so you're on your own paying for it.

[duid12]

6. you misunderstood

No no. If you have insurance the hospital charges $X for a procedure...you pay some, the insurance company pays the rest....if you don't have insurance the hospital charges more for the exact same procedure...I am not talking about allocating the cost between me and the ins company...they CHARGE more in total to those w/out insurance...

[MiltonLeBerle]

8. you misunderstand the question-

Insurance companies pay less per procedure than a non-insured person having the exact same procedure-

for instance(using totally arbitrary numbers)-

two people have colonoscopies, one person has insurance, the other doesn't

the cost of the procedure is say, $1200.00- that's what the uninsured person #1 pays.
but for the insurance company that's picking up the cost of the procedure for the insured person #2, the bill will only be about $400.00-

the same procedure- the hospital gets $1200.00 from the uninsured person, but only $400.00 from the insurance company, which has the power to negotiate volume discounts.

[MiltonLeBerle]

9. you misunderstand the question-

Insurance companies pay less per procedure than a non-insured person having the exact same procedure-

for instance(using totally arbitrary numbers)-

two people have colonoscopies, one person has insurance, the other doesn't

the cost of the procedure is say, $1200.00- that's what the uninsured person #1 pays.
but for the insurance company that's picking up the cost of the procedure for the insured person #2, the bill will only be about $400.00-

the same procedure- the hospital gets $1200.00 from the uninsured person, but only $400.00 from the insurance company, which has the power to negotiate volume discounts.

[MiltonLeBerle]

4. how do they do it? Volume, Volume, Volume...

Insurance companies are able to negotiate discounts based on the volume of business they do with the hospitals.

It's waaaay beyond fucked-up that the people in the most need are forced to pay the highest rates.

[cherryperry]

5. We don't need a middleperson!

Off the insurance companies...universal healthcare for all - and I don't mean universal access :eyes: !

[CWebster]

7. Negotiated bulk rates?

That it is why it is better to pool resources to get a better return.

[Kolesar]

10. 4 and 7, Milton LeBerle and CWebster are correct

That is what has allowed companies with medical benefits to "control costs" for the last decade. Costs are creeping up now.

Clean air would help, too, if our government would regulate it better!

[1monster]

11. Also depends on the hospital

My husband was in two hospitals in March. The first hospital overcharged us so much for pharmaceuticals that even with the insurance company paying half of what they charged, the hospital made a tremendous profit. AND the hospital still billed us for the nearly $8,000 remainder.

The second hospital had a contract with the insurance company which lowered the overall cost by about $1,200.

With regards to hospitals, you may be able to negotiate a lower payment. If you can make a CASH offer, you may be able to lower it even further.

It nearly broke me completely, but I was able to negotiate that nearly $8,000 down to $1,000 to be paid in 30 days. But it still burns me that hospitals can charge whatever the heck they want. I ran the hospital pharmaceutical charges by a pharmacist friend. He told me that we could have gotten 2,000 tablets retail on one of the drugs for what the hospital charged us for two tablets. :grr:

[Yupster]

12. Because your insurance company

works as your agent and negotiated the rates with the hospital which you don't have as much power to do.

Why does a baseball player want an agent?

Why does a worker want a union?

Because groups have more power to negotiate.