Insurance versus Self-pay

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AmyQ
AmyQ Member Posts: 2,182
edited October 2015 in Employment, Insurance, and Other Financial Issues

Can anyone help me to understand why an insurance company can and usually does pay significantly less dollars to a facility or physician and the balance is written off when self-pay is required to pay the entire non-negotiable balance. In other words, if I am uninsured and receive a bill for an office visit for $250, I am expected to pay the full $250. However if I have insurance, their algorithm would say they have negotiated an office visit max payout to be $75 and the balance, $175 is not paid, nor not due by the patient and is written off by the clinic. I don't understand. This adds further financial burden to the uninsured. Do clinics or physicians negotiate?

Amy


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  • rainnyc
    rainnyc Member Posts: 1,289
    edited October 2015

    AmyQ, physicians and offices definitely negotiate, both for the uninsured and for the insured when there is a gap between what's covered and what isn't.

    Example, one of our doctors isn't in our family's insurance plan, but we have good reasons for keeping her (longtime relationship). I was upfront with their office when we went onto this insurance plan that we'd be paying out of pocket. When I get a bill from them, it is substantially discounted.

    So don't be afraid to negotiate. I believe the consumer reports health website has more advice about how to handle this.

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  • MelissaDallas
    MelissaDallas Member Posts: 7,268
    edited October 2015

    When I had ovarian cancer I had just had my hours cut to part time & I had lost my insurance. I met with the hospital social worker & they evaluated my income & assets. My hospital & all the providers then discounted my bill 90%

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  • proudtospin
    proudtospin Member Posts: 5,972
    edited October 2015

    when I was first diagnosed, my surgery was at a Catholic hospital. When I got the first bill, I hit the roof! so called them and asked to negotiate the cost, they were fine with that

    so do try to negotiate and be honeset

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  • exbrnxgrl
    exbrnxgrl Member Posts: 12,424
    edited October 2015

    AmyQ,

    I have no explanation about the differences in charges, but my experience (limited) has been when I needed a provider that my insurer would not cover, I was able to negotiate some decent cash only payments.

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  • AmyQ
    AmyQ Member Posts: 2,182
    edited October 2015

    Thank you. My daughter had no insurance while briefly unemployed, but needed medical treatment to the tune is $750. I'm going to suggest she work out a lower fee

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  • WinningSoFar
    WinningSoFar Member Posts: 951
    edited October 2015

    The reason that insurance companies pay lower prices is that they negotiate prices ahead of time and they do enough business with the hospital to get their attention. An individual has no negotiating power and they don't negotiate until after the fact. That's the hard truth.

    Still, please do negotiate. And keep negotiating. I had a friend who negotiated with a hospital and settled with them by signing over her house. That was crazy, IMO. She settled WAY too soon.



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  • peggy_j
    peggy_j Member Posts: 1,700
    edited October 2015

    Sorry you're experiencing this. Yes, the insurance companies negotiate.

    FWIW, some doctors will take it as a business write-off if they don't get their full fee paid. (so, for example, if you are able to negotiate the $750 down to $500, they might write off the $250 as a business loss, which helps with their taxes).

    Some hospitals/doctors offices have social workers to help out with issues like this. Or perhaps your local cancer support center can point you in the right direction.


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  • AmyQ
    AmyQ Member Posts: 2,182
    edited October 2015

    Thank you all - I'll have my daughter call and plead her case.

    Amy

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