Do health care facilities charge private pay patients more than health insurance companies ?
Question:
Answer:
The answer, as with everything in life is yes and no.
Let's start off with your first two questions, by law, Health Care Provides (HCP) must "charge" everyone the same. HCP's will negotiate discounts with insurance and other payors to that charge. It's already against the law to "charge" people different amounts. The key work is CHARGE, what finally gets paid to the HCP is based on negotiations with the various payors.
Insurance companys negotiate for large groups of people every year or two. Even then there are items that come up that the insurance company will have to pay charges for that item or the HCP will have to eat the cost because it was excluded from the conrtact.
Very few private pay patients pay charges especially in the community hospital environment. The boutique hospitals, plastic surgery centers are the one's that usually fix a charge and stick with it. Normally, they won't even accept insurance payments.
Most HCP's will negotiate a price either a flat fee or a price based on charges. If you have the means to pay you and it's not an emergency, you should negotiate with the HCP prior to the services being given. That way you knkow what it will cost and you can shop around.
If it is an emergency situation you will need to work with the HCP to negotiate what you will end up paying. You need to know that, if you start with the line, "I can't afford to pay this" the first thing they will do is try to convert you to free care. That is the only way the HCP can get any money if you are unable to pay. To do that, the HCP is required to verify your financial data to make sure that you meet the free care standards.
If you are able to pay something, just not the full charge then you should be able to negotiate a payment equal to one of their big insurance payors without any problem. My suggestion is to set up a meeting with their Director of Reimbursement and the CFO. The CFO is usually the person, the by-laws of the organization allows to negotiate rates.
The most you should pay is about 60% of charges, unless you're talking a transplant of some kind. Then you will need to add in the cost of the organ or implant.
If you can't afford that, you will probably need to provide some kind of financial information to the HCP to negotiate a lower payment. If the payment is lower than what Medicare is paying, some states and/or institutions require financial documentation to show why that payment was agreed to.
Good luck. Most HCP want to have a fair resolution and most will accept the Medicare rate, the local Blue Cross rate or the rate for the largest HMO in the area.
I just hope that you aren't some rich SOB trying to get something for nothing because you're entitled to it. If you are I hope the HCP stands tough and get's every dime they can.
It really depends on the negotiations. Recently patient
advocacy is becoming increasingly popular. That way
you as an individual can negotiate a final cost with
the hospital just like the large insurance companies
can. Patient advocate will help you in this regard.
Check out the information and the video below.
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