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View Diary: First Doctor Visit in Five Years: Why Repubs Want Us Broke or Dead (224 comments)

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  •  The rates quoted in the diary... (22+ / 0-)

    ...are not the rates set by the insurance companies, but are the "retail rates" that the providers set.

    In some respects, this is the nastiest part of the scam -- that blood work that would have cost the diarist $1000 without insurance is the non-negotiated rate that only those without insurance will ever actually pay.

    The negotiated rates through insurance companies are much, much lower.

    I've seen this whenever I get blood work done through my doctor's office.  When I receive the insurance statement, I will see four different numbers.

    The first number is the billed amount, which might be $500.

    The second number is the allowed amount, which will be much lower, perhaps around $90 (yes, it is usually a small fraction of the billed amount for lab work).

    The third number is what the insurance company will pay, which would be $72, if I've hit my deductible.

    Finally, the fourth number is what I'll need to pay out of pocket, which would be $18.

    Note that the big savings here doesn't come from what the insurance pays, but instead from the negotiated discount.

    Political Compass: -6.75, -3.08

    by TexasTom on Wed Mar 26, 2014 at 05:57:06 AM PDT

    [ Parent ]

    •  Exactly. The worst part of current (12+ / 0-)

      system is that uninsured individuals pay MORE than insurance companies would pay for an insured person.

      For example, I recently was sick and was prescribed medicine. At first my insurance didn't go through at the pharmacy and the medicine was rung up at $150. Then the insurance went through and the amount the insurance company was billed was $50. My co-pay $5.

      So the insurance company negotiates a discount of one-third the price an uninsured person would pay.

      •  Those prices listed for the uninsured (6+ / 0-)

        are nonsensical. From what I've read, the pricing is more related to some wild ass guess than it is related to actual cost of service/procedure delivery. When treatment and hospital pricing has been questioned, some health care execs have sputtered, "Oh, but no one actually pays that amount!"

        Maybe the providers get bigger write-offs with those high prices, or get better negotiating power with insurance companies.

        I did have evidence that pricing was not so fixed when I was uninsured for several years before  becoming eligible for Medicare. Luckily, the worst that happened was some skin cancers and one emergency room visit for xrays and stitches. Both dermatologist and ER hospital were willing to negotiate the billed amounts. Otherwise, when I really, really needed to see a doctor I could find one that would reduce the office visit charge to $50 or $60. This is not to say that my situation was ideal; only that the "list price" for medical care is not a fixed price.

    •  Yes, fortunately I have been blessed to have (7+ / 0-)

      good insurance through my employer, and now on Medicare, but I was always upset at the scam of pricing.  

      Why should people who are fortunate enough to work for a company that has sufficient negotiating power to force providers to lower their prices get lower cost health care?  

      It's really another gift to corporations - they get a tool to attract good employees at an artificially low cost to them.  And another GOP tool to shaft the working poor.

      “The future depends entirely on what each of us does every day.” Gloria Steinem

      by ahumbleopinion on Wed Mar 26, 2014 at 08:16:29 AM PDT

      [ Parent ]

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