How does health insurance REALLY work?

[tinksmom 0]

Anyone? Anyone?

This is not just about weight loss surgery. I have been to a local surgical center for several procedures. Each time I am handed a sheet with the cost of the procedures and, in the next column, my insurance company's negotiated price. I obediently pay my percentage of that, then look at the original numbers in disbelief. For an operation that the facilty charges the uninsured $20,000, insurance (and I) anted up $7000. Another time it was $9500/$1700. These places actively court the insured, so they must make money on these payments. I know there is very little discount for self-pays, as a friend had a similar spinal procedure and paid close to the full price quoted me. The statements for doctor fees...surgeons, GP's, and specialists..show a similar range. Wouldn't you think cash payers would get more of a discount? Wouldn't we be able to afford to offer health care to more people if we were able to pay a larger percentage of the much lower amounts before insurance kicked in? It boggles the mind.

[Katy517 1]

My understanding is that in many cases there are different prices for cash pays vs. insured so the prices you're referring to are those that are billed to insurance companies knowing there will be a significant reduction in the amount actually payed. I know a few people who are cash payers for healthcare (they consider themselves to be self-insured) and they typically negotiate prices for large ticket medical expenses in advance at greatly reduced prices to what gets billed out to insurance companies.

[kelking 0]

Providers (doctors offices, hospitals....) become part of a (many times several) networks. Within these networks there are negotiated prices which they agree to accept for these services. Anything else above and beyond that negotiated price they agree to write off. I believe the reason their 'off the shelf' price is so high is to help accommodate for the number of people that do not have insurance and do not fully pay their bills. (IMHO, one of the major problems with health insurance today.) One thing that many people do not know is that there are companies out there that will help you negotiate a lower bill with or without insurance. In most cases, if they are able to negotiate you a lower bill, they will take a percentage of the savings. Here is one of those companies....INSNET (no I am not affiliated with this company...I work for a company that sells insurance and I used to have an insurance license.)