Does a lower self-pay rate necesarilly mean cheaper for your insurance?

[Guest BikiniBeachy]

I have insurance that only covers $7,500 of surgery....so I have to find the cheapest place, but is that the same as self-pay if it's the rate they charge my insurance?

[ssdown 0]

You often times get what you pay for. I would think that the ethical way for a doctor's office to bill for a procedure is the same for self-pay and insurance. At least you have some insurance to help you out. I had none and paid $16,000 out of pocket. Ask around at your support meetings. There's lots of information there. SS

Edited May 26, 2008 by ssdown

[MacMadame 81]

Usually they charge your insurance more because they know that they won't get all the money they charge. However, if they have a contract with your insurance company, that means they have agreed to except what your insurance company says is a usual and customary charge. So they shouldn't charge more than that. If they try to get you to pay the difference, find some place else!

[Melle 0]

I am wondering the same thing because my insurance pays 90% with a lifetime max of $8000. I am pretty sure that you pay more if you self-pay. When insurance is paying, they usually negotiate stiff discounts that fall under the "usual and customary" clause. For example, my statement from Cigna about a toe surgery I had listed the Dr billed $590, then showed the discount and that the insurance paid $136. I owe nothing.

I hope this is the case with this surgery too.