4 ms·

#2 is illegal under Medicare/Medicaid rules. We are required by law to charge the same price to all payers, including patients. We can't offer a cash discount

by riahi 10y ago

#2 is illegal under Medicare/Medicaid rules. We are required by law to charge the same price to all payers, including patients. We can't offer a cash discount at the time of service, as it is Medicare fraud. We can charge you, accept a lower payment, and then write off the rest as a loss. In your example, who is this magic insurer? Which reimbursement rate are we setting as the bar? I hope its not medicare or medicaid, as they often reimburse below cost. Is it the highest negotiated reimbursement a given imaging center has negotiated? Each of these contracts are negotiated individually between the payers and the imaging center. Because of the variable reimbursement and the federal requirement that one price be charged to EVERYONE, you see huge markups lest you undercharge a payer that would have paid the full amount.

zimzam 10y ago
I think you misunderstood. The poster is saying that if the prices are as follows: Sticker price (uninsured people pay this): $5000 Insurance A in-network price: $2100 Insurance B in-network price: $2300 Insurance C in-network price: $1800 Medicare price: $800 That anyone paying without insurance (cash) should be able to pay the $800 Medicare rate since it is the lowest rate. That's not asking for a cash discount but rather forbidding price discrimination.
- riahi 10y ago
  Medicare and Medicaid often reimburse below cost. Healthcare businesses make up the difference from private insurance. By forcing people to accept the lowest rate (which is not negotiated, but effect by decree), you absolutely destroy the funding for services. Good luck keeping any healthcare facilities open at those reimbursement rates. Medicare is allowed to set prices by fiat for physician and hospital services. It is barred by law from negotiating on medications. Perhaps the ire should be directed there.
patrickg_zill 10y ago
My personal view is that most people would be OK with the lowest non-Medicare rate, i.e. "the free market rate". Why Medicare reimburses at an unprofitable rate is another discussion.

by riahi 10y ago

zimzam 10y ago

I think you misunderstood. The poster is saying that if the prices are as follows: Sticker price (uninsured people pay this): $5000 Insurance A in-network price: $2100 Insurance B in-network price: $2300 Insurance C in-network price: $1800 Medicare price: $800 That anyone paying without insurance (cash) should be able to pay the $800 Medicare rate since it is the lowest rate. That's not asking for a cash discount but rather forbidding price discrimination.

riahi 10y ago
Medicare and Medicaid often reimburse below cost. Healthcare businesses make up the difference from private insurance. By forcing people to accept the lowest rate (which is not negotiated, but effect by decree), you absolutely destroy the funding for services. Good luck keeping any healthcare facilities open at those reimbursement rates. Medicare is allowed to set prices by fiat for physician and hospital services. It is barred by law from negotiating on medications. Perhaps the ire should be directed there.

patrickg_zill 10y ago

My personal view is that most people would be OK with the lowest non-Medicare rate, i.e. "the free market rate". Why Medicare reimburses at an unprofitable rate is another discussion.