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The worse case of this is with medical billing in the US. Health insurance companies get discounts while individuals do not...

philwelch 6y ago
Sure they do. I’ve negotiated discounts on medical bills a few times.
- dazhbog 6y ago
  From 1000% markup to 500% markup?
  - philwelch 6y ago
    I’ve gotten the exact same price the insurance company pays pretty consistently, and sometimes even less.
    - ensignavenger 6y ago
      I've attempted to negotiate medical bills and gotten no where in the past, so that's another anecdote.
      - camhart 6y ago
        Did you have insurance? If you do not, they're a lot more willing to negotiate.
      - philwelch 6y ago
        Yeah, to clarify, all of my successes were before Obamacare.
- lotsofpulp 6y ago
  It’s not the same to discount a bill (that you legally owe) compared to an insurance company having pre negotiated prices. If a healthcare provider decides to lower the amount they claim you owe because they believe it will cost them more to pursue you more than they will receive, that’s different than agreeing to a price before the services or products are exchanged.
  - philwelch 6y ago
    Sure, and that’s exactly what I’ve done, too. I have agreed to discounted prices, with surgeons, before the surgery was performed. I am not an insurance company. It only requires asking.
    - lotsofpulp 6y ago
      I haven’t had success with that. It’s hard enough to just get procedure codes out of them so that I can ask the insurance company how much something will cost.
      - camhart 6y ago
        My experience has been the CPT codes change a lot once the procedure is complete. I even had an estimate for a surgery at $1800, but the final bill (including everything like anesthesia), heavily discounted because I'm in a healthshare (not considered insurance), came out to ~$10k (instead of ~$18k without the discount). Nothing went wrong/crazy in the surgery--and it was a fairly standard one. Once I paid the 10k, several months later I got ~$600 back saying I'd over paid, but they didn't include an explanation. Hospital pricing is a strange beast.
        philwelch 6y ago
        Yikes. Stories like this make me increasingly think about options like Surgery Center of Oklahoma if I ever need a procedure done and I have crappy or nonexistent insurance. (https://surgerycenterok.com/ https://surgerycenterok.com/)
      - philwelch 6y ago
        I never asked for procedure codes and it’s possible that since Obamacare, health care has gotten so bureaucratic and regulated that it’s no longer possible to do what I did. I never dealt with “procedure codes” and we didn’t have insurance. I just called the doctors office after finding out surgery was needed but before it was scheduled to get a cash estimate for the procedure and negotiate the price, and we made a deal, and then during one of the pre-op consults the doctor herself gave us a new written estimate with even more of a discount. For a different procedure, a different surgeon just gave us an estimate based on the insurance rate and when I asked if he could do more, he just said, “well if you do XYZ for the rest of your life you could just not have the surgery” and walked away like a rock star. Which is fine, hilarious in retrospect, but the insurance rate was enough of a discount and his point was valid.
camhart 6y ago
If you do not have insurance, then most medical bills will be discounted. However if you have insurance, they won't give you a discount beyond what the insurance company negotiated. I'm part of a healthshare, which isn't considered insurance, so whenever I have a health care bill, I ask for a "self insured discount", and most places give anywhere from 10-50% discounts (the more common in my experience being closer to the 50%). In my experience labs (blood work) tend to have smaller discounts (10%) compared to hospitals (35-50%).
- thephyber 6y ago
  I think your parent is referring to the fact that most medical bills are not discounted until the individual haggles after the bill is already sent. The sticker shock[1] can be quite something. You seem to already know how what to tell the billing department but I'd wager most Americans don't. Example: some hospitals have tried taking their debt collections against low income individuals/families to court and have gotten wages garnished. Those same class of defendants have won something close to 100% of cases with the help of pro bono lawyers who help get those bills adjusted to something reasonable. The list price for medical services in the US is ridiculous, but that's because not everyone knows that hospitals don't expect almost anyone to pay list price -- and also because those hospitals get to write off the discounts as losses for tax purposes. [1] https://www.vox.com/policy-and-politics/2019/1/7/18137967/er-bills-zuckerberg-san-francisco-general-hospital https://www.vox.com/policy-and-politics/2019/1/7/18137967/er...
  - Spivak 6y ago
    Yeah, but the negotiating position is "if you don't discount this significantly I won't (and probably can't) pay it and you'll get pennies when you sell my bill to a debt collection agency." It's not "I think x,y,z should are overpriced."
  - toast0 6y ago
    > and also because those hospitals get to write off the discounts as losses for tax purposes. If they're following accrual accounting, they earned income (at list price) when they performed thr procedure. If later it turns out they accept less money for it, the discount should be subtracted from their taxable income to reconcile. Most business don't use cash accounting. It's not rational to be excited to write off a discount; yes, it reduces your taxable income, but only because it reduced your actual income.

philwelch 6y ago

Sure they do. I’ve negotiated discounts on medical bills a few times.

dazhbog 6y ago
From 1000% markup to 500% markup?
- philwelch 6y ago
  I’ve gotten the exact same price the insurance company pays pretty consistently, and sometimes even less.
  - ensignavenger 6y ago
    I've attempted to negotiate medical bills and gotten no where in the past, so that's another anecdote.
    - camhart 6y ago
      Did you have insurance? If you do not, they're a lot more willing to negotiate.
    - philwelch 6y ago
      Yeah, to clarify, all of my successes were before Obamacare.
lotsofpulp 6y ago
It’s not the same to discount a bill (that you legally owe) compared to an insurance company having pre negotiated prices. If a healthcare provider decides to lower the amount they claim you owe because they believe it will cost them more to pursue you more than they will receive, that’s different than agreeing to a price before the services or products are exchanged.
- philwelch 6y ago
  Sure, and that’s exactly what I’ve done, too. I have agreed to discounted prices, with surgeons, before the surgery was performed. I am not an insurance company. It only requires asking.
  - lotsofpulp 6y ago
    I haven’t had success with that. It’s hard enough to just get procedure codes out of them so that I can ask the insurance company how much something will cost.
    - camhart 6y ago
      My experience has been the CPT codes change a lot once the procedure is complete. I even had an estimate for a surgery at $1800, but the final bill (including everything like anesthesia), heavily discounted because I'm in a healthshare (not considered insurance), came out to ~$10k (instead of ~$18k without the discount). Nothing went wrong/crazy in the surgery--and it was a fairly standard one. Once I paid the 10k, several months later I got ~$600 back saying I'd over paid, but they didn't include an explanation. Hospital pricing is a strange beast.
      - philwelch 6y ago
        Yikes. Stories like this make me increasingly think about options like Surgery Center of Oklahoma if I ever need a procedure done and I have crappy or nonexistent insurance. (https://surgerycenterok.com/ https://surgerycenterok.com/)
    - philwelch 6y ago
      I never asked for procedure codes and it’s possible that since Obamacare, health care has gotten so bureaucratic and regulated that it’s no longer possible to do what I did. I never dealt with “procedure codes” and we didn’t have insurance. I just called the doctors office after finding out surgery was needed but before it was scheduled to get a cash estimate for the procedure and negotiate the price, and we made a deal, and then during one of the pre-op consults the doctor herself gave us a new written estimate with even more of a discount. For a different procedure, a different surgeon just gave us an estimate based on the insurance rate and when I asked if he could do more, he just said, “well if you do XYZ for the rest of your life you could just not have the surgery” and walked away like a rock star. Which is fine, hilarious in retrospect, but the insurance rate was enough of a discount and his point was valid.

camhart 6y ago

If you do not have insurance, then most medical bills will be discounted. However if you have insurance, they won't give you a discount beyond what the insurance company negotiated. I'm part of a healthshare, which isn't considered insurance, so whenever I have a health care bill, I ask for a "self insured discount", and most places give anywhere from 10-50% discounts (the more common in my experience being closer to the 50%). In my experience labs (blood work) tend to have smaller discounts (10%) compared to hospitals (35-50%).

thephyber 6y ago
I think your parent is referring to the fact that most medical bills are not discounted until the individual haggles after the bill is already sent. The sticker shock[1] can be quite something. You seem to already know how what to tell the billing department but I'd wager most Americans don't. Example: some hospitals have tried taking their debt collections against low income individuals/families to court and have gotten wages garnished. Those same class of defendants have won something close to 100% of cases with the help of pro bono lawyers who help get those bills adjusted to something reasonable. The list price for medical services in the US is ridiculous, but that's because not everyone knows that hospitals don't expect almost anyone to pay list price -- and also because those hospitals get to write off the discounts as losses for tax purposes. [1] https://www.vox.com/policy-and-politics/2019/1/7/18137967/er-bills-zuckerberg-san-francisco-general-hospital https://www.vox.com/policy-and-politics/2019/1/7/18137967/er...
- Spivak 6y ago
  Yeah, but the negotiating position is "if you don't discount this significantly I won't (and probably can't) pay it and you'll get pennies when you sell my bill to a debt collection agency." It's not "I think x,y,z should are overpriced."
- toast0 6y ago
  > and also because those hospitals get to write off the discounts as losses for tax purposes. If they're following accrual accounting, they earned income (at list price) when they performed thr procedure. If later it turns out they accept less money for it, the discount should be subtracted from their taxable income to reconcile. Most business don't use cash accounting. It's not rational to be excited to write off a discount; yes, it reduces your taxable income, but only because it reduced your actual income.