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A quarter million US dollars. Of course the hospital never expects to receive this amount of money. Either they will negotiate it down for uninsured patients,
by jzwinck 5y ago
A quarter million US dollars.
Of course the hospital never expects to receive this amount of money. Either they will negotiate it down for uninsured patients, or they will accept a lesser amount from the insurance company.
Insurance companies like this over representation of costs because:
1. If you have a percentage copay (edit: "coinsurance"), say 10%, they will tell you to pay $25k because it's 10%, but they might only pay $75k. In this example you clearly paid 25% but they tell you it's only 10%.
2. A quarter million dollars is terrifying and you better not ever lose your insurance.
- axiosgunnar 5y ago> If you have a percentage copay, say 10%, they will tell you to pay $25k because it's 10% [of $250k], but they might only pay $75k [after negotiating the $250k down to $75k]. That's fraud.
- jzwinck 5y ago250k not 2.5M. But yes I agree the practice seems fraudulent.
- axiosgunnar 5y agooops yes you're right, fixed.
- londons_explore 5y agoIf you have enough $$$'s, you can probably argue that in court and win... But you'd just win a refund of some of the copay.
- Cthulhu_ 5y agoNope, it's fraud and the insurance company will / should be destroyed. But they will probably settle out of court for the damage + a little extra to not be stuck in court for a decade.
- deleted 5y ago[deleted]
- PragmaticPulp 5y ago> That's fraud. Yes, exactly, which is why it doesn’t actually happen. I’m not sure where the OP got this idea, but this isn’t how insurance billing works in the United States.
- deleted 5y ago[deleted]
- chadash 5y ago> If you have a percentage copay, say 10%, they will tell you to pay $25k because it's 10%, but they might only pay $75k. In this example you clearly paid 25% but they tell you it's only 10%. I think this is coinsurance, not copay. Copay is the $50 (or whatever) flat fee you pay every time you see a specialist. Coinsurance is a percentage of costs that you share with the insurance company, up to some maximum out of pocket amount. I believe that this percentage is always on the negotiated rate, not on the original charge.
- 100011_100001 5y agoA lot of insurance companies will have a 10-20% coinsurance for hospital visits, not a traditional co-pay like you went to a specialist. That 10-20% goes against the deductible, so depending on the bill you might not even pay the full 10% because it hits your deductible max. Edit: I was informed that it's not 10% co-pay but coinsurance. So I updated my post to reflect that.
- astura 5y agoThat kind of cost sharing is called coinsurance, not copay. Most policies have deductibles, coinsurance, and copays as types of cost sharing. Coinsurance you pay is also against the amount that insurance pays (negotiated rate)
- 100011_100001 5y agoThanks for the clarification on coinsurance.
- sumtechguy 5y agoThat is highly dependent on what your plan is. Some plans are flat co pay. Some are percentage. Some are mixed. Some max out at particular amounts, some dont depending on the care you are doing.
- jzwinck 5y agoThanks I edited my comment to say it's called coinsurance. But the point is the same, and in my experience it is not always based on the final negotiated amount actually paid to the healthcare provider.
- 100011_100001 5y agoAt least for the insurance I have had over the years the insurance caps are applied prior to the co-pay. In some bills you can see the charge, and how much the insurance paid instead. My 1 week old was in a neonatal ICU for 2 weeks. This included an ambulance run from one city to another one 1 hour away because they original NICU didn't have the right equipment. Total bill was $97,000, insurance bumped it down to $68,000.
- jtbayly 5y agoI'm seriously doubting claim #1. Can you back it up?
- jzwinck 5y agoIt happened to me in the US and I asked a friend who was a practicing medical doctor at the time, plus another person who worked at a major insurance company. They both confirmed it can be done.
- xyzzyz 5y agoIt doesn’t actually happen. When you get a bill, you can see clearly how much hospital charged, how much insurance negotiated down, and how much is your share. If insurance sent you this, but then secretly conspired with hospital to pay even less than what they told you they pay, that would be criminal fraud. Suffice to say, this almost never happens.
- IG_Semmelweiss 5y agothat's not correct. Coinsurance is calculated on the contracted amount / allowable amount. The latter is the negotiated amount that insurance will pay SOURCE: Medical billing experience (Edited for typos).
- shados 5y agoHow does #1 work in practice? I've went through several insurance providers over the years, and they always have "Amount billed by the provider", "amount negotiated", "co-insurance" which is on the amount negotiated.
- skeletal88 5y agoThe obligatory comment about how crazy this is on many levels. 1. You are being charged prices that you are not expected to pay, but need to negotiate on 2. When you go to a doctor to have a procedure or have an emergency then you don't know what you are paying. In normal countries there is A price list, which is THE price list for all hospitals that are part of the national health care system. If they want to have a contract with the national health insurance, then they need to agree to these prices for all the possible procedures. So when someone is saying "but we can't be sure of the price, maybe there are complications and additional costs" then this is bs, many-many other countries manage to have fixed price lists. Or maybe there is an item there for exceptional cases, when something addtional needs to be done in addition to the original procedure? Either way, it's already handled, the patient doesn't need to worry about this stuff. And the same goes for private clinics, they also have a fixed price list, nobody would go to them if you could get a surprise bill that would be 2-3-10x the amount originally agreed upon, that would be insane and.. very bad PR for the clinic.
- IggleSniggle 5y agoJust out of curiosity, which normal countries do you have experience with in this regard?
- _aplt 5y agoFrance, Belgium operate like this. Although in Belgium I've found out that you can still have unexpected costs because for some reason, only one type of procedure per day can be reimbursed. Which means if you have a problem that takes two (or more) ultrasound scans to be diagnosed, only one of those will get reimbursed and you'll have to pay for the others. This happened to us with our kid, first hospital did a scan, concluded that we should go to the children's hospital close by for better treatment, the doctor there did a scan there the same day to see for himself (at 23:30! half an hour later and it would have been reimbursed) and of course this one had to be paid for. Which is beyond stupid IMO. Well at least it wasn't US-level prices.
- opwieurposiu 5y agoWe took a baby to the hospital while in NZ. Thought baby had chicken pox, turned out to be just "Hand Foot Mouth" which is not as bad. There was a big price list on the wall at check in. Paid $70 up front and baby got to see a german doktor, all done in half an hour. I think the price was cheaper or even free if you were a NZ citizen.