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If they pay 20% of price A and the insurance theorethically covers 80% of A, but in actuality pays only B << 0.8 A, then that sounds like fraud.
by revelation 14y ago
If they pay 20% of price A and the insurance theorethically covers 80% of A, but in actuality pays only B << 0.8 A, then that sounds like fraud.
- pbreit 14y agoBecause everyone in all industries pays list price. Right.
- voodoomagicman 14y agoThe problem isn't the insurance negotiating a discount - it is that if your insurance has agreed to pay 80% of the cost of your care, and then is able to negotiate a discount, you should pay 20% of the discounted price, not 20% of the pre discount price.
- SoftwareMaven 14y agoI've never not had my co-insurance portion be anything but the percentage of what their negotiated rate was. I don't know if it is fraud, but breach of contract would probably apply if you did (assuming it wasn't in the fine print).
- deleted 14y ago[deleted]