Originally Posted By: CivicFan
here is how the prices work in the hospital.
1. Every procedure has a price in the price master.
2. Every payer type negotiates a deal, a contractual adjustment, to the price.
3. The size of the adjustment is determined by the negotiating power of each party.
4. The uninsured patient has the least power so receives the least contractual adjustment. In the Catholic healthcare, they receive the same adjustment as the weakest commercial insurance payer (usually around 20%). In most other hospitals, the discount is 5%.
5. The only power the uninsured person has is to not pay the bill. It's quite a powerful tool but is akin to MAD - mutually assured destruction.
The lunacy of this practice is the type of thing that should have been addressed in "healthcare reform" - which of course wasn't.
A simple example is basic dental cleanings. When employed, I had dental insurance and with the negotiated price, the dentist got like $85 for this routine procedure. After being losing the insurance, it cost me $125 paying out of pocket. He had the money in his account the next day and had no expenses from his billing personnel.
As to hospital costs, I have a friend who is a IBEW member. He works and gets paid very well and then gets layed off. While waiting for his turn in the line to come up, he has had surgical procedures twice, and was able to get the hospital to write off the entire bill on one occasion, and cut the bill in half on the other. All within a calendar year of making around $50K. Poor schlubs like me then get hosed for the full amount, and end up making up for the hospital's "losses".
There has to be a better, more equitable way to address these situations.
here is how the prices work in the hospital.
1. Every procedure has a price in the price master.
2. Every payer type negotiates a deal, a contractual adjustment, to the price.
3. The size of the adjustment is determined by the negotiating power of each party.
4. The uninsured patient has the least power so receives the least contractual adjustment. In the Catholic healthcare, they receive the same adjustment as the weakest commercial insurance payer (usually around 20%). In most other hospitals, the discount is 5%.
5. The only power the uninsured person has is to not pay the bill. It's quite a powerful tool but is akin to MAD - mutually assured destruction.
The lunacy of this practice is the type of thing that should have been addressed in "healthcare reform" - which of course wasn't.
A simple example is basic dental cleanings. When employed, I had dental insurance and with the negotiated price, the dentist got like $85 for this routine procedure. After being losing the insurance, it cost me $125 paying out of pocket. He had the money in his account the next day and had no expenses from his billing personnel.
As to hospital costs, I have a friend who is a IBEW member. He works and gets paid very well and then gets layed off. While waiting for his turn in the line to come up, he has had surgical procedures twice, and was able to get the hospital to write off the entire bill on one occasion, and cut the bill in half on the other. All within a calendar year of making around $50K. Poor schlubs like me then get hosed for the full amount, and end up making up for the hospital's "losses".
There has to be a better, more equitable way to address these situations.
