dealing with medical costs in an HDHP

[CivicFan]

Originally Posted By: JHZR2
Originally Posted By: CivicFan
With insurance, you get charged the negotiated rates for your deductible. So, you are effectively taking advantage of the negotiating power of your health insurer.

As self pay, you would be paying the gross charge (the basis). Some not-for-profit providers will have an adjustment for uninsured patients. Normally, this discount is less than the negotiated discount by the health insurer.

If you think that the provider did not appropriately take the discount, you could first contact your insurance company and talk to them. You need what is called an "EOB" or "Explanation of Benefits". That will spell out the gross charges and the adjustment.

It is possible that the provider has not applied the proper adjustment.

Welcome to the free market of health care.

And best of luck. This is going to consume quite a few hours of your life. just make sure you do not end up in a collection agency.


But that was my point, how do I know that I am truly getting the actual "negotiated" rate for this service? Am I to just take their word for it that the adjustment they provided is correct? Seriously, $1000/hr is a bit extreme.

Or do I call the insurance company and ask them what the correct negotiated rate is?

I will ask for a complete EOB from the provider. Thanks!


Talk to your insurer and see what the proper charges should be. My wife had a similar situation where the doctor was charging us gross charges for our deductible and not the negotiated rates. It took her about 3 months and numerous calls to the insurance company and the doctor, and calls from the insurance company to the doctor, to have the doctor's office fix the issue. It's a very stressful process.

 

[kb01]

I've had a HDHP since they were first rolled out back in 2005 or 2006.

The biggest issue I've seen is that providers often want their billed rate upfront and will then reimburse the difference between it and the contract rate once the EOB is cut. It acts essentially as a cash deposit in case insurance rejects the claim, patient is no longer insured, etc.

It can really complicate matters when they want payment upfront for a significantly inflated rate. My wife's OB wanted $5,000 up front to cover her deductible for pre-natal care. When it only cost $3,000 we had to hound the provider for our $2,000 refund. It was a long, painful process to get the money they owed us back, made even worse by the fact that we owed the hospital an equivalent amount. Our HSA was drained, so we didn't have any money to give the hospital until the OB refunded our money. The whole thing was a headache.

We can no longer afford insurance ($1,000/month going up to $1,200/month), so we're scoping out individual policies. We're probably switching over to one with a $10,000 deductible. The reduced premiums will be nice but it will be pretty awful if we have a major hospitalization.

 

[kb01]

Originally Posted By: JHZR2

But that was my point, how do I know that I am truly getting the actual "negotiated" rate for this service? Am I to just take their word for it that the adjustment they provided is correct? Seriously, $1000/hr is a bit extreme.

Or do I call the insurance company and ask them what the correct negotiated rate is?

I will ask for a complete EOB from the provider. Thanks!


The provider will bill your insurer and then your insurer will cut an EOB with all of the adjusted information based on contract prices.

 

[CivicFan]

The key is, once they have your money, they have no incentive to cooperate with you. Is true for almost any aspect of our lives.

 

[kb01]

Originally Posted By: CivicFan
The key is, once they have your money, they have no incentive to cooperate with you. Is true for almost any aspect of our lives.


Absolutely. We can pretend a doctor is better than a typical contractor but in the end, it's exactly the same thing. It would be nice if they were more flexible, like paying half up front and the other half when they complete the job, but that doesn't seem to be an option for medical services around here.