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.
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.