The price of medical care should be the same whether billed to insurance or paid in cash. It seems charging insurance companies more than someone paying cash would drive up the cost of insurance. There should just be one price, that’s it. I know I’ve personally had to opt out of billing to my insurance, which I pay monthly for, because it was going to cost me more to do so. Itemized bills should be part of this as well. I’ve personally had bills from the Emergency room where I was charged nearly $20 for 4 Advil. That’s should not be a thing.
All prices should also me made public and easily accessible to the public, allowing for shopping for multiple opinions and to prevent upcharding itemized services.
This is not correct.
The only way someone who pays cash pays less money is if they pay at the time of visit in full because it decreases the cost of administration to the facility. Insurance Corporations use many tactics to delay payment including making Healthcare facilities chase after denials and agrue about the reason they need to be paid. This is a delay tactic so Insurance Corporations can keep the money invested in the stockmarket longer. It drives up the costs for a Healthcare Facility because they have to pay employees to keep rebilling. That means hourly wages for employees who have to get that reimbursement. It is also the cost of equipment to do the billing and any paper etc that goes into filing the claims. It is also means Doctors have to spend more time explaining what is already known to the Insurance Carrier to get reimursed. Another delay tactic by Insurance. There are more costs involved to the Healthcare Facility when people do not pay cash at the time of visit in full.
If the Healthcare facility has to chase after money from a patient that also increases costs. This is why paying cash at the time of visit or setting a schedule for payment that is followed through on without resistance decreases the Administration costs.
In addition, when patients have to pay cash they end up paying more than people who have insurance. If a patient goes to the ER with a headache because they think they might be having a stroke the bill runs $2200.00 or more in some places. All they do is give them an IV for a migraine when it is not a stroke. But that is the cost to the CASH paying patient. The Insurance Corporations would never pay that amount. It would be cut to a fee schedule set by the Insurance Coropration for participating providers.
There is an issue with pricing in hospitals that needs to change. But they actually charge cash paying patients much much more.
It is actually cheaper if everyone would start paying cash up front for healthcare but not because insurance gets charged more. Insurance has set fee schedules that Hospitals and providers agree to in a contract. No matter how much they are charged they still only pay that fee schedule. The fee schedule is usually less than a cash amount. In some cases you may be charged by a facility a similar amount that the insurance industry pays if you pay up front. So it’s not that insurance industry is paying more at all. The Corporations with the power to set that fee schedule are the Insurance Industry.
If everyone pays cash up front it cuts the costs to the Healthcare facility Administration and having to chase after all the delays and denials from Insurance which can then be passed on to the patient. The reason it works is because the Administrative costs are decreased by removing all the insurance industry tactics to delay and deny paying the bill. This obviously cannot be done at all Hospital situations. But Hospitals have also become monopolies consuming all private offices. Hospitals do overcharge. It is an issue. But that is not true of all Healthcare Facilities. And the Insurance Industry does not pay what a cash patient pays. The cash patient does not have a fee schedule that cuts the price. A Hospital can charge the Insurance Industry 50,000 and they will only pay what the code on the fee schedule the Insurance Industry sets. If that is $250.00 that is what the Hospital will get from insurance. But if a cash patient gets that same procedure they will be charge $50,000. They can only be given a certain percentage off that fee. They end up paying much more than the Insurance Corporation. In addition, contracts from Insurance Corporations require that copays and deductibles must be charged. Many decades ago the copays and deductibles were not as high. They have increased over the years. It is a requirement by the contract with the Insurance Corporation that the Healthcare Provider charge these fees to the patient. Thus if a patient chooses not to use insurance and still wants to bill their insurance it must be for the amount of the actual payment in order to go toward the deductible.
When Doctors are able to open all cash facilities the COST (not just the price) of the service goes down. An example of this are some surgery centers for outpatient procedures like shoulder surgeries. All prices are listed. Cash paid upfront is able to be cut because the facility doesn’t have to pay employees to chase after a payment. In addition, the only way a facility can provide a reduced price to a cash patient is with certain circumstances. That may include paying up front at the time of visit or prepaying. If they have to chase after the money it increases the COST of the service by requiring that employees are paid to chase after the payment etc. It is also means the facility is having to use all their equipment, supplies etc without them being paid for by the service and possibly not getting the payment at all. You cannot go out to eat and pay for the bill later, can’t go to the grocery store or gas station and pay for the bill later unless you use a credit card. That 's going to cost more money because of the fees and interest. If you pay cash at the time it costs less. By not paying for healthcare at the time of service the business has to pay for the bill until they receive that money. That means they may also have interest etc. A full picture of what is happening really has to be looked at on the topic.
See the following policy suggestions also:
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