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Comment by kgantchev | Hacker News Reader

No, uninsured people also don't pay it. They are offered a fraction of the cost if they pay "cash" once you're leaving.

I went to the same ER in San Francisco with the same problem 3 months apart (kidney stones). The first time around I was uninsured and the bill was $2000- they told me that they'll cut it down to $500 if I paid on the spot, which I did. 3 months later I had the same problem, had purchased insurance, my bill came out to $8000 and my deductible was $2000.

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Can confirm. Had a procedure (hernia repair) and at the time of setting it up my insurance was in flux. I asked for the cash price to move things along and was quoted just ~7k all up. Insurance ended up covering it but received one of those invoices were it starts at over 20k before the magic "discount" gets applied.

I have been assuming the magic discount is some sham the insurance companies push for to scare people into believing they would not get it if it weren't for the insurance.

It's BS IMHO to not be advertising the ACTUAL cash amounts they would quote somebody..

That's not my experience. I was out of state and needed medical attention. I was on Medicaid. Urgent Care straight up wouldn't accept my out-of-state Medicaid plan and suggested I go to ER. They too didn't accept out-of-state Medicaid, listed me as having no insurance, and billed me full-price for the some of the services. There was no discount for paying on the spot. I paid for those initial services and got more bills from the doctor and other departments. They never accepted my out-of-state Medicaid but eventually "gave me a discount." I paid some of it myself but told them if they wanted the rest to bill Medicaid.s

Okay, interesting. I had read some articles about medical debt that alluded to those levels of savings for paying cash in one lump sum quickly but still, it's pretty striking that you get a 75% "discount" for cash on the spot.

And not to mention when they say "on the spot," they mean it. In the room, right there, as you're checking out. If you don't have access to any payment methods or you need to wait two days until you get paid or something, you're looking at a 50-100% increase over the final quoted "cash price" even if you're still paying cash.

So you paid more on insurance? And the bill while on insurance just happened to be inflated so much that the deductible came out to be the price of the procedure the first time around? That sounds like fraud.

Sounds like health insurance!

If you dont have 500 available at the time of health issue you pay more?

But it still sounds scammy pricing tactic to me. That is not how stores or anything else works or should work.

Or you pay nothing at all (they aren't going to repo your kidney), or end up working out a deal to pay whatever you can later. They offer the discount because on average they figure the discounted price is higher than what they'll get paid later.

Can you just say "I don't want to use my insurance at this stage and I want the price from last time?"

As always, it depends. There is a certain point at which your visit is tied into your insurance so you can't just undo it. At that point the hospital is now fighting with the insurance company to pay and you're stuck in the middle.

If you delay payment you probably have to help pay for those that will not.

One reason that stitching up minor cuts is so expensive could be that those who need that treatment (e.g. because they were in a fight) are statistically less likely to ever pay their bills…

Do you have a source that people getting small cuts stitched up are less likely to pay their bill?

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