Comment by russdill | Hacker News Reader

Comment by russdill | Hacker News Reader

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I had a hospital call me recently and inform me that the cash price for an upcoming procedure would be much lower than the price they would bill the insurance company. Since I wasn't going to meet my deductible this year, they suggested I accepted the cash price to save money.

I asked them if the insurance price was the price billed to the insurance company or the negotiated price that actually gets paid. They could not give me a straight answer. I had them stay on the line while I added my insurance company to the call. The agent at the hospital communicated the necessary information to the insurance company (there's a ton of stuff that effects the price, down to which radiologist happens to be scheduled that day). And of course, the negotiated price for the insurance company was lower than the cash price the hospital was offering.

I really don't think this attempt at getting me to pay the cash price was some accidental mix up. I think someone at the business side has figured out not only can they convince people to pay a higher rate, but that then they don't need to deal with billing the insurance. A double savings. I wonder what percentage of people they successfully scam with these calls.

To anyone outside the US reading this who is really confused, I'll see if I can start a GoFundMe to explain the US healthcare system to foreigners

This specific con really ought to be illegal and it's becoming incredibly common to the point that I see it every time I'm at any medical facility now.

The exact statement you described is used: "Oh you won't hit your deductible yet so pay this lower cash price" and you are spot-on that it's a sly way for the facility to get more for the procedure by hoping the patient doesn't understand negotiated billing. And it works... almost every time I've seen it offered it's accepted.

Not to even mention the secondary effect that this causes the patient to not make progress towards burning their deductible so if they have more medical events that year they'll basically pay that amount AGAIN.

This month, a family member was scheduled to receive a (fairly involved) CT scan (at an in-state state university hospital) on a date that just happened to fall into a "COBRA dead interval" (the first month of COBRA-funded health insurance eligibility has a 'pay later' clause; retroactive coverage for the first month does not spring into existence until some weeks after payment for that month's coverage is made, which might well be after that first month had already passed); in attempting to explore options, I learned from the provider (hospital) rep that if we elected to have the CT performed as originally scheduled (therefore in the absence of verified insurance coverage), we would be required to pay the "self pay" amount ($444[1]) at the time of the procedure; if we chose instead to delay the same procedure until insurance coverage was confirmed restored, the amount to be billed (to insurance) would be $3700.

Since this conversation occurred within the "COBRA dead interval", there was no feasible way to ask the soon-to-be-restored insurance provider how much they would be able to discount and/or adjust the $3700 price of this same procedure downward... based on past history, I'm not confident that an insurance company would pre-commit to a set of discounts and/or adjustments for a procedure price (i.e. the final price we'd be required to pay out of pocket if below our deductible) prior to a (post-service-delivery) claim being filed and processed. Catch-22? Or "we can't know what's in the [legislation] until we pass it"?

edit: add [1] the "self-pay" amount would constitute payment in full.

How long did this whole process take, and what was the result? Did you get to pay the negotiated amount?

I was on the phone about 40 minutes. The rate in the end was the negotiated rate from the insurance company. The amount of time and effort involved in finding out how much something will truly cost certainly seems like an intentional feature

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