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Comment by mirimir | Hacker News Reader

There's one simple fact that can save patients real money: network providers generally can't go after patients for fees that aren't covered by insurers. Forgoing that right is typically part of their deals with insurers. They often go ahead and bill patients anyway. But they back off when challenged, saying that they billed in error.

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Can you explain further what you mean? I recently had an x-ray that was not covered by my insurance, and the hospital submitted it to my insurance to ensure that it would apply to my deductible.

I guess you mean a fee that is uncovered in the sense that it would not apply against the deductible.

(It's total BS, the price I paid was 5x the medicare reimbursement rate, like 15x the medicaid reimbursement rate and I would speculate at least 2x what the insurance company would pay (based on researching the 'typical cost' of the particular x-ray on the internets).)

Was this in-network? Typically if something is in-network but applied to your deductible then the rate you pay is your insurance company's "allowed amount", the rate they "negotiated" with the hospital for the service, and exactly "what the insurance company would pay".

It was in network. I don't believe it though. I did say I was speculating, because I don't have any evidence. I would love to see what they actually pay, assertions that they must pay the allowed amount don't really make me any less skeptical about it.

I was specifically referring to stuff that's covered, and where the provider bills the patient for it's cash-price fee, less what the insurer paid. Network providers generally can't do that. But out-of-network providers certainly can, and those fees can be huge.

In your case, I'm guessing that your insurance doesn't cover outpatient services (or perhaps just imaging) at hospitals. Even if the hospital is in network. If that's the case, make sure to have that stuff done at stand-alone clinics, where it should be covered.

It was the imaging. Good to know that it should be covered at a clinic (I was actually at the urgent care clinic adjacent to the hospital, but they get their imaging services from the hospital).

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