Is it normal for hospitals to charge insurance providers more than they charge private patients who pay direct

Question

Is it normal for hospitals to charge insurance providers more than they charge private patients who pay direct

Answer 1

Private patients tend to pay more, because the insurance providers have negotiated with hospitals to get discounts for their members.  Check around to be sure, though--some medical providers (though probably not hospitals) might give a discount to avoid the paperwork involved with third-party reimbursement.

Answer 2

Yes. It's called a "discount for cash paying". Because it's faster and simpler if a patient pays for their care at the time of service - there's no need to bill any entity, or wait for payment, or have to appeal a denial, or anything like that - a patient who is going to pay right away pays less.

Providers often have two prices - one that goes to insurance (set to cover the highest paying plan) and a discounted one for self-paying patients. And it's perfectly legal.

Answer 3

No, because most of the time, the hospital has 'prenegotiated' the price for a particular service, with the insurance company.

So actually, the UNINSURED person pays more for the same service, than the insurance company does.  Especially after you factor in the copay business.

Answer 4

No Hospitals charge the uninsured more. Part of the benefit of having insurance is that the hospitals and Doctors have agreed to charge a lower fee for being included in the insurance network. Some doctors and hospitals will give the uninsured a lower price if you just ask.