Question:

Is this true for insurance plans?

by  |  earlier

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i read a ? earlier and was amased in what i read!!!!!!

please read and tell me if this is true!!!!!

"The hospital (or any medical facility or doctor's office) has to charge every patient the same amount for each test, regardless of their ability to pay (private insurance, medicare/medicaid, or nothing). So, in your instance, an ultrasound at the place where you received it cost everyone $460.00. Because you have private insurance, your insurance company paid $233.00 while you paid $20, totaling $253.00. The reason why the bills are so high in the first place is because medicare and medicaid only reimburse the doctor or hospital approximately 1 CENT for ever dollar they charge, some state plans actually pay even less than that. That would mean that if you hadn't had insurance and were on a government program, that your doctor would have only been reimbursed about $4.60 for your test plus any type of copay that was applicable."

IS ALL THAT REALLY TRUE????

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3 ANSWERS


  1. yes


  2. No.

  3. NO.

    The hospital will have a fee schedule that they charge for each procedure. They will charge that amount whether or not you have insurance. However, the insurance companies, including Medicare and Medicaid, have negotiated the rates down. In your example the $253 is the negotiated rate with that particular insurance company. It may be different with other insurance companies.

    Medicare and Medicaid also negotiate the cost but it is nowhere near 1 cent. It would be around the same as your example.

    Hospitals charge the $460 to people without insurance. If you don't have insurance you can negotiate a lower rate yourself but it's usually nowhere near the insurance company rate.

    The biggest reasons the bills are so high - If someone goes to the ER (which many do that don't have insurance) many times they'll give false information (especially the illegals) so the hospital cannot collect. There have been several hospitals in the southern border states close their doors because of this. Another reason is the lawsuits people like to bring against hospitals and doctors. They have to pay the high malpractice premiums or payoff the lawsuits which means they have to charge more to cover. A third reason is medical schools and medical equipment are very expensive.

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