Re:California's ‘Surprise’ Billing Law Is Protecting Patient...
by riahi on Friday September 27, 2019 @11:56PM
(#21098333)
Any place that accepts insurance is bound by the terms of the insurance contract, which usually includes a most favored nation clause, meaning that you won't accept cash payment for less than the negotiated reimbursement from the carrier.
Similarly, you cannot charge less than you accept from Medicare/Medicaid.
What we can do is bill you, then write off whatever is equal to the highest contract we have. People in private practice approve this not infrequently; but corporate and mega groups have removed individual decision making and stripped us from pricing discretion. These are the pains of 3rd party payers.
I advise everyone who has an HDHP or no insurance to find a reasonable cost direct primary care. The subscription is often much cheaper than you'd think.
My last visit to one medical for a pretty average checkup netted my a bill of ~$450. I checked their website, and saw a price for the same “procedure” for 100. When I called up they said that was the price for uninsured patients who had that procedure and that because I was insured, they were legally compelled to charge me $450. Ultimately the support agent hinted at me to say some magic line about financial hardship so she could lower it to ~250.
As a patient all the doctors and admins are pointing at the insurers and all the insurers are pointing at the doctors and admins.
It’s hard to trust any of you.