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[IP] Insurance Co. rates vs Self Pay rates

> I  want to complain about the other kind of insurance fraud. The unholy
> alliance between the insurance companies and the Medical industry.
> I just got an EOB for some lab work which shows that the non-insured
> for the procedures is $100.10 but the negotiated insured charge is $19.37.
> This is ridiculous - the lab is able and willing to profitably do the work
> for
> $19.37 but if you are uninsured they are going to hit you for $100.10!!!!
> That is a 5X difference!!! This is not a negotiated discount. It is pure
> fiction!!!!! And this is not the only time I've seen such fictitious
> un-insured pricing.
> As far as I am concerned it smells like a conspiracy to make sure that you
> only get the medical care and treatment that the insurance companies
> dictate.
> If you don't follow the dictates of the insurance industry not only do you
> pay
> for it yourself but you pay a 5X penalty as well!! This is truly a "hurt
> people most in need" sort of attitude. And it STINKS.
> Pat
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Insurance companies only dictate what they will pay for a procedure, not
what you can do. if you want to, you can ask your county medical society to
intercede on your behalf.. They all have third party payment groups that
examine this stuff with a fine tooth commb. Also, the hospital can charge
their monetary loss to the average daily rate from which they calculate
reimbursement. It is really quite a complex formula If you are self pay,
most hospitals have reduced rate payment. by the way, they cannot do tests
for 19.dollars and change and make money. the technician's time to oversee
the test, the secretarial staff's time and the costs of reagents, bar code
labels an quality control is a lot more than 19.00 and change, spot
A. L. Bender, M. D.
email @ redacted
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