Cash Price Vs. Network Price

[rmorris]

the provider is explicitly restricted from billing ANYONE less than the billed amount sent to the carrier.

Did I read that right? The cash price is not allowed to be less than the BILLED amount to the insurance??? Or did you mean to say the cash price is not allowed to be less than the CONTRACTED amount?

And this brings up another question - don't all carriers have different contracts with these providers? Meaning the network discount for BCBS is $90 on consultation, UHC is $100, and Principal is $120...so the cash price would have to be at least $120?

 

[somarco]

The cash price is not allowed to be less than the BILLED amount to the insurance??? Or did you mean to say the cash price is not allowed to be less than the CONTRACTED amount?

Contracted rate is the correct answer.

don't all carriers have different contracts with these providers? Meaning the network discount for BCBS is $90 on consultation, UHC is $100, and Principal is $120...so the cash price would have to be at least $120?

No.

Provider could not bill a BCBS patient less than $90, UHC less than $100 . . .

 

[rmorris]

Provider could not bill a BCBS patient less than $90, UHC less than $100 . . .

But see this then contradicts the original statement unless I misunderstood. If IHG was saying the BCBSKY contract stated they cannot bill ANYONE less than the contracted rate they have worked out. That read to me as in even a cash customer with no insurance cannot get a lower rate than the agreed upon discount between BCBSKY and this provider.

Makes sense if it only goes against mutual clients (BCBS cardholders)

 

[somarco]

even a cash customer with no insurance cannot get a lower rate than the agreed upon discount between BCBSKY and this provider.

Not so.

Go back & read my response again.

 

[rmorris]

Sorry...wasn't disputing your comment as you stated "insured clients"

I was referring to IHG when he mentioned BCBSKC (not KY) cannot bill ANYONE less than the amount they bill to the carrier. After re-reading, he probably means inregards to a specific client. (Can't charge $70 to a BCBS policyholder if the network price is $100)

SO - back to the whole issue that I have is that a cash customer with NO insurance may walk out for $60. But the patient behind them with BCBS may walk out for $90. I say it's not fair, but then again, neither is me paying $14 for blood work when that same cash customer has to pay $150.

 

[somarco]

The provider is free to charge whatever they want to cash patients that do not have (or present) insurance. I can't imagine why they would accept less than the "going" rate, especially at a time when insured patients are stiffing their doc.

As for health guy, I suspect he did not intend to mislead, or misstate the issue. Nor do I believe we are in disagreement on what a provider may bill.

As for your closing comment, why does it have to be fair? Airline passengers do not pay the same for their seat even though everyone leaves and arrives at the same time. Car buyers do not always pay the same for the same car. Even diners in restaurants may not pay the same for the same meal (if some have coupons).

 

[rmorris]

Touche' somarco...Touche'

 

[IndividualHealthGuy]

In my best Jesse Jackson cadence:
"The only way to be fair, is ObamaCare!"

LOL