Choosing to self pay

[sman]

That is true everywhere. Cash rate is 50% less than insured rate.

Insurance will pay inflated rates.... because they benefit financially from doing so...

I ask for the cash/self-pay price often. I have to see a specialist twice year. If they file with my insurance, the cost of the visit and labs is a little over $300. Self-pay for the visit is $111 (they discount their charge 70%) and the labs are usually around $50. Of course, none of this gets applied to my deductible, but I'm willing to make that trade to save a few hundred dollars.

Had to have an MRI last year. Priced it through insurance and it was close to $2k. I did self-pay and it was $560.

We need price transparency across the board and we need to have a flat price whether they file on insurance or self-pay.

 

[Tahoe Ray]

Had to have an MRI last year. Priced it through insurance and it was close to $2k. I did self-pay and it was $560.

Same deal with the MRI. My wife needed one a few months ago and the pricing for cash vs. insurance was very similar to yours.

PT is a lot less expensive with cash pay too.

 

[sman]

Same deal with the MRI. My wife needed one a few months ago and the pricing for cash vs. insurance was very similar to yours.

PT is a lot less expensive with cash pay too.

It's asinine that we have to play this game. I miss the days of true inexpensive catastrophic coverage.

My son was just recently complaining about his premium and the fact that he never goes to the doctor. I told him when he was little, we had a plan with a $3k deductible that covered 4 of us (two adults and two children) for less than $400 per month. Same plan today would be at least 4 times that.

 

[SamIam]

That is true everywhere. Cash rate is 50% less than insured rate.

Insurance will pay inflated rates.... because they benefit financially from doing so...

How do they benefit paying the inflated rate?

 

[scagnt83]

How do they benefit paying the inflated rate?

It allows them to charge more in premiums. Which provides higher profits.

Carriers are legally required to spend 80%-85% of premium dollars on medical care.

5% will be eaten up by overhead.

Leaving most with apx 5%-10% in profits per premium dollar.

---

That leaves 3 methods to increase profits

1. population growth
2. increased medical costs
3. internal efficiency


Internal efficiency can only save so much.

US Population growth has been apx 7% the past 10 years.

Health Insurer Profits have increased by 300% the past 10 years.

So obviously population growth is not driving health insurer profits.

---

That leaves medical costs.

If they pay larger amounts to doctors, they can mathematically (and legally with regulators) justify increasing premiums.

That premium increase keeps the 5%-10% profit margin intact.

If they gradually build up to paying 3x the cost of care they did 10 years ago. They have tripled their net profits.

Increased medical costs, are literally the ONLY significant way for a carrier to increase profits above and beyond the population growth rate.

---

Its a game played between doctors and insurers.

Providers know they can charge more and more without carriers pushing back.... because carriers profit more and more from the higher costs.

A $300 monthly premium earns them $30 per month in profits.

A $900 monthly premium earns them $90 per month in profits.

The only way to get that large of an increase in 10 years, is by agreeing to pay higher medical costs to Providers.

 

[C Ins Solutions]

Had a genetic test (expecting a baby). Cigna paid the lab a contracted rate of $1,300. Out of curiosity I called the lab in California and inquired about the cash pay, $250. This is one of many things makes our system so difficult to explain to our clients and what contributes to their frustrations with the products we offer.

 

[somarco]

Cigna paid the lab a contracted rate of $1,300

What was your OOP share?

 

[scagnt83]

Had a genetic test (expecting a baby). Cigna paid the lab a contracted rate of $1,300. Out of curiosity I called the lab in California and inquired about the cash pay, $250. This is one of many things makes our system so difficult to explain to our clients and what contributes to their frustrations with the products we offer.

Perfect example of how providers jack up prices, simply because insurance will pay for it.

And a perfect example of insurance doing nothing to help control the cost.... because higher costs of care lead to higher insurance premiums.

Providers profit more, carriers profit more, and citizens suffer more.

All in the name of a fake "free market" that is nothing but crony capitalism... not free market capitalism.

 

[DonP]

Perfect example of how providers jack up prices, simply because insurance will pay for it.

And a perfect example of insurance doing nothing to help control the cost.... because higher costs of care lead to higher insurance premiums.

Providers profit more, carriers profit more, and citizens suffer more.

All in the name of a fake "free market" that is nothing but crony capitalism... not free market capitalism.

I'm a little confused . When I've seen insurance payments in the past they seem very low . The dr many times in an mri gets 1/3 to 1/4 of what he bills . I thought most of the time the insurance pre negotiated price was lower than the cash price an individual would pay . Why would a huge carrier doing billions of $'s of business pay more than a single person cash payer ? Has anyone ever negotiated paying cash for procedures with drs or hospitals ? Will the negotiate?

 

[C Ins Solutions]

What was your OOP share?

$75 copay. It actually gets even more comical.
The amount charged by the lab was $8,470. Contracted rate $1,222, a reduction of $7,172 all while the lab offers the test at a $250 cash pay. Make it make sense. Imaginary numbers.

I sent the claim to Cigna and my regional rep. Crickets.