Why should the cost of a medical procedure differ depending on if you have insurance or not?

If a hospital can contract and agree to do knee surgery for x dollars according to an insurance rate schedule, why could they not do that same surgery for the same price for one who is uninsured?

One of the crappiest things about our system is that the uninsured get charged HIGHER base prices than the insured - why? Aren't the dollars of the uninsured the same legal tender as the insured? In some cases, I could see where the concept of "self-insurance" could make sense IF people felt that they would be charged reasonable rates.

insurance i paid 0 -same thing without insurance-16,000 dollars...

about 12,000---with a note from blue cross/blue shield that they "negotiated the cost".

are charged more than people with group policies.

If you have coverage that includes a Perferred Provider Network (PPO), the network will negotiate discounts with providers, including hospitals. The hospitals then make up the difference by charging the uninsured more. Not fair, but that's what they do.

If we had single-payer universal healthcare, the government would negotiate the discounts (like Medicare does now) and the providers would just have to suck it up because everyone would be on the same plan.

though the hospital I managed to get covered under a state plan. (Mainecare)

When I did the medical even with referals cost me a $10 co pay even with this long all day stress test for an enormous pain I had in my chest , due to my age my doctor felt it best to have the testing done , turned out to be acid reflux disease .

I paid a good amount for this insurance through my job around $350 per month .

waht killed me was the dental ins , at first I had paid $33 dollars to have my 6 upper front teeth ground out and bonded , this was because the ins was on my dentists list of providers but this changed a few times , in fact every year and just for one root canal cost me $600 out of pocket .

They have this system so setup that there is no way of telling what you actually have . No insurance now I can't even think about getting the work in need done .

:grr:

if retail health care prices weren't inflated.

"In some cases, I could see where the concept of "self-insurance" could make sense IF people felt that they would be charged reasonable rates."

H.R. 676 "single payer" seems the best way to go for everyone. Take the corrupt entities completely out of their self-defined racket.

Try to think of it on a much smaller scale.

You own a company that makes toner cartridges. You calculate all your costs based upon 100,000 cartridges a year, and determine you have to sell your cartridges for $20.00 each to make a net profit of 5%. You open up a store and price all your items at $20.00. somebody from the largest office complex comes by and asks what kind of price can you offer if he buys all the cartridges for his entire complex from you and says they use 500 units a month. You give him a discount of 20% because with his guaranteed volume needs, you actually lower your unit costs AND have a guaranteed base business. As more high volume users sign contracts with you, the more you lower your unit costs, and the higher their volume purchases, the better deal they get.

Insurance companies work out similar deals with hospitals, and none of the contracts are the same. The hospital has certain guarantees, and so does the ins. companies, at least for the length of the contracts.

There is another BIG PIECE to the hospital dilemma though. They are all required by Federal Law to treat ANYONE who comes into their ER, even if they have no money at all. The number of destitute patients is unpredictable, but their care is still a cost to the hospital. Hospitals constantly monitor their actual costs v/s insurance receipts and direct payments. As you can imagine, there's always more costs than receipts (mostly due to patients who are unable to pay anything). They take the amount of the shortfall, and divide it by the anticipated uninsured procedures for the next month (or quarter), and assign a % to each of those things. THAT's why you hear people talk about the $10.00 aspirin!

I realize it may not sound fair to you, but someone has to cover those costs, and the uninsured is the only variable party.

It's certainly to the hospital's advantage to contract with insurance companies because is they didn't, they wouldn't exist very long. Imagine if you had BCBS coverage and your policy stated you are covered at every hospital in (your city) EXCEPT for "XXXXXXXX".


It's a very complex system and difficult to describe in a few sentences. I hope at least some of what I wrote helps you to understand...at least a little.

And I represent some doctors so I know this. Insurance companies pressure doctors and hospitals to keep the uninsured rates as high as possible so they can say that they are saving their clients money. (yes its a lawsuit waiting to happen)

they charge the most to medicaid and other indigent funding programs since the state and feds don't tightly negotiate contracts for services like the insurance companies do.

make money off very vulnerable people.

not that it matters if you're uninsured. Who could afford the odd $60,000 for a hip replacement out of pocket? It's so sad - and unfair - what's happened in this country. People (like me) who have worked all their lives, paid all their taxes, followed all the rules, now cannot afford to have basic medical care because the insurance companies require billions of dollars of profit. That's what it boils down to: profit.

The difference is whether the insurance system is working on one hand, and if it isn't on the other.

expects hospitals to have different fee schedules.

The hospital is expected to have a fee for non-insureds that is about 40% discounted from the insurance rates.