Why is it that a person without health insurance has to pay full price for a doctor's visit...?

Question

... but when someone with heath insurance visits the doctor, there is a discount on the cost when it is covered by the insurance?

I had gone for a year without health insurance, and I had to make a few different trips to the doctor. Every time I received the bill, it was for the full amount of the visit.

Now that I have health insurance, I went to my insurance website to see if my doctor's visit had been covered, and it said that the cost had been reduced (i.e. instead of the insurance company having to pay the $210, they only paid $65).

Why is that? Shouldn't it be the other way around? People with no health insurance should be paying the lower price out of pocket.

I didn't mean that *I* got the discount. The insurance company got the discount. I'm not an idiot.

Answer 1

Quite simply, economics. Insurance companies negotiate lower rates with doctors and medical groups in order to secure better prices for their customers. In exchange for the increased traffic from the insurance companies, the doctors, hospitals, etc. agree to provide services at a price lower than they would otherwise charge. In other words, they compensate for the lower prices with increased numbers of patients.

If you did not pay for health insurance yourself, and were still charged a lower rate, that cost would still be paid by somebody, namely the government. It's called "socialized medicine". So now, your "health insurance" is provided by the government and the "premiums" are paid by the citizens through taxation, regardless of whether they want to pay for you or not. Some people would refer to you as uninsured while to others you're just a burden.

Answer 2

Some doctors do give some type of discount to cash payers. With the average price for health insurance for a family in the USA approaching $1,000 a month, you wonder where it will stop.

Consumer Driven Health Care is where many will spend their health care dollar in the future. Instead of paying high costs of health insurance. Stuff like health savings accounts along with a high deductable health insurance plan can save hundreds.

Discount Health and Dental Benefits also add value for those paying out of pocket. Some companies like Ameriplan USA of Dallas TX offer a full package of benefits for less than $60 per month for the entire household.

Answer 3

Part of the contract the doctor has with the insurance company is that the doctor agrees to take on a predetermined number of patients with this insurance.

The other part is - yeah, the insurance company only paid $65 of a $210 charge - but what is your copay? Because of the higher rate of reimbursement, I'm assuming your copay is on the lower side. So, if you think about it, the insurace is paying roughly less than fifty cents on the dollar for the visit. How fair do you think it is if YOU got paid fifty cents on the dollar of your salary?

Answer 4

Insurance companies have contracts with companies and doctors to pay a certain amount of their bill. If you do not have insurance then you are required to pay the full amount. I have a copay and my insurance company pays the rest. And no you should not pay the lesser amount just because you dont have insurance. Doctors have to make a living too and when you visit a doctor or go to the ER, and dont pay your bill, then this just drives the cost of health care higher. Best deal is to get insurance, then you will only have to pay the copay.

Answer 5

Discounts are offered from doctor's offices to health insurance companies as part of negotiation for the doctor to be in the health insurance company's network of providers. Being in a network gives the doctor's access to more patients, so they'll take a discounted payment in exchange for that.

The insurance company will put the doctor in their network for a reduced fee when a patient visits that doctor. Win-win situation for health companies and doctors.

Losing situation for the uninsured.

Answer 6

Fees are negotiated by the PPO that the insurance company utilizes. Usually, if you can pay up front, you can negotiate the fees yourself to get a better rate. You never know unless you ask. By the way, you may want to consider purchasing health insurance so you can take advantage of the co-pay benefits and lower fees for services rendered.

Answer 7

There are bulk-agreements between doctors - insurance companies - pharmacies - etc. That is why the insurance company pays less for the same treatment / medicine.

No, it should not be cheaper for a person without insurance. If you don't want to pay for an insurance, why should you want any benefit of it?

Sorry

Answer 8

Yes, it should be the other way around. I finally found one Dr, that does Physicals and to just see a dr. here w/o insurance is 75.00 but I found a Dr. at the occupational urgent care that did the check up for 47.00 which was a lot better.. My daughter had to have the physical for a college application..but you know without insurance, they really don't give you a break....it is something that every President claims will be an issue that they'll change and then nothing changes...I don't know what will happen next....

Answer 9

The insurance negoyiate lower feeds because they list the doctor in their referral booklet. The doctor agrees to lower fees because they are getting a lot of their patients from the referral.
You need to negotiate with the doctor for a lower fee. If you don't ask you won't receive.

Answer 10

When you purchase insurance you and I are all paying for "Pre-Negotiated" rates by Doctors who have "Signed Contracts" with healthcare corporations ie. Blue Cross, United Health, Aetna, Cigna and others. Think of it like this, in the USA approximately 250,000Million People pay into Health Insurance multiply that by approx. 200.00 and you can figure how much they are collecting (approx). The press says that approx. 46,million people here in the USA don't have healthcare, why should we (paying for healthcare) for the approx. 13% of our population that feel it is not important.