Do hospitals charge more or less for non-insured?

Question

I am needing a medical test and procedure but don't have insurance. The hospital finance department had me fill out a form and provide pay stubbs to see if I qualified for assistance. They called me back and said I did and they would take care of 80% of the bills. My question is 80% of what? Do they raise the cost for non-insured? I've heard that people whitout insurance actually pay more because the insurance companies are only willing to pay a certain amount for medical care. Is the hospital really helping me?

Answer 1

The amounts charged are the same. Each procedure done has a set amount that they charge for, the bad thing is that they cannot tell you what your bill will be until they are done. The doctor may have to do A, B and C to equal one amount or they may have to do A, D and X to equal a totally different amount. Each case is different. The difference between self pay and insurance is the amount the hospital discounts up front.

Hospitals contract with insurance companies to be a participating or preferred provider. Part of the contract is agreeing to automatically discount their rates. In discounting their rates for that insurance, they are hoping that the members will use their facility more.

Some contracts give a percentage off the top, some give rates based on procedure code, some discounts are based on category (E&M, Surgery, Diagnostic Testing, etc)

These discounts are taken 'off the top' and deductibles, coinsurance/copay's are based on the amount AFTER the discount. If your total is $1000, contracted 30% discount, and a 10% copay here's the formula:
$1000 - 30% = $700
$700 - 10%= $70.00
Patient owes $70.00

With no insurance you owe: $1000.

So in some way, yes, you do pay more without insurance. You are not eligible for the discounts, and therefore are billed the entire amount. Sounds crazy, because people who cannot afford insurance surely can't afford to pay the entire amount with out any discount!

Because of this I recommend that you review the bills, or have someone do this for you, and make sure that you are billed for services you received! Don't be afraid to question something! In my experience 'billers' concentrate on making sure that insurance claims are 'clean' (no errors) because this is stated in the contracts that they sign. Why would they spend extra time looking over a patients self pay bill? Patients don't know that you can't bill 'A' of you already billed them for 'B'. Some hospitals don't care. They feel that they are discounting your bill so, if they 'add' in a few extra's then it's ok. You'll be happy seeing that large discount and not question it, fearful that you will have to pay the entire balance.

I also need to add that the hospital is getting a kick back for 'discounting' your bill. There are funds set up help low income people and that is why the required all the documentation. They also need to do this for a specific number of cases to obtain 'certification' and receive additional federal funding. Remember, the bottom line is alway in sight.

Answer 2

It depends if it's a public or private hospital. Hospitals typically charge the same amount if you're insured or not. But if you can pay cash for your portion you can usually get a discount. People who are uninsured pay more because they don't have insurance picking up all except for the deductible and/or copay of the bill, thus there being less risk for the hospital in receiving payment for services rendered. Typically when the hospital notifies you that they will be covering 80% of the bill, then you're only responsible for 20% of the ENTIRE bill. Never assume though. Call the finance department at the hospital and they can tell you the exact details. You should look into some basic medical insurance. I strongly recommend it. I'm the kind of person who rarely gets sick and I've never broken a bone. But you have to prepare for the unknown, so I bought an essentials plan that covers 6 annual visits without a copay and a low annual deductible. I was recently shopping for health insurance and there are some PPO plans that are as low as $33/month. Try: http://www.ehealthinsurance.com

Answer 3

In theory, a medical provider can charge whatever they want. Generally, they charge the same across the board, and for a person who is self-pay, many will give a discount. Insurance companies are only bound to pay what the prenegotiated contract states - no matter what amount is billed to them.

What you should be looking at is the 80%. Is it of the billed amount, or is it based on the medicare fees? (Many insurance companies based their contracted amounts on what medicare pays.) I would call the finance department and ask them for sure - this way, it will head off an ugly surprise later.

Answer 4

Working for an insurance carrier I can speak on behalf of experience on this subject .

There is no general yes or no anwer given my perception of doctors and hospitals. In my personal opinion, healthcare is business and priorities focus on doctors making too much money versus keeping people healthy. Once again, opinion.

Example: I work for a healthcare carrier which is also my insurer. My wife, was pregnant and obviously required a hospital stay. The hospital billed my insurance and I ended up paying $700 in out of pocket cost and the carrier absorbed the $5200 in connection with the stay.

My friend's wife was pregnant basically at the same time and was uninsured. Same Hospital, different OB doctor. He pre-negotiated with the doctor $2100 & $2500 with the hospital for the same services as a cash pre-payment case.

Your situation appears different and depends on the hospitals affiliations and or state aid that may be used. Also, private hospitals like doing what you describe as they are creating a very large taxation write off that they can inflate. They may not be money directly off you, they are probably using your case to protect some of their profits their making elsewhere.

Answer 5

Please check out this website www.mybenefitsplus.com/12859320 if possible before you get the procedure. I am an independent business owner and can answer any questions you might have. These programs are designed for people who are either uninsured or under-insured and are extremely affordable!! The medical program also includes a hospital advocacy portion where your hospital bill can and will be negotiated for you at tremendous discounts if it is over $2500. ****The best thing is that because these are not traditional insurance plans, there is no waiting period. You will qualify for the discount immediately with no deductibles or restrictions on preexisting conditions.
Please contact me if you have any questions!
Best of luck,
Christine

Answer 6

Hospitals charge more for non insured. However, in your case you are insured (by the government). The form you filled out and pay stubbs you submitted were used to determine that your income qualified you for government assistance with your bill.

The hospital will get 100% of the money. You will pay 20% and the taxpayers (government) will pay the other 80%.

Answer 7

Despite what the other answerers are saying, there are NOT 2 different set of fees depending on if you have insurance or not. The payment will be different due to all sorts of contracts with various payors like medicare, blue cross, medicaid and so on.