why do doctors offices?

Question

charge like 60 bucks for an office visit to someone without insurance, but bill insurance companies 100 for the same visit?

is this maybe why my insurance rates are so damned high?

Answer 1

In the order asked:

Providers can, in theory, bill whatever they want. Insurance companies only pay what they're contracted to pay - not a penny more. Contracts are usually based on the current Medicare fee for service rates. So, doctors will often cut a break to someone who is self pay - especially if they pay at the time of service, because it cuts down on their cost. They don't have to have someone bill the insurance, wait the 4-6 weeks for the insurance to cough up what is usually fifty to seventy-five cents on the dollar that's billed, and/or chase down that money if the insurance sits on it. (And many of them do - for often the DUMBEST reasons.) For a visit that my office charges $85 for, we see $55.17 AT THE MOST - and it includes the patient's copay. Most often, it's about $47 - which is about sixty cents on the dollar. (rounding)

Nope. Insurance rates are so high because not only do their suits give themselves six-figure salaries and five-figure bonuses, (and nobody regulates them!) there are people who abuse the insurance - they doctor shop - if they don't like what Dr. A tells them, they go see Dr. B, Dr. C, and so on until they get what they want. OR they go to the ER for a hangnail. OR there's doctors who do testing for everything under the sun and write unnecessary prescriptions. (like antibiotics for a cold.)

Answer 2

Not all doctors are in bed with the insurance companies. The $100 is an inflated rate, because all insurance companies get discounts- some more than others.

One time when something wasn't covered under our insurance, I asked the doctor's office for a discount, since most other things are discounted for insurance, and they said to deduct 25% from the bill. They wouldn't have volunteered it for me, but did so when I asked.

I do remember reading an article some time ago in The Wall Street Journal about a few doctors that are starting to open practices that only deal in cash directly from their patients. They are tired of having tons of staff to deal with the bureaucracy of insurance companies- procedures, billing practices, disputed charges, etc. These were general practitioners- not doctors you go to for cancer and other expensive treatments.

Answer 3

Some doctors will give you a break if you don't have insurance and it also depends on what the doctor does at the visit. Some visits may be more expensive than others if they did lab work or the appointment took more time. My doctors office used to give cash pay patients 10% of surgery costs. If you are questioning it, talk to the billing department to find out why they are doing that.

Answer 4

Insurance companies typically have a set rate they have negotiated with the doctor to pay for a service. If you look at the statement from your insurance company they usually pay less than 50% of the billed costs. An individual can negotiate with the doctor on services if the doctor is willing.

Answer 5

jacks---
so the short answer is "because they can".
the system allows them to be able to bill for 'u&c charges" usual and customary. there is a range that they can charge...but u know and i know they always charge the very most they can. by doing this it offsets any losses they may have.

it is unforunate...that people who do not have insurance end up paying the high end. Perscriptions are the same deal...if you do not have insurance...they will charge you $100, $200 or more for your RX....it is obscene.

our society is trully geared towards those who have and is not concerned with assisting the 'have nots'.

thanks for asking --good luck :)

Answer 6

I would think to help defer expenses. The clinic I go to also gives cash patients a 10 percent discount.