From the shocking hit on UHC’s CEO and the resulting nationwide backlash, to the waning days of open enrollment, insurance is having its moment right now - and it is not a good one.
Sometimes, after receiving healthcare services, I ask "What's the cash pay amount for that CPT code?" Often, the answer is HIGHER than the insurance-negotiated rate, which makes no actual sense. I just offered to eliminate all your overhead in this transaction, and you quoted me a higher price. Things are indeed broken.
Yes!! This is insanely common at the pharmacy as well. This results from the game providers must play to try and capture the max reimbursement. In most contracts you cannot accept more than your cash price from insurance. So if an insurer was willing to pay up to $500 but your cash price is $350 they will only send $350. So an artificially high cash price is set (lets say $1,000) just incase there is a plan willing to reimburse $600, or $700, or maybe they pay the whole $1,000.
Sometimes, after receiving healthcare services, I ask "What's the cash pay amount for that CPT code?" Often, the answer is HIGHER than the insurance-negotiated rate, which makes no actual sense. I just offered to eliminate all your overhead in this transaction, and you quoted me a higher price. Things are indeed broken.
Yes!! This is insanely common at the pharmacy as well. This results from the game providers must play to try and capture the max reimbursement. In most contracts you cannot accept more than your cash price from insurance. So if an insurer was willing to pay up to $500 but your cash price is $350 they will only send $350. So an artificially high cash price is set (lets say $1,000) just incase there is a plan willing to reimburse $600, or $700, or maybe they pay the whole $1,000.