Quote:

Originally Posted by dyna mo what's your bargaining tool to compel the hospital to negotiate your bill?

The bargaining tool is the quantity of persons insured and the insurance company's management of the payment of medical benefits for those customers.

Hospitals, clinics, labs and doctors want to be approved providers to be able to sell their services to that insurance company's customers (like 30,000 customers in that county, 200,000 in that state -- that idea). So the insurance company can negotiate bulk rate flat contract prices.

But PornoMonster you are wrong on the allocation of the contract price for the person insured will pay if I understand you correctly.

You say the ''retail bill'' is $100K your share is $20K
If the $100K bill is contracted down to $80K the insured would pay his deductibles and the remaining 80% of the $80K contract price would be paid by the insurer.

A better example is a $10K bill.
That bill's services are negotiated to a contract price of $8K

The insured has already paid his 100% deductible costs.
The insured has a 80%/20% co-pay deductible to pay still.
This co-pay amounts are capped by the out of pocket maximum of the policy -- $13,900 per policy year by law now. This amount includes policy premiums and all deductibles as well as copays.
The insured would be liable for 20% of the $8K contracted rate that was negotiated.
Bottom line he owes $1,600 to the billing provider (the hospital, etc)
The insurer pays the hospital $6,400
$2K of the $10K is just 'air'.

This complex mess will lead to a tax supported mandatory universal health care at some point in time.