LogFAQs > #883241627

Questionmarktarius posted...

If insurance is going to pay you up to $1350 for a MRI, you better damn well believe that a hospital is going to charge exactly $1350.

That's not really how it works though.

For one reason or another, the *actual cost* of a service, like an MRI, is not really standardized. Since these prices aren't advertised, insurance companies basically play a game of trying to maximize how much they get paid by patients (their customers) and minimizing how much they pay out of benefits.

Since hospitals don't know how much to charge, an insurance company might offer $200 reimbursement to the hospital on that MRI. Down the street a few miles at the next hospital, the bill is higher, and the insurance company is willing to shell out $650.

The continued squirming from insurance leads to them getting patients on technicalities. You didn't meet this criteria, the hospital was out of network, etc, etc. They deny reimbusement. Patient gets slapped with the bill. The hospital *never* intended the patient to pay the $650 and virtually always works with a patient who then says they need to pay out of pocket and can't afford it. The hospital is better off getting something rather than nothing, but its much lower than the insurance company's reimbursement.

Now the hospital is running out of money, so they bill higher in subsequent services to make up the difference to stay afloat. Again, since no one knows the true cost of an MRI, it's okay, and this other insurance company ends up covering it. But they also deny a different patient's claim somewhere else--again, to maximize their own profits.

The end result after a lot of this cat and mouse is the insurance company continues to squeeze more and more money away from both patients and healthcare professionals. Patients have no money to pay for bills they expected to be covered because they're paying premiums. Hospitals can't stay open without continually raising the cost. And insurance continues to siphon the gasoline from the car until it runs empty and it all crashes.
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"He has two neurons held together by a spirochete."