Some people need help with hospital bills. And some folks need help with their doctor's bill. So you think the doctor's bill is out of control? You're probably right. And you're probably asking yourself, "How can i lower my doctor's bill?" If you don't have insurance, the cash price a doctor charges you is probably determined by the following formula.
1. The doctor's office determines how much their highest paying insurance will pay for any specific encounter (this is where knowing the ins and outs of CPT medical coding comes in handy).
2. Once the office determines which insurance is the highest paying for any specific code, they will add an additional 15-50% or more on the top line charge on their defined fee schedule.
3. This fee schedule applies to everyone, whether they have insurance or not. Insurance reduces the amount by their contractual agreed upon price and the rest is forgiven.
4. If you are a cash paying customer, you have no contract to receive the service at a discounted price
5. If you don't have insurance, you get screwed.
Why do doctors' offices do this? Let's imagine if a physician billed $100 for a high level outpatient consult but the insurance company would have paid $200. If the physician only submitted a bill for $100, he will only get paid $100, even if the insurance company would have paid $200. But if he had submitted a bill for $250, he would have been paid $200. He captured 100% of the allowable insurance fee schedule. Do you ever wonder why your doctor bill is so high? That's why. They are billing to capture insurance dollars.
1. The doctor's office determines how much their highest paying insurance will pay for any specific encounter (this is where knowing the ins and outs of CPT medical coding comes in handy).
2. Once the office determines which insurance is the highest paying for any specific code, they will add an additional 15-50% or more on the top line charge on their defined fee schedule.
3. This fee schedule applies to everyone, whether they have insurance or not. Insurance reduces the amount by their contractual agreed upon price and the rest is forgiven.
4. If you are a cash paying customer, you have no contract to receive the service at a discounted price
5. If you don't have insurance, you get screwed.
Why do doctors' offices do this? Let's imagine if a physician billed $100 for a high level outpatient consult but the insurance company would have paid $200. If the physician only submitted a bill for $100, he will only get paid $100, even if the insurance company would have paid $200. But if he had submitted a bill for $250, he would have been paid $200. He captured 100% of the allowable insurance fee schedule. Do you ever wonder why your doctor bill is so high? That's why. They are billing to capture insurance dollars.
You see, physician billing is all about maximizing the insurance fee schedule from third party insurance companies. That's no secret at all. The people who get screwed in our current health care system are the people with no insurance. These folks pay the highest prices with the lowest overhead. It's all backwards.
How much can a doctor bill a patient? They can bill whatever they have established as their fee schedule. Can you ask the doctor's office to reduce their fee? Of course. Many offices offer cash price discounts for their uninsured patients.
It should be the other way around. If the office is not submitting a claim to insurance, their cost of collecting that claim goes down. The cost of business goes down and the price of providing the service should goes down.
The NYT recently wrote a piece detailing one of this author'spersonal experiences with getting his medical bills reduced. As a physician, I know exactly how the system works. If I didn't have insurance, how would I lower my doctor's bill? How would I ask for a discount? I would say, "I want a discount for paying cash". In fact, I did that last year with fertility treatments. I asked for and received a cash paying discount of 10% plus free ultrasounds worth several thousand dollars off our medical bills. It was a nice gesture and appreciated on both ends. The contract was mutual. It was WIN-WIN
I suppose a lot of physicians are used to getting stiffed by the uninsured and will accept steep discounts when given the opportunity to collect 50-70% of their charges. I would never pay full price for a hospital stay any more than I would for a physician's cash price visit, a price which has no relevance in real demand pricing. Let the physician charge you $100 and then bargain them down a percentage of their fee. How much you can negotiate is between you and then. Every doctor and hospital is different. But you won't know if you don't try. Getting anything at all for many docs is a blessing. If you don't ask, they won't tell you and they won't publish fees below their insurance schedule either. So get out there and bargain your way to free money.
