It's not insane to think that a service provider would give a discounted rate to a firm they have continuously done business with over time, who spend a large amount of money, and consistently pay their bills in any other area of business, so at the face of it, it seems sensible. The orders of magnitude are terrifying however
You're not describing health insurance firms here. They constantly innovate new reasons to delay, diminish, and forget about payments to providers. For small procedures, many providers charge cash patients less because they know they'll get paid when the service is provided. They do this even though it often violates contracts they've signed with insurance firms.
If you provided something that cost $100 to produce and there are two easily and legally segregable types of customers, one who will pay the bills in 99.9% of cases and whom you charge $110 and one who pays the bills in 30% of cases, how much would you charge the second type of customer?
(Having said that, I don't think the pathological cost divergences in US healthcare are mostly explained by this)
While that is true in a general case, since there is no transparency in healthcare costs and they can hit you with whatever number and “procedures” they like, it’s more of a “how much legal power do you have to defend your assets versus the healthcare provider’s legal power to take your assets” situation.
Which means you need the big guns (health insurance company or your own millions for legal fees) on your side, or else be destitute and have nothing for them to go after. But if you’re in that sweet spot where they can make up a bill since you signed a paper that says you’ll pay whatever you need to keep you alive, then you’re screwed.
But they are charging that other customer $500 for that $100 procedure. If they charged him $110, it's much more likely that he could pay. And it's not like insurance companies are easy to deal with, optimizing payouts means hospitals hire entire coding departments and they still sometimes see long delays untill payment for complicated procedures.
And unlike, say, choosing between buying a $250k Lamborghini vs a $20k Toyota, the patient has to choose the $250k bypass surgery or he'll die. Which is why this can't fairly be judged purely in business terms, customers have little choice in whether or not they purchase healthcare services.
I don't think anyone in this tree disagrees with you here - the question the parent asked was how much should they charge? If the dollar cost of the procedure is $90, and insurance companies pay $100 and pay every time, how much should someone who has a 30% chance of paying pay for the procedure?
Please stop repeating this. Insurance companies do not "pay every time". Hospitals have to employ entire departments of RNs to argue with insurance firms that this procedure was justified and that test was necessary. Cash patients don't get to make that argument!
I would pool the customers together, and not segregate them even though I know how, and find a way to charge everyone $10 a year whether they needed the $110 service or not.
Because I’m not a sociopath, and I don’t think of healthcare as a product just like kitcat bars, and I don’t think a civilized country should allow this to happen.
The moment you accept framing it like people are buying and selling kitcat bars, you accept misery and death that are completely avoidable in economically advanced countries.
To be clear this is a much more sensible option, I totally agree. I live in the UK, not the US, and the utterly insane healthcare system is one of the main reasons I would never ocnsider moving.
We hire a lot of Europeans at my company, and they are shocked and bewildered by our healthcare system.
"Wait, you mean I pay nearly $5000 a year for healthcare insurance, but they won't pay for healthcare until I reach a $5000 deductible!? And if I don't ask each and every doctor at the hospital if they take my insurance, they may not be covered at all?"
The best part is that the hospital can bring in an out-of-network doctor or nurse after you've passed out from anesthesia... Without asking you if you were cool with this, before you undertake the procedure.
That's one way to discover a giant out-of-network bill, when you went in for surgery at an in-network hospital, performed by an in-network surgeon, with an in-network anesthesiologist... And an out-of-network nurse, whose job consists of holding the saline bag for 30 minutes, at ten times the billed-to-patient rate of anyone else in the operating room.
I am very afraid of this. My wife has had a few surgeries in recent years. We've always verified, at every possible stage, until I've said goodbye in pre-op, that everything is in-network. But there's no way to know what might happen later.
I wonder if our attorney could prepare a contract that stipulates no out-of-network interaction without authorization. But who would we get to sign it?
