
Eugene of Ventura, CA on June 10, 2008
They paid what my contract said, as far as I can tell. The problem is, that when you buy health insurance, you only know what is in your contract. You are also buying into the contract between the insurer, and the provider. In cheaper policies, those contracts are weaker, or non-existant. The provider can, and will,deny the most important insurance benefit of all. That is the negotiated rate.
When you buy insurance, you have no legal right to know beforehand what, if any, negotiated discount you will receive. The insurance pays what it pays, and you own the rest. Even if the insurance doesn't pay a dime, the biggest benefit is the discount, if it exists. If there is no negotiated rate, the hospital will give you a 10% discount, just to prevent you from applying for charity care.
Providers are now starting to say that any line item on the bill for which there is no payment, is not part of the insurance contract. Therefore, they can deny a negotiated discount, even if it is in the contract, because the contract between you, and the insurer denies payment. Providers are as guilty as insurers for this mess. Providers will try to treat each line in the bill as a separate contract for the purposes of denying a discount. But they want the bill taken as a whole in denying charity care.
My gross hospital bill was 7500. I sent my UB92 ( which the patient has a legal right to demand) Hospitalvictims.org told me that Medicare would have payed 3960. A large insurer would have payed about 4600. The hospital gave me a 10% discount, to prevent charity care. They offered me another 561 discount, to pay in full, in 10 days. I payed 2200. That is about 1600 more than if I had Blue Cross. This is a small bill, but I may need a major surgery soon. These principles will apply. My bill will be 2 to 3 times higher than the provider accepts from medicare. And my limited insurance won't pay much.