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Once I had commercial insurance from out of state. A doctor visit was covered as in-network and all was well. But they did a lab. The lab was in a hospital 10
by ryanobjc 4y ago
Once I had commercial insurance from out of state. A doctor visit was covered as in-network and all was well. But they did a lab. The lab was in a hospital 100 miles away. The insurance said "ok you have to pay the deductible for this lab", which is like fine, how much can a single lab cost? Single urine sample, easy.
Well didn't you know, the hospital did NOT have a negotiated in-network rate with the insurance company. The hospital insisted that we owed them $650, because that was our deductible.
Other in-state insurance companies cut those stupid bills down by 95-97% with 'allowed amounts', but the out of state insurance didn't have that negotiated rate with them.
In the end I called the hospital and told them I knew from other insurance bills how much it should have cost, and that we can just not pay, and ignoring collectors is easy. I offered them $50 (for a $20-30 lab) and they send me a new bill "writing off" the other $600.
So, you want out of state insurance, well, be careful what you wish for, it just might come true, and you may not like it at all.
- HyperSane 4y agoWhy isn't stuff like this covered by price gouging laws?
- eitally 4y agoBecause as a whole, this industry can't actually determine what fair pricing is. There are too many perverse incentives concurrently in play for anyone to realistically make sense of things.
- simfree 4y agoWe can easily look north to Canada or east to Japan for context on what services and procedures should cost. Japan has the health insurers and medical providers engage in structured fee negotiations and standardize prices in systems. There is no reason in the USA that injecting a Covid vaccine should cost $42.70, while injecting a Mpox vaccine should cost a different price of $67 when self paying at Kaiser. Meanwhile, insurers pay significantly less than this for the same service. https://wagner.nyu.edu/files/faculty/publications/hlthaff.2019.01804.pdf https://wagner.nyu.edu/files/faculty/publications/hlthaff.20...
- HyperSane 4y agoAuctions are an excellent price discovery mechanism.