They hospital is charging the insurance company WAY more than what they are contracted for, then when they receive the contracted amount from the insurance company, they try to get the patient to pay the difference! Our insurance company just says, "Hospitals set the rates they charge", so they know this whole system is a scam, but apparently they make enough not to do anything about it.
Yes, what the insurance pays is the true contract amount but for some reason there is an agreement between the hospital and the insurance company to charge more.
There is clearly a lower rate to charge for self pay (and a true unseen balance insurance are liable for)
But when a patient comes in with insurance and attempts to go with self pay, we are contractually not allowed to bill them that lower amount. We have to bill them the inflated price. From my end. The hospital claims it's insurance contracts forcing them to charge patients this amount.
They hospital is charging the insurance company WAY more than what they are contracted for, then when they receive the contracted amount from the insurance company, they try to get the patient to pay the difference! Our insurance company just says, "Hospitals set the rates they charge", so they know this whole system is a scam, but apparently they make enough not to do anything about it.
Yes, what the insurance pays is the true contract amount but for some reason there is an agreement between the hospital and the insurance company to charge more.
There is clearly a lower rate to charge for self pay (and a true unseen balance insurance are liable for)
But when a patient comes in with insurance and attempts to go with self pay, we are contractually not allowed to bill them that lower amount. We have to bill them the inflated price. From my end. The hospital claims it's insurance contracts forcing them to charge patients this amount.
It's probably both tbh.