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  1. #1
    Join Date
    Sep 2011
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    question about provider rates

    What is the term called where a provider charges a patient amount $X if they know the patient has Insurer A who reimburses at 75% But when the provider knows that the insured has Insurance Company B who reimburses at 65%, that same provider charges the patient $Y for exactly the same procedure which is significantly more that $X. Is this legal/ethical etc. Thanks
    email me ggregwads@gmail for clarification

  2. #2
    Join Date
    Jul 2006
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    Re: question about provider rates

    i would think your insurance company would want to know that the same service is priced differently depending on which insurance company is billed. you would have to have some proof, evidence.

  3. #3
    Yawn...'s Avatar
    Yawn... is offline I ain't got time for pedantic Ghandi type internet nerds User Rank
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    Re: question about provider rates

    Quote Originally Posted by ggregwads View Post
    What is the term called where a provider charges a patient amount $X if they know the patient has Insurer A who reimburses at 75% But when the provider knows that the insured has Insurance Company B who reimburses at 65%, that same provider charges the patient $Y for exactly the same procedure which is significantly more that $X. Is this legal/ethical etc. Thanks
    email me ggregwads@gmail for clarification
    It is called a free market.

    A provider of services is free to charge an 'agreed upon' price for the service.

    You may have an implied agreement. Implied due to action of one party where the other party assumes you have agreed to their charges - though the specific amount and terms of charges is not prearranged.

    Or, an explicit agreement where the price is agreed upon before the services are rendered.

    It is not unusual for a health care provider to have different contractual agreements with various insurance companies. Their charge for a specific service may be vastly different depending on the contractual arrangement with each carrier. AND far different if you have no insurance and/or pay cash.

    After all, we live in a free country. We don't want to be like the rest of the industrialized world where health care has uniform pricing and costs about half in aggregate in relation to GPD.

    After all, F#@k the 14 million or so unemployed americans without health care, and the other 50 to 60 million working americans that don't have health care.

    Health care providers can charge a lower price, or a higher price, or any price for those folks - and if necessary sue them for not paying there medical bills and/or force them into bankruptcy and take their assets (like their homes).

    But yes, it is perfectly legal.

  4. #4
    Join Date
    Sep 2011
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    Re: question about provider rates

    thanks mumbles, appreciate your time yawn, but free market is not what I had in mind, rather I am looking for an "insider" term that describes having various rate structures depending on the reimbursement level or if the patient is uninsured

    I am not sure the procedure is ethical or legal

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