Does anyone know why the healthcare system prefers those with health insurance over those who self pay?

[couchweed92]

I was going in for my acl surgery this morning, feeling good about having paid dr. lintner $7k in full and arriving early. i arrive to the office 2nd floor/room 800. as i make my way in, a rather large woman relays a message from another woman (on the phone) who was at home using a sick day or something… the message stated that i still owed $13k to the surgery center. that’s already $20k for knee surgery.
then she says i still owe the anesthesiologist an undisclosed amount, which no one seemed to know how much exactly and the anesthesiologist just decided to never answer his phone. anyways what i want to know is who charges $13k for a room for a few hours? dr. lintner has the ability to do the surgery and charges just more than half the amount of a room? if anything the doctor deserves $13k and the room should be, what, $500 tops? not 13 thousands dollars! who set that price? it’s kind of making me feel like i’m dealing with criminals, that’s evil to charge so much for a place of healing! just a place for you to get fixed up and proceed with your life… now i dont know what i’m ganna do to get 13 thousand dollars… i can’t even work with my knee dislocating when i walk. why is it the the room actually costs less when you have insurance? insurance covers the room regardless so why does the price go down for those insured, how does it make sense to do that? why isn’t it cheaper for someone who can’t afford health insurance? i’m afraid i won’t ever be able to fix my leg and i’ll just have to accept this as a part of my new life!

Updates

5 mo

but insurance covers the costs of the $13K room and the cost of my surgery

[madhatters4]

the room costs less because the insurance company gets certain discounts. why? because the insurance company can work with a provider to drive business to the location. so, as an example, the center may reduce their room fees to say $10k because they know the insurance company has a large population of patients... quantity

why the room costs more than the procedure. sounds like you are talking about a hospital? the room costs are exorbitant and certainly the prices you are quoting. but the costs go towards overheard. basically a costs associated with what they hope to cover in regards operating costs (not hte operation but the business operations) to the company

it's no that providers like insurance companies more. in fact most do not. but they negotiate discounted rates on services with insurers in an effort to get more patients. if the insurance company gets great rates at a certain place they will push patients to go to that facility.

for you i would call the billing department of the surgeon and work on a discounted rate as well as a payment plan. most people don't realize this is a very realistic opportunity to save yourself literally thousands.

[couchweed92]

it’s a surgery center, they required $13K paid in full.. they specifically said they don’t do billing, uninsured

[couchweed92]

uninsured people must pay the full amount

[madhatters4]

"they don't do billing uninsured"
do you mean they won't let you get the procedure there without insurance?

[couchweed92]

they won’t let me pay later, they don’t send you the bill through the mail. they require you to pay upfront before you get taken to the room

[madhatters4]

maybe shop around for another place to get surgery then. since you are not using insurance you can have your pick of the litter.

[In_Trance]

More money

[couchweed92]

but why does it cost more to be uninsured?

[In_Trance]

It doesn't. They raise the cost for you and the insurance provider when you tell them you have coverage

[couchweed92]

looking at the package price for those that have coverage shows the whole thing from surgery to the location of the surgery would be essentially free beside some co pay fees

[WindAtMyBack]

Insurance companies pay the hospitals enough money for enough patients that they have bargaining power. You can basically look at it like a quantity discount. It's similar to a manufacturing company buying a million screws for a penny each, and you have to pay a dollar each at the hardware store.

A lot of individual doctors actually prefer cash payment rather than going through the insurance companies. Some offer deep discounts for cash. There is a lot of red tape with insurance companies. Hospitals are large enough that it's worth it. But it can be a pain in the ass for small private doctors offices, so they don't like dealing with it. There are some doctors who take cash only.

As far as the room, those operating rooms charge by the minute and it's not cheap. They often round the time up to the nearest 15 minutes, half hour, or hour. Rounding up can add hundreds to the bill, potentially over a thousand. I've read that you can challenge them on this, since they are charging you for time you didn't actually use. I don't know how successful challenges are.

The cost per minute of the operating room partly depends on how clean it is. In some cases the air is almost pure air. I bring up air quality because I've worked in a clean room before (not an operating room). You might see just a room. But the room itself is very advanced and techy - and expensive.

If I were you, I'd try to bargain on the price. You won't have as much clout as an insurance company, but you can do it. It's like buying a new car. Don't pay the sticker price. If you don't have the money, work with them. They have a finance department that does nothing but work with people who don't have the money. My sister recently got something for 35K knocked down to under 3K.

[molonski2]

Both any form of insurance , and the entire USA medical system is completely and utterly fcked ! Your story , honest story is a disgraceful outcome , and all should be ashamed.

[boobliker]

they can get add moreand more to them with out come back here in the uk we just have to wait for the right dr to do the job

[gorydetails]

You are dealing with criminals. I think Trump was trying to get them to post their prices.