re: #580 reine.de.tout

Your insurance company has an agreement with that hospital that includes what the charge will be that the insurance will pay for particular services.

It used to be - many insurance companies, and the government programs like Medicare and Medicaid - at one time would reimburse a provider a certain percentage of the UCR (Usual, Customary and Reasonable Fee), with the UCR established based on the average of the PREVIOUS YEAR’s rates. So, to counter that and get paid at a higher rate, providers set their fees for services higher and higher - in the case of your insurance company, it has made an agreement with the hospital that any of its clients that come to the hospital will be covered by them BUT they will only pay X for this or that service.

So - that is why the “charge” was $5000, but you paid $100 and your insurance company paid $900 and the whole thing was considered squared up.

And it reams the uninsured, because the hospitals hve to recoup their losses from undercharging the insurance companies, and they can only try to do so by massively overcharging those who lack insurance.

Which leads to many uninsured people not being able to pay their inflated hospital bills and defaulting, ruining their credit ratings in the process.

The Sword of Damocles threat of such financial and/or credit rating reamings that hangs over the heads of all uninsured people who might happen to have a major medical problem befall them is why insurance companies can grossly inflate the amount they charge for their health insurance coverage, even while they pay far less than indivuduals for health care services, thus reaping more profits and incurring less costs. And why the CEOs of such companies make multi-million-dollar salaries.