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Way off topic, but here goes. In today's world, when a health insurer has a contract with a provider (doctor, hospital, etc.) - this is what is called a "participating provider"- the provider agrees to a certain fee; the insurer pays their portion, and the patient is responsible for their portion (the copay, deductible, and/or coinsurance), but the provider cannot charge the patient more than the contractual fee. This is the basis for all the "managed" insurance products - the "in-network" portion of PPO and POS plans, and HMO plans. If a patient goes "out of network" in a PPO or POS plan, and any time in an indemnity plan, the provider can bill whatever they like - the insurer pays their portion of what they think the bill ought to be (there's a whole 'nuther discussion here about billed charges vs. "usual, customary and reasonable" charges), and the patient gets stuck not just with "their portion" - the copay, deductible, and/or coinsurance- but with the difference between what the insurer thinks the bill ought to be and what the provider charged - aka "balance billing." You may be able to negotiate with the provider to decrease this amount, but the insurer is not involved here at all - you are on your own.
In the healthcare world, a participating provider accepts a contract fee lower than his usual billed fee in return for a higher volume of business and a greater liklihood of being paid. Therefore, when insurance is involved rather than paying out of pocket, the overall cost is lower.
In the auto world (glass, body shop, etc.), it looks like whenever insurance is involved rather than paying out of pocket, the overall cost is higher. I suppose it's possible that there are contracts between the shops and the auto insurer that pay less than billed charges, but I don't know. I do know that if a healthcare provider offered to waive the deductible (as is common practice with the glass shops), that would be considered fraud (a federal offense if Medicare is involved). The overall picture certainly appears to be that the charges are inflated when insurance is involved - which ultimately increases our insurance premiums.
_________________ Marvin McBride
Spec Miata #62
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