Insurance/Hospital discount question

[KrisM]

Thanks for all the thoughts. It's awfully confusing.

[ahisma]

What the hospital is describing is a "prompt pay" discount. It is permissible (with several caveats), but very well may violate the provider's agreement with the payer (the insurance carrier).

ETA - personally, in this situation I'd let insurance handle it and not mess with it. You're risking taking on a significant hassle. Health systems are overloaded right now and things just aren't moving smoothly (understandably, for sure). We've had a lot of administrative slowdowns (which is why I'm on my computer right now - we had a contract a system needed signed by EOY - I got it for review on NYE!)

[MSWR0319]

OP - just wondered what you ended up doing and how it worked out. I just got a call for DS's sleep study and they want me to pay now for a $600 discount. They told me my cost would be $3600 minus the discount after insurance but I find that hard to believe since our deductible is $2500 and then 20%. We've had sleep studies before and they weren't that expensive. I'm wondering if the amount they're using is before write-offs from the insurance. We aren't going to do it I don't think.

[Kestrel]

https://www.cnbc.com/2021/01/05/hosp...y-benefit.html

I read this the other day, and thought it might be helpful. Now you can actually get the pricing on your procedure in advance and "shop" hospitals for the best rate, as well as seeing if you've got all the discounts you are entitled to.

[KrisM]

I've meant to update, but never remember at the right time.

No one asked us to pay that day. No one called again. We didn't actually have any contact info for the person who called to offer the deal either. So, nothing happened, lol. I had decided if they wanted the co-pay/deductible, I would go ahead and pay it then, but there wasn't an option for it. I was in the hospital and in the waiting room the whole time, too.

It's been 3 weeks and it's still not through the insurance yet, so still no bill.

[MSWR0319]

Thank you for this! I was able to look at prices at both of our local hospitals. Turns out our deductible went up this year and I didn't realize it, so the estimate they gave me is unfortunately probably right.