Insurance/Hospital discount question

[KrisM]

Anyone knowledgeable about insurance and hospital discounts?

DH is scheduled for surgery on Monday morning. Yesterday, someone from the hospital called to go over insurance info, etc. He said that after insurance, our portion would be $4500 and if we paid within 7 days, it would be discounted to $3900.

Our insurance has a $3000 deductible and then pays 20% above that and we have a max out-of-pocket of $4000. We also have an HRA as part of it and have accumulated about $4400 in there. So, we will actually not have to pay anything from our actual pockets, since the HRA will cover it.

I called our insurance today and asked about paying it within 7 days to get the discount. I wanted to know if I paid it at the hospital on Monday, would I easily get reimbursed from the HRA. I was told the hospital should not be offering any discounts, since they are contracted with the insurance at a certain price. If the hospital is offering a discount for paying, it may mean they are not fully billing the insurance and we would not be able to be reimbursed at all and it would also not go towards our deductible for the year.

I now realize that I think we are only looking at saving $100, since the $4500 the hospital guy gave us is wrong, since the max out-of-pocket is $4000/person. So it probably doesn't really matter in the long run. But I am wondering what sounds right to you, if anyone has experience with this. It's a big hospital, so I am surprised they might be doing something they shouldn't like this (if they are).

DH also pointed out that every orthodontist we saw offered a cash discount for paying in full and wondered how this was any different.

[niccig]

It sounds like a discount for prompt payment.


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[ChicagoNDMom]

When a family member had a procedure recently, they were offered the same “pre-payment” discount during the pre-op instruction call with the hospital. Like you, they thought it seemed a bit fishy so declined to pre-pay. Ended up, it would have saved $300-400 if they had pre-paid.

[MSWR0319]

Our hospital offer discounts if we pay by certain dates for some procedures and other procedures other discounts if you prepay. I don't think it's abnormal. Like others have said, we did it with braces as well. The discount is on the portion you owe, not on the portion the insurance has agreed to, so what the insurance agent said isn't necessarily right I don't think.

[KrisM]

So maybe I'll pay Monday. Or I'll call and ask again. I don't want to get stuck not getting reimbursed though, but it sounds like maybe that shouldn't be an issue. And hitting the deductible on Jan 4 is good for the year, so I don't want that messed up either!

[nfowife]

Just making sure you known hat max out of pocket means your husband should not have to pay a dime for any dr appts, prescriptions, copays, etc for the rest of 2021.

[firstbaby]

Since you already have the money set aside and you are planning on hitting the out of pocket max, I would just let them submit as usual and pay out of your HRA once the billing is settled. I recently had a procedure and the front desk gave me an insurance summary sheet showing my portion was $35. Ten steps from their desk as I was going back, an insurance coordinator met with me and advised me the full cost of the procedure was $4k and did I want to apply for assistance from some program? I said I was confused because the summary I got was that I would owe $35. Once she looked over the paper she seemed a little embarrassed and agreed that was correct.

I’ve also noticed the hospital here has gotten much more aggressive on billing. DS was in the ER and a couple of weeks later we received the bill - it was a few hundred dollars. That day, I got a text that our payment was due immediately. I actually texted the number back and said we just got the bill that day. Annoying!

Good luck on your husband’s surgery!

[MSWR0319]

I keep thinking about this. I'd call back and ask questions. Something doesn't seem right since like you said, he told your our OOP would be $4500 and not $4000 which is your OOP max. I'd just want to make sure that the cost they are giving you truly is after insurance.

[SnuggleBuggles]

I would wait because I always find the estimates before to be really off.


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[carolinacool]

I have never heard of a discount when using insurance. Although it certainly doesn’t mean it doesn’t exist. I had an ultrasound in mid January about three years ago. I called and talk to the hospital and they told me what my portion would be with the deductible and after insurance. My part was essentially my deductible, so about $1600. Then she said I could also pay out-of-pocket without filing insurance and my part would be something like $900 if I paid by a certain date. I chose to pay the higher amount and go through insurance because I wanted anything I paid to count toward the deductible, and I knew I would be having some other procedures that year.