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Is it true when you have insurance Doctors charge them alot more then they would a cash paying costumer?

I heard they charge insurance companies a higher cost because it is an insurance company, and normally they charge you less.

My nephew went to the doctor he has no insurance he paid 45.00 for the visit, yet they would charge 85.00 to the insurance company when he was insured.

Is this true?????

Answer Question

Asked by KFree907 at 2:21 PM on Apr. 14, 2010 in Money & Work

Level 20 (8,947 Credits)
Answers (17)
  • yes. I am going to the doctor tomorrow and my co pay with insurance is 50. When i didnt have insurance my co pay was only 40

    Answer by shay1130 at 2:23 PM on Apr. 14, 2010

  • it may be true but its also insurance fraud and a doc can get shut down, lose his liscense over it.

    Answer by Bearsjen at 2:23 PM on Apr. 14, 2010

  • every doc is different though. That was just for a regular check up too. I would also have to pay up front if i needed anything else done.

    Answer by shay1130 at 2:25 PM on Apr. 14, 2010

  • Yes. Just look at any health insurance claim form. Private doctors can charge as much as they want hoping for the Insurance to pay the maximum that the plan allows.

    Answer by Energ8zr at 2:26 PM on Apr. 14, 2010

  • They actually negotiate with the insurance, at least that's how it works with out insurance. Because when we get the bill we see what the doctor initally charged, then what the insurance said was reasonable and the doctor's office would accept it. So it's like the doctor would charge $100 for something, then the insurance company would say "no that's only worth $80" and the doctor would say "ok $80" It's weird, but that's my understanding of it.

    Answer by mybella81 at 2:29 PM on Apr. 14, 2010

  • I think in many cases that is true, but they word it differently. They will say since you are paying cash they will give you a "discount"! Oh about 10 years ago my knee was injured and I needed an MRI to see what was wrong, I didn't have insurance but since I was paying for it that day with cash I was charged $600 instead of $1,000! Of course it did me no good because it's torn cartilidge and I couldn't afford the surgery anyway.

    Answer by Mom2Jack04 at 3:09 PM on Apr. 14, 2010

  • Not always. Sometimes they bill a higher rate to the insurance company, but then they have to accept whatever the insurance company is willing to pay them. WIth one of my doctors my insurance company set a limit on what it would pay for certain procedures, and their limit was less than what I would have paid without insurance. My husband has actually paid more without insurance for some things than my insurance company has been billed when I had the exact same service.

    Answer by Anonymous at 3:13 PM on Apr. 14, 2010

  • Heck yes. I had a surgery that is out of pocket 15k. They billed my PPO $67k
    I took my son to a therapist. If I paid out of pocket $95/hour Billed to my PPO $145/hour

    Answer by Orionsgirl at 3:16 PM on Apr. 14, 2010

  • I don't know about our doctors (we have good insurance, have never gone without it), DHs doesn't charge any different. My chiropractor does charge differently for self-pay - a treatment that I pay for is $34, if I ran it through my insurance it would be $36 - for paperwork mainly. Her other services (accupuncture, primarily) is also charged slightly differently.

    Answer by Anonymous at 3:26 PM on Apr. 14, 2010

  • the docs may give unin sured discounts. so that could be charging less, and its a tax writeoff.

    Answer by mrsjosey1018200 at 3:30 PM on Apr. 14, 2010

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