Choosing to self pay

[DonP]

If a doctor bills at higher than the negotiated rate, then received less, can he write off that "loss" on taxes? If so, that could explain some things too.

I've asked this question a few times . Supposedly they can't write it off . If they could every dr would never pay any taxes as there write offs more than income .

 

[DonP]

Doctors bill insurers at the negotiated rate.

If you see doctors receiving less than what they bill, that is because they are billing Medicare/Medicaid directly. Or, they are billing higher than the negotiated rate in hopes of receiving more.

Cash prices are ALWAYS lower than the insurance negotiated rate. Its been like that for 20+ years. Especially for those on insurance under age 65. But very true for those on MAPD and Supps as well.

The provider has the claims process to deal with, and the overhead cost of filing the claim and communicating with the carrier. That is the "official" reason for the difference in price.

The unofficial reason..... insurers make more money when they approve higher costs of care... because it allows them to charge more in premiums... which provides them with a higher amount of net profits. (5% of a $1000 premium is a lot more than 5% of a $500 premium)

I've never dealt with cash with drs more seen anyone with ins do it that's why I didn't know the protocol . Now will drs offices negotiate with cash payers ?

 

[sman]

I've never dealt with cash with drs more seen anyone with ins do it that's why I didn't know the protocol . Now will drs offices negotiate with cash payers ?

Yes, they will. Well, not so much negotiate, but they have a cash pay price. For example, my specialist bills the insurance company $370. The negotiated rate is like $220-something. They (Piedmont) have a cash price of 30% of the billed rate so I pay the specialist $111 for a visit instead of the $220-something negotiated rate.

 

[C Ins Solutions]

I've also never understood the copays that are higher than the cash pay or contracted rate. For example AvMed has a $275 MRI copay which has been as high as $500. When I asked why a policyholder would pay a copay that is 2x the actual cost of the service, AvMed had no explanation. End result consumer loses.

 

[LeeV]

If a doctor bills at higher than the negotiated rate, then received less, can he write off that "loss" on taxes? If so, that could explain some things too.

Can you be clearer with your question?

Who is the doctor billing in this instance, the carrier or the person with self-pay? If the person is self-pay, the doctor can bill whatever they want, there are no contracted costs. If the doctor is billing the carrier, the carrier will simply pay the negotiated and contractual rate.

Highly doubtful that the doctor can write off these amounts. If they were allowed to do so, every provider would be billing much higher than the contractual rates and writing off significant amounts.

 

[somarco]

AvMed had no explanation.

Unless things have changed, AvMed is an HMO. Different animal from PPO or OM . . . different rules

 

[somarco]

why a policyholder would pay a copay that is 2x the actual cost of the service,

Because they don't know the cash price . . . and may not have that kind of scratch laying around,

Over half the folks on Medicare are not wealthy like agents, and a $300 amount due might as well be $30,000.

They also are maxed out on their credit cards with a $500 limit.

The poor will always be among us . . .

 

[C Ins Solutions]

Because they don't know the cash price . . . and may not have that kind of scratch laying around,

Over half the folks on Medicare are not wealthy like agents, and a $300 amount due might as well be $30,000.

They also are maxed out on their credit cards with a $500 limit.

The poor will always be among us . . .

The higher cost is really more so an under 65 ACA issue than it is Medicare Adv. Your avg Medicare Adv plan has the out of pocket equivalents of a platinum or gold ACA under 65 plan.

 

[scagnt83]

I've never dealt with cash with drs more seen anyone with ins do it that's why I didn't know the protocol . Now will drs offices negotiate with cash payers ?

They have a set rate for small stuff. But they will negotiate on larger procedures.

 

[somarco]

Your avg Medicare Adv plan has the out of pocket equivalents of a platinum or gold ACA under 65 plan.

MA plans in GA have OOP limits of $5k to $10k which is probably more than the FL plans and I have no idea what the Obamacare cap is on plans regardless of the metal class.

Regardless, I presume you are reacting to my statement that a $300 medical bill for a low income individual might as well be $30,000 . . . they can't afford to pay either. My statement was hyperbole to illustrate how some folks can't pay much more than a primary care copay.