[Jaquen H'gar]

[ QUOTE ]
[ QUOTE ]
Another caveat as it pertains to MSA's is that you will incur charges from doctors/hospitals at full retail cost, which can be up to 4-10x what the insurer negotiates. I look at my statements, and routinely see doctors bill for $1,000+ and get paid less than 25% of that by insurance.

Under any major insurance, of course, you aren't responsible for the difference - however under an MSA you're pretty much forced to pay the arbitrary charges a doctor sets (take it or leave it).

[/ QUOTE ]

To the best of my knowledge doctors rates are negotiable by an individual. It may not seem like it and if you accept service before hand, it likely won't be, but you are able to work with most doctors on costs if you are paying by yourself.

The best examples of this are the more commercial medical procedures offered in the US. Take Lasik, or cosmetic surgery for example.

[/ QUOTE ]

You shouldn't confuse apples and oranges, cosmetic (i.e. unnecessary) procedures with other medical care. Most non-cosmetic procedures are for the most part non-negotiable unless its provided free and even then, there may be problems. If a physician accepts Medicare patients then he can't be cutting deals with his other patients unless he cuts the same deal with them, at least according to the U.S. government. CMS (Medicare) considers this as the doctor defrauding them by not giving them whatever discount he gives you. Doctors can even get into trouble by giving away free medical care if they don't do enough to fully document the patient is stone ass broke. Usually this documentation is more hassle than its worth. In addition, the way most medical practices are set up, the doctor likely doesn't even know how much you are being charged for his services. What? Yeah, that's right. Generally the doctors are very ignorant of how much you are being charged and somewhat ignorant of insurance/Medicare reimbursement (they can ballpark it). Charges are set every few years commensurate with surrounding doctors' charges. The doctor marks a code on the billing sheet documenting his level of care. This sheet goes to the billing office/service who applies a predetermined price and bills you. Insurance companies disallow some of these charges based on prior negotiations with the doctor. Medicare doesn't negotiate, they simply set a reimbursal rate and the doctor can accept it or not.

Here's an real life example with real charges: placing a central venous catheter in a patient, can be done at bedside with local anesthesia but usually done in an OR.

Doctor's charge: $750
Medicare allows: $239
Blue Cross pays 120% of Medicare allowance: $286

Your bill will look like this:
BLUE CROSS patient (if deductible already met): Charge $750, adjustment -$464, BC pays $228, you owe $58
NO INSURANCE patient: Charge $750, you owe $750.

So why do physicians charge so much if it is going to be disallowed? Why charge $750 if Blue Cross will only pay up to $300 and Medicare less than that? Because Medicare will adjust what they pay down. If a doctor only charged $300 for the above procedure, Medicare would only pay about $100. Blue Cross generally sets their reimbursement rates at Medicare + 10-30%, sometimes much higher for specific procedures.

The real negotiation in medical charges for the uninsured is not how much of a discount you are going to get but what the payment plan will be.

In addition, even if you are lucky and get a surgeon to completely wave his surgical fee, you are still going to be on the hook for the hospital or surgical center charges which will easily be 2-5x that of the physician's. Here you are dealing with a corporation and so will not likely to be able to speak one-on-one with somebody with the power to give you a discount.

Take it from somebody that has had this (uninsured status) happen TWICE in the past year, neither my fault. My son was hospitalized for three days. Presumably we had insurance. We get the discounted bills from the doctor and hospital stating what we owed after our specific insurance company disallowed and then payed 80%. We paid. Two months later we get letters from doctor and hospital stating insurance company NEVER paid and we owed the balance. I call my insurance company and get an answering machine, saying leave a message. How does a big (presumably) company not have a live person or automated call answerer. One week after useless trying, newspaper reports my insurance company has gone broke and will not pay anything. Yep, I got stuck with the bills. Fortunately, being very familiar with medical billing, I went through my bills with a fine tooth comb and found several errors that saved several hundred $$. Still, I was out thousands.