Negotiated Fee Rate
What is the regular Price?

Newscast about Hospitals being required to post rates - charges

Kaiser Foundation
Health Insurance Explained

The Negotiated Fee – Rate is the amount of payment that an Insurance Company has negotiated with the Participating Provider as the maximum they can charge both the Insurance Company and YOU!

Excerpt from Blue Shield Explanation
Excerpt from Blue Shield Explanation

It’s the  secret number the insurance company and the provider have worked into their contract. The industry often calls that number the “adjusted rate” or the “negotiated rate.” View an actual Specimen Policy Explanation – Page 42 Blue Cross EOC  & 167 More explanation– Can MD’s charge more? Uninsured?

How do I know that the amount I’m being billed
is the correct amount?

Once your insurance carrier pays their portion of the bill, they will send you an explanation of benefits (EOB) to show how the claim was paid. You can compare your EOB to the statement sent by the hospital. How the carrier paid the claim is based on their contract with us and their contract with you. If you feel the insurance company should have paid a higher amount, please contact them directly for resolution. Patient Billing FAQ’s

True Cost of Health

Todd Friedman, Esq. can help if debt collectors are harassing you when you don’t owe the $$$

Might it be better to pay cash? 

Hospitals will be required to post online their standard charges

This was to have started in 1.1.2018 I’m not sure if it really has.    Did you know they are already required to do this if requested?  Cal Broker 8.7.2018 * The Hill *    CMS is looking for a contractor to create a price comparison tool.  Modern Health Care 8.28.2018 LA Times 6.10.2016

Trump Executive Order 

Trump Executive order directs federal agencies to issue guidance that would:

  • Require hospitals to disclose information about negotiated rates in a format that’s understandable and usable by patients and consumers.
  • Require insurance companies to provide patients with information about the cost of their care, including out-of-pocket costs before they receive services.
  • Develop a comprehensive roadmap for consistent, limited, and consumer-centric quality metrics.
  • Expand the availability and use of HSAs to cover direct primary care arrangements and healthcare sharing ministries. It also seeks to include more preventive services that can be covered in the deductible period.

Issue guidance on the number of funds that can be carried over at the remainder of the year for FSAs.  WhiteHouse.Gov

Healthcare Payments Database,   

Some  argue that negotiated prices are proprietary — that is, legally protected trade secrets — and that their disclosure could foster collusion between providers. Other observers maintain that disclosure could help policymakers understand what is driving cost increases and how best to target efforts to make care more affordable.

The Secret of Health Care Prices: Why Transparency Is in the Public Interest, analyzes, for the first time, the legal and economic implications of collecting and releasing this data, including a review of trade secret statutes and case law regarding the protection of negotiated prices as trade secrets and data dissemination practices from the 18 states with mandatory APCD collection programs.

Accompanying the report, a blog post  examines recent developments in price transparency policy, the arguments for and against the release of proprietary price information, and steps California could take to help ensure its new database is a success

3 comments on “Negotiated Rates – Itemized Bill – Regular Price?

  1. After contacting my providers, it isn’t going to make much difference to them what I am on – Grandfathered or ACA Obamacare, because, unbelievably to me, my present Grandfathered costly plan reimburses them less than Medicare does!

    This is a complete reversal of the 90s when my husband’s health insurance switched from private individual market to Medicare. After the switchover to Medicare, I had to fight for his treatment and doctors saw him as a one payment body in a bed. You wouldn’t believe how bad it was, all due to the difference in insurance..

    Now I am hearing just the opposite — Medicare has less restrictions on authorizations and better reimbursement than private health insurance! Unfortunately for us seniors the anticipated cuts to Medicare due to the newly passed tax bill could put us right back to the 90s Medicare scenario.

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