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i've heard that most providers will 'negotiate' down to what they'd get from Ins. Most patients just don't know that.

I have two experiences with this. First was when I needed outpatient surgery, and the surgeon (participating with my insurance) wanted to use an outpatient center that wasn't participating. They called me up to discuss this, and asked if we were using them "due to medical necessity". Or something like that. Basically, they were looking for a reason to use their accounting checkbox that said that they could accept the UCR amount from my insurance company instead of their "billing rate".

Second was with a specialized test center. Not participating either, so the insurance company only paid about 2/3 of the bill. They never billed me for the remainder. I think they just wrote it off, as it's easier to do it that way than to negotiate rates with all the different companies.

joe
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