Wiki Self pay question!

[cuncleb]

Hello!
Can a hospital charge more for a private pay patient versus a patient with insurance? Looking at a billing sheet for a local Texas hospital it shows private pay being charged more than insurance charges?

 

[sls314]

Hello!
Can a hospital charge more for a private pay patient versus a patient with insurance? Looking at a billing sheet for a local Texas hospital it shows private pay being charged more than insurance charges?

Yes. There's no requirement that a standard self-pay discount be less than the insurance rate.

Doing so might even complicate the insurance contracting process.

If the hospital says "This is our standard rate for self-pay" and it's less than the insurance company's rate, that could be leverage to lower contracted rates on the next renegotiation. (The argument would be "If you only need to get paid X, why would we continue to reimburse you Y?")

However, many hospitals offer a sliding scale for a family's household income based on a percentage of the federal poverty level. The patient would have to apply for that financial assistance and usually submit documentation of income and/or assets.

The standard self-pay rate published on the hospital's website would generally be just the basic self-pay discount without any financial assistance that a specific patient might be eligible for.