If one had a pre-existing knee problem and this was deemed a "pre-existing condition" then for most insurance companies the patient not only has to foot the bill but does not get the advantage of the insurance-negotiated “customary and reasonable” prices. So if you have health insurance for everything but joint surgery, and you need a knee replacement, the anesthesiologist might charge $2,000 to the insurance company, but absent insurance coverage he might charge you $8,000.
Let’s change this. Let’s mandate that insurance companies negotiate for price on their clients behalf even if there is an excluded coverage for a pre-existing condition. They have already negotiated prices and so this would only involve a small amount of additional administrative work.
I have spoken before how the self-insured get killed by prices that are many times those charged to the government and insurance companies. The self-insured don’t pay a 10-20% premium; they frequently pay a 300% premium. The folks have no lobby, and many times they don’t have the ability to negotiate up front, because the service provider is one of the minor components of the health care package – say the laboratory work. Try calling up the hospital lab and even getting a return phone call when you about negotiating price. If you did manage to negotiate with a hospital (which is very tough to do) that does not mean that you have negotiated with their independent lab.
I suggest that the insurance companies be allowed to charge a surcharge (say 10-20%) for the cost of this additional processing, because the net savings would be huge.
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