[quote name='caltab']I am understanding what you are saying. I am well aware that someone who is insured pays less then the billed amount because insurance pays part too...that would be the entire point of insurance.
Someone who is insured is often billed far less than someone who is uninsured for the exact same procedure. The insured patients are billed the discounted rate that the insurance company negotiated with the health care provider. The insurance company then pays their percentage of the disounted bill based on the coverage. Someone who is uninsured can be billed the non discounted rate and is responsible for the full bill.
This quote from the article spells it out pretty clearly, "Hernon is uninsured, and in one of the strangest twists of the US health care system, the uninsured often pay two to four times as much for the same services as most health insurers and government programs. Many patients who must pay their own bills are charged full price while insurers negotiate steep discounts for themselves and their members."
Perhaps I am some how totally misunderstanding what you are saying, but I don't think I am. But I won't keep cloggig up this thread...the poor OP just wanted to know about his bumb tooth.[/QUOTE]
LOLZ...this is getting frustrating, but it never hurts to learn about how insurance works.
Well, it looks like you get the point of insurance, but you're getting tripped up with the way the word "discount" is being used and how insurance actually works.
The thing is that there is NO discount. If both of us chipped in for a $1 bottle of water, it doesn't mean that you nor I got a discount on it compared to someone that bought it on their own. You and I might pay less as individuals, but that doesn't change the cost of the bottle of water.
For Hernon's example, it is established that he is responsible for 100% of the surgery and any insurance provider is responsible for less than 100%. The catch to this is that the insured patient could be responsible for the entire difference that the insurance carrier doesn't pay and this depends on the payment policy of the care provider(doctor, hospital, whatever). Let's say that the insured patient uses up their insurance allotment in less than a year, that doesn't somehow mean that they'll be paying $100 for a filling that would've cost $80 before that patient went over the coverage limit.
You're under the impression that the insurance company negotiates the actual price of a service. For example, if a dentist charges $100 for a filling, the insurance company negotiates the cost of a filling down to $80. That is not how insurance works. What insurance does is negotiate how much of that $100 cost it will pay to the dentist and not how much the patient will ultimately pay. The insured patient will then be responsible for the rest of the $100 not covered by insurance. So if two patients, one has insurance and the other doesn't, walk in for a filling, the cost of the filling is still going to be $100 eventhough both patients will be responsible to pay different amounts at the time of getting the same service. At the end, the care provider still get's it's $100 for that filling: no more, no less.
What each party pays is not necessarily THE determining factor in what the service actually cost.