Quote:
Originally Posted by golfing eagles
Was I writing in a language other than English? Shands will NOT accept UHC MA. The do not participate in it, if they did they would NOT be out of network!!! And "out of network approval" has nothing to do with Shands, it is a decision made by the insurer as to whether or not they will pay them their asking price or reimburse you. What you are saying is that a patient can show up at Shands, no insurance, but with a boatload of cash , and they won't see him. Unlikely.
Perhaps DB has some insight on how this works from a hospital administrator's point of view.
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I always loved patients with cash!
Having said that, most hospitals will first try to negotiate with the insurer to reach an equitable agreement. This might look something like 80% of the usual and customary fee paid by the insurer and the remainder as an out of pocket by the patient.
It would be extremely unusual for a hospital to completely turn down a sincere effort by an insurer to cover an out of network patient. In fact most health plans have a summary document which explains to a patient what % of a bill they can expect to pay as an out of pocket fee. And that % is always greater then what a patient would pay if they had stayed in network.
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