Quote:
Originally Posted by dbussone
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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Now
IF there is no provider in network that does the same procedure, and IF it is considered medically necessary to have that specific procedure, don't they cover it as though it were in network?