> These are the prices they charge people who lack insurance.
No, they are the fake numbers they keep around as starting points so that (1) insurance can claim to have negotiated price down, and (2) they can claim the inflated numbers to be the “usual and customary charge to the general public” for purposes of government programs like Medicaid which include the usual and customary charge to the general public as one of the factors in reimbursement rates.
> They're very real if you get a bill with them on it.
A number of providers give an automatic, no negotiation needed discount from the chargemaster to uninsured patients, and most of the rest expect to allow themselves to be negotiated down. The chargemaster isn't the real price, and has no consistent relationship to it across providers.
I think the expectation in these situations is that the patient goes into the billing office and asks for a realistic price, and the hospitals mostly say yes. Kind of like how Verizon kept doubling my bill and then every 6 months I'd call them and ask them not to double it and they'd mostly say yes. I guess the outcome is that anyone sufficiently savvy or with savvy relatives gets out ok, and the un-savvy people get deeply, shamefully screwed.
Which is a horrible system, but it has an interesting property. The more likely someone is to complain, the more likely the system will actually work for them. To me it seems like some perverse evolved survivorship trait, for the system itself. But then I don't work in the industry, so I could be wrong about all of this.
Nope. Those are the prices that they start with that your insurance claims they negotiated down to 50% or whatever on your bill from insurance for your copay.
You can see the problem. Both the hospital and the insurance company are incentivized to keep that number artificially high.
They (hospitals, out of network specialists) are also under no obligation to negotiate with you. You are on the hook for whatever your insurance refuses to pay, which can be substantial regardless of what your deductible is.
They might negotiate with you, but they might not, in which case you are at the mercy of whatever your state's creditor laws are. Florida? Great laws protecting your primary residence and wages from garnishment if you're head of household. Missouri? Not so much.
