Your Health Insurer’s Poor Negotiating Skills Mean Higher Bills for You

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Male patient getting a CT scan
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Sick of the high costs you pay for medical services? In at least some instances, your fat bills may be the result of poor negotiating on the part of your health insurer.

For example, too often, health insurers pay more for radiology services than they should, according to a recent study published in the journal Radiology.

These overpayments trickle down to ding patients’ wallets. In a summary of the researchers’ findings published by the Radiological Society of North America, study co-author Ge Bai, a professor of accounting at the Johns Hopkins Carey Business School in Baltimore, says:

“Many commercial plans are leaving money on the table when negotiating price with hospitals, especially for expensive CT and MRI scans. High prices paid by commercial plans eventually come back to bite U.S. employers and workers through high premiums and out-of-pocket costs.”

An individual hospital typically contracts with several insurance plans. In some cases, one insurance company may manage more than one of these plans.

Yet, the researchers found that insurance companies often negotiate different prices for the same services and that some insurance companies even negotiate different prices among several of the plans they manage with the same hospital.

The price variations were especially pronounced for services that require the use of expensive equipment such as CT and MRI machines. Prices for such scans regularly differ by as much as five times within the same hospital, Bai says. She adds that within the same hospital and within the same insurance company, prices can vary six-fold.

The study authors note that insurers increasingly negotiate prices on a percentage basis of Medicare rates. The goal is to improve “pricing fairness and comprehensibility,” the researchers say. Yet, too often, health plans are not negotiating prices as effectively as they could, according to the study.

For tips on cutting the cost of your care, check out “How to Negotiate Your Medical Bills.”

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