How do these medical bills get paid ?

Years ago before my wife became a nurse, she was a medical secretary for a surgeon. She did a lot of the billing to the insurance companies. They would purposely bill much higher than they KNEW the insurance was going to pay because if they billed closer to what they thought would be paid the insurance would simply pay much less than that. Total cat and mouse game!

First hand experience ~ If patient is “cash pay”, meaning they have no insurance, then medical has entirely different payment schedule that usually reduces by huge percentages.
Why so low? Here’s probably the main reasons.
1. Medical gets payment faster thru cash. Insurance/coding can delay payments for years.
2. Excludes middle people. No “medical coding” to be performed, evaluated, re-evaluated, etc…
3. No expense for Doctors/Medical groups to hire coding group.
4. No insurance expense to Doctors/medical group to have their accounts payable / accounting / liaison persons interacting with coding & insurance group to concur about prices.

Samaritan Ministries is a Christian health share group. We have been members for 5+ years. Members monthly share (their dollars) get mailed directly to other members who have medical needs for 11 months of the year. Some months our dollars get mailed to Texas, or South Dakota, or California, or wherever. One month a year, all member’s monthly share goes to Peoria IL’s staff to pay administrative salaries, website expense, etc.
Administration coordinates all needs & shares. Mails each member a monthly notice that explains which household is in need, which person in that household is in need, briefly describes their need, gives a dollar amount that we should mail to that family’s address. Pretty simple.
Wife & I have both been on receiving end of shares (members checks) which arrive by mail with thoughtful prayer from faithful members

If you’re interested, go to this link
[URL=[URL=https://samaritanministries.org/resources/classic-basic-guidelines%5d]https://samaritanministries.org/resources/classic-basic-guidelines][/URL]https://samaritanministries.org/resources/classic-basic-guidelines[/URL]

Edited by AC7060IL - 20 Aug 2024 at 3:25pm

It's a big game :  In last 8 months of my wifes life , in the first 2 months she used 100% of drug and donut hole prescription coverage of policy 
 3 trips to hospital and 2 stays in recovery facilities for 2 weeks each time semi-private room 
 Then in 8th month Hospice - which is total on Medicare or not part of insurance 
Total bill was $980,000  - Medicare said most hey would pay was $550,000 
Final bill insurance paid $220,000
 My total out of pocket was $3,000 and that was for the drug coverage in the first 2 months 
Now figure what a person with no insurance would pay or with Standard Medicare which is a 80/20 type paying system 

Probably a tax evasion move on the part of the hospital. If you have someone without the ability to pay, seeking care, charge the living daylights for the care. $15.00 for an aspirin, $1000.00 for a check-up, no pay no problem, the hospital has $1015.00 they put down as ‘bad debt’ against earnings.

Lars(wi) wrote: Probably a tax evasion move on the part of the hospital. If you have someone without the ability to pay, seeking care, charge the living daylights for the care. $15.00 for an aspirin, $1000.00 for a check-up, no pay no problem, the hospital has $1015.00 they put down as ‘bad debt’ against earnings.

Aren’t most hospitals “not for profit “ and therefore does this action really mean anything? I don’t know, I’m not a tax expert especially for nonprofit.

There’s a guy here at work whose wife is a medical train wreck. Numerous exotic expensive surgeries, drugs, therapy…. His medical expenses are in the 100’s of thousands, probably pushing a million now since I haven’t talked to him about it in a few years. This is AFTER our insurance has paid.

He gets bills in the mail, huge balances, threats of collection agencies, etc. He just laughs and sends them $50. Will never be paid off. Not remotely possible. But if he sends them money every time they ask it just rolls over to the next month.

So there’s this and the whole can’t refuse treatment thing in this as well. Lots going on.