Re: Negotiated fee rate

>>Blue Cross won't give me a list of NFRates, and the hospital says they
>>don't
>>have it. Are they hiding the relatively low rates from the uninsured? Do
>>I
>>have to pay a bill without the evidence of the calculations used?
>>
>>I assume it should be my right to see this list.
>
>
> Why would this be a "right"?
>
> You agreed to pay a portion based upon the current reimbursement
> formulas. The reimbursement formulas are typically proprietary info
> held close to the vest by the insurer. Since there's usually very
> little difference between insurers and hospitals, reimbursement is the
> key to gaining (or losing) business.
>
> It's not uncommon for the hospital billing dept not to know the exact
> fee paid for a specific procedure until they receive the number from
> the insurer. It's often not based upon a list or menu, but a
> (sometimes) elaborate calculation agreed upon by both parties. You
> are a beneficiary of this lower rate, but not necessarily privvy to
> the details.

I understand their motivation for keeping me in the dark, but it makes me
uncomfortable. There is no way for me to check up on their adherence to the
agreed upon contract. The information being withheld from me leaves me
powerless.


.

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