Health insurance is the primary method patients use to pay for office visits and medical treatment. While many believe that nobody pays 100% of their medical bills, there are several scenarios in which 100% of the full bill charge is paid to the medical provider.
These reasons include: (1) Affluent patients who are self-insured or have 100% policies; (2) concerns about confidentiality and privacy; (3) sheer gratitude for care (lifesaving and/or relief of pain/suffering/dysfunction); (4) ability to gain faster treatment (move to head of line, “pay to play; (5) out of country patients; (6) sometimes – a combination of the above.
Affluent patients often pay 100% of full billed medical charges. This is because (a) they can afford to pay 100%; (b) they are self-insured (no medical insurance) and choose not to negotiate the bill; (c) they have a high-benefit health insurance policy which pays 100% of billed charges; (c) they feel an obligation to pay the full charges for medical care; (d) they wish to be given the ‘maximum’ medical attention (versus the reality that patients who pay less can and do receive less medical care and/or lower quality medical care; (e) they are foreign nationals who can pay and/or lack health insurance.
Medical billing experts such as those working with Abacus Analytics have seen scenarios in which affluent patients have paid 100% of their medical bills. Abacus Analytics medical billing experts have testified in deposition and trial about scenarios in which the full bill amount is paid.
Patients may pay 100% of the full billed charges for privacy and/or confidentiality concerns. Their goal is to have the bill paid, closed, and filed without being sent to anyone, particularly health insurance payors outside the medical providers offices where confidentiality can and often is compromised. This is particularly true for high-visibility patients where release of their medical problems could have undesirable ramifications. These include very senior officers of large corporations whose illness/injury information could reduce the value of that corporation’s stock value, credit rating or relationships with stockholder and/or sensitive negotiations with other companies. Patients with high level political positions or in campaigns getting treated in the alcoholic ward. Movie stars also often pay medical bills at 100% of charges to maintain confidentiality & privacy rather than bill it through an insurer like Motion Picture Health & Welfare where it’s well-known that the paparazzi have the staff on retainer to ‘leak’ medical information about stars.
Some patients pay the full bill out of sheer gratitude for the medical care which relieved pain, suffering and maybe dysfunction. This is particularly true when children or babies are treated successfully. It’s not unusual for parent and sometimes grandparents to write a full check to the hospital and/or physicians/surgeons for the full bill when a baby’s life is saved or any loved one is cared back to health. There are even instances where I have received monies which are deliberately above the total charges – sometimes very much above the total charges – as a thankyou for the care – usually accompanied with a note specifying the money be used for ‘general funding of the hospital/physician or sometimes dedicating the money to a specific project (children’s hospital.)
It is a poorly known fact that some patients can obtain some needed medical care sooner by paying full billed charges – or even more than the full charges. This occurs when medical facilities have limited capacity, which is increasingly common in the U.S. and patients are put on a waiting list. Agreeing to pay full charges or more can in some scenarios move the patient higher on that waiting list – perhaps even to the top for more immediate treatment. An example is the waiting list for various transplants which have limited organs available and long waiting lists. It is not unusual for patients to die before their ‘turn’ arrives for the ‘next transplant.’ This is highly controversial of course so it is covert and rarely exposed to the public. This practice is increasing in the U.S. as availability to medical care decreases for a variety of reasons outside this article. Side note: this practice is remarkably common in socialized countries (England, Scotland, France, Canada, Russia…) where it is well-known as “going private.” This means not using the ‘free’ socialized medical system (with wait times of years for a simple CRT in some countries) and obtaining medical care in private hospitals from private physicians – albeit at a high cash price which is for 100% of the medical fees.
Out of country patients often pay 100% of the full billed charges. This is very common in some hospitals which cater (market) specialized medical services to foreign (affluent) residents. At Cedars-Sinai Med Ctr in Beverly Hills we had entire floors (highest with best views) which were reserved for patients from foreign countries. These patients came to the U.S. for higher quality care and were more than willing to pay 100% of charges.
Sometimes patients pay 100% of the bill for a combination of the above reasons: gratitude, affluence, 100% insurance policy. It’s important to remember that every patient incurs 100% responsibility for the entire bill at time of services rendered.
As seen in the examples above, it requires a qualified medical billing expert to be able to effectively articulate the complexities within healthcare finance. While the layperson may believe that nobody pays 100% of medical bills, experienced medical billing experts can explain how this is simply not true. By retaining a qualified medical billing expert through Abacus Analytics, law firms can receive a true valuation of the patient’s past and/or future medical bills.
Contact Abacus Analytics today to speak to our medical billing experts. The medical cost professionals at Abacus Analytics can provide you with expert witness testimony and trial testimony. Contact Abacus Analytics at 844-633-2678.
Michael is an avid medical billing expert and team member of Abacus Analytics and focuses on stories and articles in and around the medical billing industry.
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