Last November, I had imaging done in a local ER. My statement showed an uninsured price of about $1500, but the hospital's deal with my insurer brought the price down to about $600 of which insurance paid nothing because my deductible was $6500.
On January 1, I changed insurers, raising my premium from $800 a month to $1100. I changed because my old insurer wouldn't pay for a $530 a month medication I was prescribed and it's clearly the safest appropriate medication for me. With the changed, my deductible was also reduced from 6500 to 1000. There are other considerations that figure into the switch, but this is a post about hospital services pricing.
I had the same imaging done in the ER at the same hospital on Feb 1. The hospital only billed the new insurer $250 for the imaging, of which they were reimbursed $120 by the insurer.
So for the 100% identical procedure at the same ER:
Charge to ininsured patients: $1500
Charge with MyInsurance 1: $600
Charge with MyInsurance 2: $250
I have no idea what they charge Medicare/Medicaid but I bet it's on the lower end.
Got to be a better way.
Back of the cocktail napkin: uninsured patients can be charged no more than the average annualized billing to insurers for any procedure. Not simple averaging of the deals with each insurer, but total billed to insurance for the procedure divided by number of insured patients who had the procedure. If my two visits occurred in one calendar year and represented the only 2 patients who had the procedure, under this formula the max chargeable to an uninsured patient would be (600+250)/2=$425. This would effectively bring average group market leverage to the uninsured patient.