MRIs are a limited resource.. with a limited number of machines. It is very hard for insurance to negotiate these down.
For HMO/PPOs it depends on whether you get to choose your own doctor or use a plan doctor on how much potential discount through the plan. Service may also suffer w/ the plan doctors.
In doing self-pay vs comparison of what I would normally pay for with insurance (including the monthly payment), self-pay easily wins. What ever savings there may be in negotiated fees for some services, easily gets eaten up in the insurance company’s overhead. I included what I would pay for dental. I have had to have considerable dental work (lost track of the number of crowns), to the point that I would have gotten close to busting the lifetime cap on some dental insurance plans. BTW before you jump in on it, the reason why I had to have so much dental work was because of a dentist, not because the lack of one.
The degree of discount on rates is largely a fallacy. An easy way to check would be to figure out how much is being paid in for a GP’s office using self-pay rates and then calculate out what the effective earnings would be (subtracting office overhead, support personnel wages and insurance, malpractice insurance). The numbers end up not working out for a large discount. I even ran this for my GP.
Why would GPs and groups like Scripts give discounts to cash payers? Maybe because they don’t have to carry overhead to manage the insurance on these. I don’t think ‘charity’ fits here, certainly when you are dealing with a client who can whip out the checkbook and cover a $3000 bill without breaking a sweat.
There is a field within an insurance company’s 10K/Q that you may want to look at. I don’t remember the exact name is, but it equates to the ratio of claims paid out vs premiums paid in. Usually this number is less than one. During the time between the premium being paid in and the claim being paid out, the insurance co has use of that money for investing.
