Hospitals readily admit that chargemaster prices are inflated. That's because they are the starting point for negotiating the discounts given to private insurance plans in return for the volume of patients they send to a hospital. Those bloated chargemaster prices, however, are the numbers used to bill uninsured patients - many of whom will struggle to pay those bills and will get nasty collection letters if they don't.
These gross prices are listed on spreadsheets called chargemasters, and are typically used as a starting point in negotiations over fees in much the same way the sticker price of a car is the initial bargaining point at an auto dealership. The chargemaster prices are typically negotiated downward to reasonable reimbursement rates for private insurers and public programs such as Medi-Cal and Medicare, according to the suit. Not so for uninsured patients of Sutter hospitals , who are billed the full sticker price, which can be 80 percent higher than the industry standard, according to the suit.
It has been common for hospitals to raise their chargemaster rates substantially each year in an effort to win higher reimbursement rates from health insurers. But the practice falls hard on uninsured patients, because most hospitals give no more than a 20-percent discount to the uninsured.
What a hospital is actually paid by an MCO, Medicare, or Medicaid is rarely even close to what is listed on the chargemaster. In fact, only the uninsured are subject to those charges.
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