I hope the plaintiffs win.
Cash payers should pay the least, right? Ha! Not how the hospitals work. I had a little 45 minute surgery. The hospital charged me $7000 for it. However, I had insurance, which had a negotiated rate of $900, of which I paid $200 for a co-pay (tier 2). Had I been a straight cash payer, they would have pursued me for that $7000. I asked up front how much this would cost. No one was able to even give me a ballpark figure.
The people without work or the working-poor are also the least likely to be able to pay, yet they are the ones charged 7X as much, their bills sent to collection agencies, and they often go into bankruptcy. I believe the insurance companies have too much power. They demand deep discounts from the 'cash' rate. If a doctor decides for charity care to decrease a cash payers rate down to the insurance rate, then the contracts demand that the insurers pay even less to maintain their discount. The origin of discounts to insurance companies came about from insurers guaranteeing a certain number of patients coming into the doctor's office, but that has been done away with a long time ago. Now they only demand discounts, (and they control if they pay.)
What about trying to do research before having surgery or a lab test performed?
Last year I had a simple foot x-ray ordered from my physician. I got it done at the hospital connected to the doctor's office building. At the check-in window I asked the lady if my insurance was going to cover this. She assured me that it would. I asked her to check with her billing friend nearby, just to be sure, and she also assured me that it was covered. A month later a large bill came to my house for the x-ray. Apparently the insurance company didn't cover it. Calling the hospital billing unit, they told me I had to talk with my insurance company. The insurance company told me I had to talk with the hospital.
This opacity in pricing is in the insurance companies benefit. The patients don't know the true cost. The doctors can't fight against it. Only the insurance companies benefit.
I hope this plaintiff wins. Transparency and consistency (between payers) in pricing (including medicare and medicaid) would do wonders for our country. Of course charge more for an appendectomy on a pt with CHF and DM and emphysema, but make the payments the same, no matter if insurer or cash payer.