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Difference Between Negotiated Price and List Price

Posted Apr 06 2009 11:15pm

One excellent reason to purchase health insurance is so that you do not have to pay full price (list) for services.   When you have health insurance, you get the discounted (negotiated) price for services that the insurer has negotiated with the health care provider.   If you don’t have insurance, then you are on your own to negotiate a price with the health care provider – and you should definitely ask the provider for a discount.  

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Insurers and health care providers consider t the “negotiated prices” proprietary information that they don’t want this price publicized.   These negotiated prices are what insured consumers are expected to pay for services, but they are kept a secret and it’s difficult, if not impossible, to find out what these prices are until after you have visited the provider.  


From what I have heard, Blue Cross Blue Shield negotiates the best discounts from provider list prices.   Where BCBS negotiates 60% off list, other insurers negotiate 40% off list.   Knowing this can help consumers make informed decisions when purchasing health insurance.


Office visit list price:    $100

BCBS negotiated price for office visit:   $ 40

Other insurer negotiated price for visit:    $ 60


It’s also very interesting that a provider can have up to 100 different prices for the exact same service, one for each type of insurance they accept.   Most price differences have more to do with a doctor’s negotiation power than with the quality of care from the provider.   Wouldn’t it be nice to know up front what providers offer the best value?


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