I'm surely hopelessly naive and ill-informed for even asking, but is there a reason a hospital or clinic couldn't operate 100% without dealing with insurance? Do such places exist in the US? We always hear how the hospital sends a bill for $40,000, then the insurance company argues that down to $2000, but woe unto you if you DON'T have insurance because you'll have a hard time getting that same deal yourself. Couldn't a hospital just... send you a bill for $2000, and if you can't pay it you either ask about their low-income waivers, get into a payment plan, or I guess get blackballed as a deadbeat?
There are some hospitals that proudly make a point of not accepting insurance. They avoid the administrative overhead of negotiating insurance contracts and pricing procedures, and accordingly have a smaller salary footprint.
As a byproduct of not working with insurance, they're allowed to advertise standard prices per procedure, because there actually is a standard price instead of 3-5 different "negotiated" prices. This price transparency is a competitive advantage, and it means they can attract price-sensitive patients for elective procedures.
The competitive advantage of price transparency is just enough to make them competitive with insurance-taking clinics.
The difference is that, in these setups, your clinic lives and dies by its reputation. Being in a big insurance carrier's network will effectively guarantee you a baseline patient volume. Going it "on your own" means you get no such guarantees. It's a riskier proposition.
There are cash-only doctors, or doctors who will accept cash as payment, and for what it's worth, the discounts for not using insurance can be substantial.
More importantly to me though was this less-talked-about perk of having a doctor who -- once he knows he's not just going to receive a negotiated rate from an insurer -- will actually take a little bit longer with you and hear out your complaints. Knowing that if you take longer, he can bill you more is actually a net good, IMO.
In practice what you describe in the tail end of your post is how it works. Except the hospital can’t blackball you for emergency care even if you have a history of failure to pay.
The hospital will work with you and put you on a payment plan if you don’t just disappear. If you stop communicating they’ll sell your debt to a debt collector which is a bad deal for both you and the hospital. They’d rather have you paying $20/month for ever then sell your debt.
That's not how it always works. Sometimes they reduce the price and sometimes they play hardball. You are completely at the mercy of the hospital who charges whatever they feel like. And if you, the insurance or the hospital make a mistake they are happy to send you a 300k bill that you will have the responsibility to clear up over the next few years by constantly calling insurance and dozens of doctors who all somehow got put on your bill.
