Please help me understand why the "self-pay" option is always drastically cheaper than my "out-of-pocket expense" when running a service through my insurance provider..??
Details
We have a HDHP + HSA, so we pretty much pay for all our health care most years in exchange for (in theory) cheaper premiums.
We also have a Direct Primary Care Physician who can get us cash prices on things through their partnerships with providers. As such, I often dig a little deeper than most for pricing info when scheduling services.
Over the past few years I've had various needs like an X-Ray, MRI, Physical Therapy, etc.
In each case my DPC doc gives us their "partner price", and then I can also call other providers to compare with their "self-pay" and "out-of-pocket" insurnace price.
The providers give me their self-pay price, but they can never tell me what the out of pocket insurance price will be. I have to ask them for all the medical codes related to the service, and then call my insurance provider. They are able to look up those codes and then give me a price.
In ALL cases, the "out-of-pocket" insurance price is literally 3x - 6x MORE than the self-pay options. Sometimes my DPC partner price is better, but sometimes the provider self-pay is better. The insurance price NEVER wins.
What's going on here? These providers wouldn't offer self-pay at a price that they aren't profitable at. Why are they gouging insurance providers?
It seems this is why our insurance premiums are so high. If the providers are paying that much more for the same service that people could pay it themselves, then of course they're going to pass that on in the form of higher premiums.
It really makes me just want to cancel the insurance and use my DPC for everything, but of course it's the critical, super expensive stuff that could maybe happen one day that keeps me paying those premiums.
Heck, charge them double, but why 3x - 6x??? What am I missing here?
Recent Examples
We had an MRI scheduled. Our DPC doc has a price of $295 and suggested we compare that to another provider that we could run through insurance. This provider has a self-pay option of $450 and couldn't tell me what the out-of-pocket would be through insurance.
I call the insurance company with the codes, and they tell me it would be $650.
Obviously, my DPC price is much better, so that's the route we go. I can then file the claim with my insurance company directly by filling out their claim form, and the $295 still goes towards our deductible.
Another example is that I was prescribed physical therapy for a messed up foot. The DPC doc doesn't have a direct option for this, so I have to go to another provider.
This time, the provider says if they run it through my insurance, yet again they can't tell me exactly what the price will be, but they are typically $300 - $600 per visit.
Their self pay price...$150 first time and $100 each time after that.
Once again, I choose the self-pay, and then I can file it with insurance myself to have it go towards my deductible.
What gives? What am I missing? Why don't providers just charge everybody what they need to charge to run their business and be profitable? It shouldn't matter who's paying...should it?