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Behind the Mystery of Negotiated Rates in Health Care

Most people find it next to impossible to determine the costs of medical treatments before they’re rendered and the bill comes in the mail. As those who do try to find out soon realize, different health insurance carriers or providers often pay different rates for a variety of treatments, procedures, surgeries, hospital care and emergency medical care treatments. The disparity of costs is due to what are known as the health insurance negotiated rate.

Negotiated rates are basically the payment amount that healthcare providers from different California Health Insurance carriers (such as Anthem Blue Cross/Blue Shield, Kaiser, PacifiCare, Aetna, United Health Care) agree to accept for services rendered. Negotiated rates are generally limited to a Preferred Provider Plans (PPOs) network, which are common health insurance plans offered by employers in which individuals agree to limit their visits to doctors or services included in a specific coverage plan. However, these rates may differ depending on demographics such as location and population density.

What California Health Insurance Agents Know

California Health insurance Agents such as Matt's Health Insurance Services would like to see more transparency in how negotiated rates are determined, but because such rates are negotiated independently among providers and local physician’s groups, clinic facilities and hospitals, it’s extremely difficult to get answers about how much a particular treatment or surgery will cost until a patient receives a bill with the Explanation of Benefits (EOB) attached. However don’t blame this lack of information on the insurance agent. When it comes to negotiated rates, most people are left scratching their heads.

Negotiated rates are mysterious, magic numbers that determine what a specific California Health insurance carrier will pay for treatments, procedures, surgeries, drugs, rehabilitation services and so forth. These rates are considered proprietary, which basically means they’re secret. How do network providers determine how much they’re going to pay out on certain services? Why does geographical location make a difference? That’s something that many in the healthcare field are taking up with state Congressmen and Senators.

Finding California Health Plans with Negotiated Rates

Many independent California Health insurance agents, like , carry major network plans from providers like Anthem Blue Cross Blue Shield, United Health Care, Aetna, and Kaiser and PacifiCare. California Health Insurance agents would love to be able to tell their clients just what they can and should expect when it comes to benefits, but in some cases, because of the very nature of negotiated rates, doing so is impossible.

Most health care recipients may determine what percentage of costs a health insurance plan carrier has agreed to pay out as long as certain terms and conditions are met, which are the amounts of negotiated rates agreed upon for each individual carrier.

When it comes to a negotiated rate however, the higher the volume of use, the lower such negotiated healthcare rates may be. That’s because volume enables providers to lower costs. Nevertheless, lack of transparency when it comes to how those negotiated rates are determined leaves most California health insurance agents frustrated because of an inability to answer specific questions regarding costs with their clients.

The good news is that negotiated rates are similar between healthcare insurance providers. Until the healthcare system is revamped, it seems that negotiated rate determination methods will continue to remain a mystery not only to patients, but also to California health insurance agents as well as many healthcare providers themselves.

If your looking for a California Health Insurance quote you've come to the right place. provides Instant California Health Insurance Quotes. As an Independent Agent we can offer several top rated carriers all in the same quote for you to compare side by side. Our quoting tool will show you Anthem Blue Cross, Blue Shield of California, Health Net, Kaiser, PacifiCare and Celtic health Plans. When you ready to get started you apply online with our secure carrier direct links or you can print out an application and fill it out by hand. When you do fill out a California health insurance application it is critical that you are absolutely honest and accurate when answering the health questions. Read each question carefully and answer honestly.

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