Hospitals negotiate the drug prices for that insurance company’s clients with each insurance company. Prices are usually different for each insurance carrier.
Hospitals are required to bill for the individual items or services provided to a patient. A patient admitted to the hospital is charged for his or her room, supplies, drugs, labs, X-rays, operating room time and other care.
If a patient has insurance, the hospital submits a bill to the insurance company for all of the services provided to the patient. The insurance company then determines the total amount owed to the hospital based upon the insurance company's contract with the hospital for that service. The company then determines if the patient has to pay a portion of that amount owed, based upon that patient's insurance coverage. Usually the amount owed by the patient is not determined by the hospital's total charge.
If the patient is uninsured, the hospital bills the patient for services.
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