Why won't doctors let me pay the insurance price at the time of service? I struggle to provide medical insurance for my family. I often considered buying a major medical policy and seeing if I negotiate routine care at a fair price, but nobody seems inter

Individual. Individual patients are often able to negotiate something up front if they don't have insurance, but the doctor can't simply lower his or her rate for all uninsured patients because doing so would establish a new "baseline." that's a problem because it is illegal to charge anyone less than you charge medicare for the same procedure. In your example, the doctor bills $234.00, knowing that he or she will only get $64.00--a 62% cut. If he charged you $64.00 for the same service, then by law he could not charge medicare patients any more than that, which means that the same 62% cut would earn him only $17.50. It's a crazy system. To be honest, I think the vast majority of doctors would prefer to stop taking insurance altogether and just charge patients directly. That would eliminate a ton of paperwork and delay, as you've suggested. The problem is that medical costs don't come in small, manageable chunks: for most people, there are no costs at all for years, punctuated by periodic big charges for illness or accidents. That's why insurance is a necessary evil.