How cash-pay patients can beat high-deductible plans

Many of us now have high-deductible health insurance plans, which makes us “cash-pay” patients until we meet our deductibles. According to a Health Affairs health policy brief, high deductible plans are now much more prevalent in both individual and group markets.

The higher the deductible, the lower the monthly premium. If you have a high deductible plan and don’t consume much medical care, you are most likely a cash pay patient. You might even avoid medical care because of the out of pocket cost. I know I have.

I talked with a friend yesterday who has a $9,000 deductible. She has a torn meniscus. She is avoiding the surgery because she isn’t even close to hitting her plan’s deductible. I suggested she try asking for a “cash pay” price from her surgeon and the hospital or surgery center where her procedure would be performed.

Negotiating cash pay prices for medical treatment has become a common practice. Often a cash-pay price for medical care can be much less than what you’d have to pay if you haven’t met your deductible.

But be aware, cash-pay prices only work if your provider does not submit your bill to your health insurance company.

According to the a Los Angeles Times article, “Even if you have health insurance, you may want to pay cash,” Gerald Kominski, director of the UCLA Center for Health Policy Research said, “If your insurance has a high deductible you should always ask for the cash price.”

After my family’s past health insurance company pulled out of the health insurance market, we chose a Blue Shield plan. They have already denied a medication I’ve been taking for years. Even after my doctor filed an appeal, they refused, and suggested I try similar medications that were obviously less expensive for them and not what my doctor prescribed.

I decided I was not going to let Blue Shield dictate my treatment if I could help it. I spoke to my pharmacist and asked for the cash-pay price for the medication if we didn’t submit to my health insurance. It was too expensive. I called a few pharmacies and asked for their cash price for my medication. I took the lowest price back to my pharmacy and asked if they would match it. They agreed.

You too can shop around for cash-pay prices and not just for medications, but for other medical services. For example, if you need an MRI, call a few imaging centers and ask for their cash-pay price. Be sure you make it clear you do not want it submitted to your health insurance. You can then negotiate with the provider of your choice.

Tips for a discounted cash price:

1. Offer to pay up front at the time of service in exchange for a discounted cash price. Medical providers wait long periods to get paid by health insurance companies and some welcome being paid quickly.

2. Offer to pay the equivalent to the price that your doctor or other health care provider might receive from your health insurance company. What many patients don’t know is that health insurance companies don’t pay what doctors or other providers bill. They negotiate a reduced fee, so the provider is paid less than what is initially billed, according to the Medical Billing Advocates of America.

3. Offer to pay by check or cashier’s check and avoid the use of a credit card since an extra charge might be tacked onto the bill. My husband’s anesthesia bill from his surgery last year was paid with a credit card from our past health insurance company. The anesthesia group added a $45 additional fee for credit card processing that was passed down to us. I put a stop to that. So can you.

4. Go to Healthcare Blue Book, Clear Health Costs or New Choice Health and look up the desired medical service to get an idea of how much local doctors and hospitals charge for what you need. You might find that there are vastly different prices for procedures done in various facilities.

5. Negotiate a cash price before you have a medical procedure, if possible. Be sure to note the name of the person you negotiated with at the medical provider’s office, the exact price, and date of the discussion.

6. You can negotiate a cash-pay price after a procedure or treatment, but it’s easier ahead of time. If you receive medical bills from a hospital, per say, you can still ask for a discount. Try this: “I can pay 30 percent of the bill now if you will write off the rest.” If they do not agree, they might come back with an alternative reduction you find acceptable.

If you think that negotiating cash-pay prices for medical care has an unseemly quality, you might consider how unseemly it is for health insurance companies to deny medical treatment that physicians deem necessary for their patients.

The drawback to paying cash for medical services is that by not submitting your claims, medical bills won’t count toward your deductible. If you anticipate a major medical expense, such as surgery or a hospital stay, consider putting your medical services through your health insurance so that the anticipated expense has a better chance of being covered.

Martine Ehrenclou is a patient advocate.  She is the author of the Take-Charge Patient and Critical Conditions: The Essential Hospital Guide to Get Your Loved One Out Alive.

Image credit: Shutterstock.com

View 28 Comments >

Most Popular

KevinMD logo - transparent