Self Pay / Cash Pay patients often Pay less than those with insurance!
We assume that those with health insurance are automatically paying less for a service than those without, right? Isn’t that the whole purpose of health insurance anyway? I bet you’d be surprised to know that in many cases, it’s quite the opposite.
It’s been repeatedly reported that insured people are sometimes paying more for procedures and services than uninsured people. Whether it’s an urgent care visit, bloodwork, or an MRI, some basic medical visits can actually cost a whole lot less for self-pay / cash-pay patients. We’ll get more into that later.
Granted, this pattern isn’t always the case. And know that cash prices still tend to be higher than insured rates. Don’t worry, you don’t have to ditch your health insurance plan. But you should always know your options before it’s too late, especially since the healthcare system is proven to be this inconsistent.
Shockingly enough, having insurance can actually sometimes double or triple what you owe the hospital after it’s all said and done. If this is the reality—which it is—then healthcare price transparency has to be considered crucial. If customers trust the provider to bill their insurance carrier in a way that’s most cost-effective, but it’s unstable and unfair, that’s another violation of price transparency in healthcare. Again, more on that later.
Why do self-pay/cash pay Patients Pay Less?
Clear Health Costs explains it best: “one procedure can have many prices at the same provider. There’s the charged price, also often called the ‘sticker price’ or the ‘rack rate’—say $100 for a routine office visit. Then that same provider may receive $100 from a cash customer, $80 from Insurer A, $75 from Insurer B, $70 from Insurer C, and so on—in the form of a negotiated rate, or contract rate.” Traditionally, patients with insurance can expect to be billed the negotiated price. But more and more often, insured patients are charged with the sticker price.
Here are some examples of patients who have paid less by not using their insurance
An anonymous Reddit user writes: “The hospital sent a bill for $290. Then they found out I have insurance. Now they want me to pay $550 out of pocket.” For something as simple as five minutes of blood work, this patient explains how they called the hospital’s billing office to question why this procedure costs $290. This felt too much for the short amount of work that was actually done. The billing office assures this patient that there was a mistake, and puts the bill on hold.
A month later, this patient is charged with $550—double the original price they were billed. Turns out, the hospital didn’t realize this patient did in fact have insurance. There was a mistake, but a mistake that took a turn for the worse. If this patient would’ve known that their self-pay / cash pay price was much lower than their negotiated rate, they wouldn’t have called and asked for the bill amount to be changed in the first place.
The Reddit user continues, “I called the billing company and asked if I could just pay the $290 from the original bill. ‘Sorry! $550 please or we send it to collections!’” Where is the price transparency here? The only time clarity came for this patient is when it was too late and there was no chance of reversal.
Another similar situation comes from research conducted by Clear Health Costs. A patient is receiving an MRI. They attest, “I figured I would likely pay $500 or $600 using my insurance. I was SO wrong. An uninsured person would pay $938 but my insurance was charged $5,265 and my responsibility was $2756.47, approximately THREE TIMES the cash cost.”
This patient called their insurance company and hospital to ask if they could pay the cash price instead but was told that they cannot after the bill has already been issued. In some cases, there is a chance of remittance. But a chance negates the idea of certainty. And in order to have the words “certainty” and “healthcare” exist in the same breath, “cost transparency” must also be there. It has to be paramount.
How can we fix this?
Ask yourself these three questions:
- How much will this cost?
- How much will it cost me?
- What would it cost as a self-pay/cash pay price?
Do insured people even know to ask for the cash pay price of services? Well, we hope now you do! You could travel from street to street to ask different healthcare providers their rates. You could take notes and ask questions. But there’s a way to this information that makes your job even easier. The answer is ZeaMed.
We provide shoppable and transparent healthcare information without inconvenience or hassle. Comparing the price and quality of services simply and effectively shouldn’t be such a rare ordeal. We work to avoid the need to call billing offices and insurance offices to request unnecessary charges to be refunded. This could take hours of frustration for all parties involved. We’re all frustrated with the system.
We completely understand, and we are pioneers in bringing the trust and clarity we all deserve. ZeaMed delivers just the healthcare price transparency you’re looking for. We’re dedicated to fighting this long-standing unavailability of price transparency, and we are thorough and passionate in our research and understanding to finally do it.