Interesting article on being insured but paying cash

[VallAndMo]

Even if you have health insurance, you may want to pay cash

http://www.latimes.com/la-edpicks-health-insurance-20160610-storylink.html

 

More relevant part:

 

Five blood tests were performed in March at Torrance Memorial Medical Center. The hospital charged the patients insurer, Blue Shield of California, $408. The patient was responsible for paying $269.42.

 

If that were all there was to this -- which its not -- youd be justified in shaking your head and wondering how it could cost more than $80 apiece for blood tests. These werent exotic procedures. The tests were for fairly common things such as levels of vitamins D and B12 in the blood.

 

Its what happened next, though, that this makes this story particularly interesting.

 

The patient, who for privacy reasons requested that I use only her first name, Caroline, was curious about why she needed to pay almost $300 for a handful of routine tests. So she called the hospital.

 

I was completely surprised, Caroline told me. The woman I spoke with in billing said that if Id paid cash, the prices would have been much lower.

 

How much lower? Try this on for size: Tests that were billed to Blue Shield at a rate of about $80 each carried a cash price of closer to $15 apiece.

 

It absolutely makes sense to shop around for healthcare like you shop for everything else. Glenn Melnick, health economist at USC

 

I found that hard to believe so I got in touch with Torrance Memorial Medical Center. A spokeswoman, Ann OBrien, didnt want to delve into hospital pricing but acknowledged that, yes, the cash prices quoted to Caroline were accurate.

 

This is utterly crazy, Caroline said. Its such a huge difference. Why wouldnt I just always tell them that I want to pay cash?

 

Great question. And answering that highlights the insanity of U.S. healthcare pricing.

 

This is one of the dirty little secrets of healthcare, said Gerald Kominski, director of the UCLA Center for Health Policy Research. If your insurance has a high deductible, you should always ask the cash price.

 

Cash prices are intended for uninsured patients -- and are frequently still much higher than insured rates. But cash prices for many common procedures have come down thanks to changing regulations and consumers increasingly being able to shop around for cheaper providers.

 

 

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Vall.

[Kirk W]

Very interesting, indeed! I wonder if an insurance company could somehow work it so that the insured appears to pay the medical facility in cash, but yet be the money behind the process. That could save some money and lower premiums......

[BigTexRex]

Interesting. So, 'am I better off paying the 20% co-payment or paying cash?

[Randyretired]

The discount for cash payment varies a lot from my experience. My insurance doesn't pay for a physical so I asked about a cash payment discount. Sure they told me but the discounted price was more than the insurance negotiated cost. By letting it go through insurance first the final bill was $10 less than the cash discount.

[Jack Mayer]

I've also tried to pay in cash and found that the price was higher. But like any negotiation you may find lower prices....it just "depends".

[TCW]

A couple of things caught my attention about this story. First, the tests were performed at a Hospital. I think it is pretty well known that everything costs more at a hospital, so comparing their charge to say Labcorp is interesting but I am not sure very relevant. This very issue was one of the big selling points of the Affordable Care Act which was supposed to reduce costs by getting fewer people to use the hospital emergency room for routine care that could be obtained outside the hospital at a lower cost.

 

Second, they used the term "billing". I get statements from BCBS all the time. What the doctor bills and what BCBS pays are often two different things. On my last doctor's visit BCBS was billed $160. BCBS paid $88. Because the doctor was an in network provider, they accepted the BCBS payment and I paid nothing. If the doctor did not accept the BCBS payment as payment in full then I would likely have to pay the difference or try to negotiate.

[Barbaraok]

Once you are on Medicare, you will see HUGE disparages between what they 'bill' and what Medicare agrees to pay. That difference then becomes a 'loss' on paper.

[Dance Chick]

Had a male friend a number of years ago who developed breast cancer. He did not have health insurance. The surgeon's price with insurance was a lot more than the cash price he obtained. He was able to negotiate a discount with the hospital for paying cash.

 

We have negotiated a discounted cash price with the hospital in past years as we had a high deductible HSA, therefore were paying a lot out of pocket. In 2014, and prior to Medicare, we once again asked for a discounted cash price with the hospital and were told they don't do that anymore.

[whj469]

I have blood work done at least two times a year. I can use Labcorp or Quest

for the blood work and I have never paid anything! No twenty percent co-pay.

How is that not better then a cash discount?

When I had a pacemaker put in 2008 the hospital billed $96,000 for the pacemaker and five days in the hospital.

The insurance company because of their discount paid $56,000. Do you think that I could get a lower price by paying cash?

I wouldn't have the $56,000 to pay cash!

[trostberg]

There are some clinics that no longer accept health insurance and are cash only. They are less expensive because they do not have to hire billers and coders etc.

[whj469]

That is interesting, we all now have to have health insurance and there are clinics that don't take insurance?

I will not be going to those clinics! Paying cash may be alright if it doesn't cost much. But I repeat: how woiuld you pay cash for a pacemake?

[trostberg]

The hoops and regulatory paperwork is not allowing MDs to spend the time they would like to with their patients. So they offer services to their patients at a discounted rate for cash. You can submit paperwork to the insurance company on your own behalf to keep track of the deductible but many of us never reach our deductible

[Ronbo]

You may have insurance but what is your deductible and then your copy? When I owned my own clinic I would much rather receive cash. My wife did my billing and we were routinely denied payment by insurance until she would call and they would pay. It is really irritating that they would deny just to try to save money, not because it wasn't a legitimate claim.

[Zulu]

There are some clinics that no longer accept health insurance and are cash only.

 

Name three.

[Zulu]

Paying cash may be alright if it doesn't cost much. But I repeat: how would you pay cash for a pacemaker?

 

Exactly. Blood work is one thing, a surgical procedure quite another.

 

Will that be check or cash?

[trostberg]

Here are some articles

 

 

 

http://www.wausaudailyherald.com/story/life/2016/05/26/get-more-1--1-time-your-doctor/84789402/May 26, 2016 ...Concierge medicine is a membership-based personalized care program where patients have direct access to their physician, spend a great ...

 

A friend is Wausau got letter from her MD a couple of years ago that he is offering this service.

 

http://www.aarp.org/health/health-insurance/info-08-2013/direct-primary-care.html

The Doctor Will See You but Not Your Insurance Direct primary care physicians expect to be paid by you — directly

by Sid Kirchheimer, August 6, 2013