Skip to comments.Patients negotiate for care with cash
Posted on 08/28/2012 2:15:52 AM PDT by Cincinatus' Wife
Palo Alto resident Ed Lee routinely negotiates for his own health care services, everything from the cost of a scan to an urgent-care visit - often securing discounts of 30 to 50 percent off the original charges.
Lee,61, a self-employed public relations expert in the semiconductor industry, started bypassing his health insurance and paying out of pocket last year when he realized that premiums and deductibles were costing him more than $12,000 before his insurer paid a dime.
....Lee became part of a new breed of health care consumer - people who pay such a large portion of their health costs that they're questioning the value of insurance. And because they're footing so much of the bill, they feel they owe it to themselves to get a decent price.
Sometimes that means shopping around for prices for blood work or offering to pay cash for a procedure in exchange for a discount.
...."The worst they can say if you ask is 'no,' "said Lee, who has bargained for better prices at times than what his insurer could get.
"Every time I've asked," he said, "I've gotten some sort of discount."
Patients, especially those covered by their employers' health plans, used to be sheltered from much of the costs of health care because they paid little more than a co-payment.
...more employers are shifting toward high-deductible policies or requiring employees to pay a percentage of each health service they receive...an increasing number of self-insured consumers find they can afford little more than catastrophic coverage.
"We're on the cusp of a very significant transition to consumers being very concerned about costs," said Dr.John Santa,......
.......Insurers and employers are shifting an increasing share of costs to consumers leading up to 2014, when the industry will undergo major changes under the federal health law....
(Excerpt) Read more at sfgate.com ...
But for now (on page 2 in the article) Tips on negotiating for health care
This illustrates how the Ryan plan, premium support, would put market forces to bear to reduce costs.
thanks for posting..
Third party pay: the monstrous, deep taproot growing this mess, along with lawsuit abuse.
Make sure the recommended services are actually necessary: You don't want to short-change your health, but you also don't want to undergo needless treatment.I once saved a hundred bucks by asking the intake nurse: "Is it ok if I wait until after I see the doctor to take the X-ray?"
It was ok and the Doc said no need to x-ray.
Another time, I was told I needed to schedule a follow up visit to get the results of a certain test. This visit would cost $125. I asked if the doctor or his staff could call me with the results. "Yes." Cost for this? Zero.
It's amazing how much waste is built into the process. I think a large part of that is because, in most cases, there is no price pressure because the consumer is not the payer.
I'm not going to get this exactly right, but Milton Friedman talks about different types of choice and market transactions.
The first is when you choose something for yourself paying with your own money. The next is when you choose something for someone else paying with your own money.
The absolute worst situation is when someone chooses something for someone else with yet another person's money. The chooser has no monetary interest whatsoever in the choice.
It’s like all payroll deductions — your money goes out the door unnoticed. Eventually, the idea that your paycheck is their personal piggy bank becomes real. And there is no accountability — the less you know, the better for them.
“Proprietary pricing,” the price your insurance company negotiated on your behalf, yet you don't know how much if any of that price was “fair,” according to market standards. In many cases you are simply told to pay some odd percentage and a high deductible ....on top of your high insurance rate.
“But Jan Emerson-Shea, spokesman for the California Hospital Association, said patients simply can't bargain for hospital prices like they would for a car.” Well why the heck not Jan? Why can't I negotiate prices for medical care. The paragraph above clearly shows the disparity in pricing between service providers. As the ultimate consumer of said service, why should I not have the ability to negotiate?
I do understand Lee's position. It is one I hold myself...$12,000 a year for coverage that never seems to pay anything. Over the course of 5 years that is $60,000. That money invested...even more. So, suddenly there is an emergency? There's a good chunk of change sitting there for that rainy day. Over the course of 10 years with no major incidents...there will be more than double that. Again, how much is a catastrophic emergency?
They use the catastrophic emergency to scare consumers and then you buy policies with all the bell's & whistles. Under 0bamacare you can't buy just catastrophic coverage,...which oddly enough is the cheapest coverage to get!!!
Personally I think the best way to bring healthcare costs back into line is for people to drop and the bells & whistles coverages. The only insurance that should be offered is catastrophic.
It’s amazing how much waste is built into the process. I think a large part of that is because, in most cases, there is no price pressure because the consumer is not the payer.
You are being very gracious. I tend to believe that much of the waste is intentional.
I’ve been turned down every time I’ve asked for a discount for paying cash, from multiple practitioners.
I do the same thing.
Not worth the cost.
Just pay the Dr and Dentist and I save thousands per year.
I’ll get insurance in a few years when I think the time is right as I get older.
Here’s a site mentioned in the article.
How Many Chickens
A few months ago I offered to pay cash for a doctor’s office visit in an attempt to negotiate the best price. I do have a high-deductible plan and HSA.
I was told no, that if I had insurance the visit had to be billed to the insurance company.
If I paid cash, the amount end-to-end processing and paperwork would be negligible. It would have saved my doctor’s office time and money (at least to me it would seem it would).
It’s amazing how much waste is built into the process.
Ask the lawyers why that is. If a doc doesn’t order a certain test, and it ends up that test SHOULD have been ordered to rule out a specific disorder, the doc is going to get sued.
Doctors can’t win in our litigious society.
A small accident can end up costing you 80thousand in hospital bills. Its a good idea to have catastrophic insurance.
My boss went to the doctor the other day and his portion AFTER medicare was $150.
He later called the same doctors office and asked how much for the same visit if he had no insurance and paid cash. They said $70.
The key is to tell them you don’t have insurance.
I pay $1,800 a year for catastrophic insurance. It pays 100% over $5,000. p/yr.
Do the math if you don’t visit the doctor every week.
Again, how much is a catastrophic emergency?
I had a heart cath. In the hospital less than 8 hours. Hospital bill....$17,000 plus. My wife spent three days in the hospital which included the weekend. One CT scan, nothing else, Hospital bill $14,000 plus. Neither cost included the doctors.
Catastrophic emergency? No Just Catastrophic expenses.
And those amounts taken out of your savings for a rainy day...5yrs. = $60,000. Still not catastrophic enough to justify paying $12,000 a year for health insurance....
I haven’t had health insurance for several years. If i really need to go to the doctor, I go, and pay out of pocket. I pay for my RX’s out of pocket and get a 20% discount because I pay for them on the spot, and the pharmacy doesn’t have to do any “paperwork” or wait for their money.
If I crash in the car, I will pay from either my or the other car’s insurance, depending upon who is at fault.
Same thing with the Harley, although I will probably be dead from that one and it will be a moot question.
Catastrophic Illness? Long term Care? THOSE aren’t covered by conventional health insurance policies so I will cross THAT bridge when and IF I get to it.
So instead of paying $12,000+ a year on premiums + co-payments, I spend about $1200.00 a year on Rx and the occasional doctor visit.
Healthcare “Insurance” is a scam.
Ask the lawyers why that is. If a doc doesnt order a certain test..
It's certain that this is a major cost factor, and it also increases cost due to high liability insurance.
We know ways to dramatically reduce insurance/healthcare costs: Tort reform, free market solutions: removing state insurance regulations to require coverage buyer doesn't need; allowing competition across state lines; and going to something like a premium support system in the case of medicare.
It's so frustrating to watch government head in the exact wrong way.
When a man spends his own money to buy something for himself, he is very careful about how much he spends and how he spends it.
"When a man spends his own money to buy something for someone else, he is still very careful about how much he spends, but somewhat less careful about what he spends it on.
"When a man spends someone else's money to buy something for himself, he is very careful about what he buys, but doesn't care at all how much he spends.
"And when a man spends someone else's money on someone else, he doesn't care how much he spends or what he spends it on. And that's government for you.
Strange Blue Cross gets about 80% off, so the guy is a piker as a negotiator.
Billing has no relationship to cost, even if it did, they would be over priced. I recently had a retina procedure, out patient, a little sleepy time in and out in under three hours, hospital bill $14,000.00. Surgeon was extra.
There would be almost no customer base for those services without insurance or government subsidies.
As you get older?
Cancer can cost millions. You can prepare for so much....
I would imagine that he is not over 65, because I cant find doctor that will take cash under any circumstances, other than deductibles. For that matter if you don't already have a doctor, you will be lucky to find one as the ones that will take new medicare patients are rapidly disappearing.
Yeah. I’m pretty young stiil and in great health...
Your odds of an accident requiring surgery are far higher than cancer.
You mean like a car accident?
Unfortunately even the Doc's grunts are smart enough to know if you're 65, you're insured.
Any kind of accident. I had a bicycle accident that resulted in over 70k hospital bills. People fall off ladders, fall down the stairs, all kids of things. A friend of mine fell down the stairs and hit her head. It damaged a disk in her neck. 3 surgeries before they got it fixed.
When you get the final bill AFTER the insurance has paid all it’s going to pay, simply write a check to the provider in the amount of around 30% of the bill and do it with a paper check. On the memo write the account number and “paid in full”. They may call you and want a little more but I’ve never had to pay full prices.
What Soviet Medicine Teaches US
In order to receive minimal attention by doctors and nursing personnel, patients had to pay bribes.
You want to increase corruption? All you got to do is centralize power. Market forces are so strong that even in a system with total control, and where everything is free, scarce products will always go to the highest bidder. In this case the owner of the product or service is the one that controls access to it and he will use all his creative power to make the most of his ownership.
You want to decrease corruption? Diffuse power as much as possible. That is why capitalistic countries under the rule of law will always have less corruption than authoritarian countries.
That is precisely why health care, courtesy of health insurance, is so overpriced. Nobody cares to shop around because "someone else" i.e. insurance companies, are paying the bill.
Excellent points. Rule of law, property rights, freedom are all essential - along with decentralize/smaller government.
Thanks for your post.
I got it, really.
Homeowners insurance that covers more than most people pay for and auto coverage on each car for 150/300/150.
Businesiness insurance to the tune of $2million.
I’ll get personal insurance next year when i start hiking, snowboarding, surfing, scuba, etc again.
Just had a shoulder operation that heals in about 6-12 months and I start doing all those things again.
Besides that, I have resources and loot to cover most things anyway.
Which reminds me; I had to see an internest a few years ago. My primary physician had just passed away otherwise he could have diagonsed me and taken care of my problem.
I knew I needed to see an internest so I called around and found the best one in town
Called them up and they wanted to know what Dr, referred me. I explained everything and initially they didn’t know how to handle it, as thet usually work through insurance.
Asked them if they had a problem with cash. They said they would call me back.
When they valled me back tbey said it might cost $4,000. Told them I didn’t care and I wou,d bring cash.
They scheduled me for the next morning.
When they were through I was stll drugged and they were laughing. Apparently I was pretty funny when they had me on twilight anesthesia. I have no recollection of the procedure or what I was saying.
I recall being at the front desk, in a daze, and tbey said I was getting a comedy discount.
The bill was $1,800 instead of the original quote of $4 grand.
I went to the drug store, got the prescription they gave me and shortly after my problem went away.
Currently I have an assistant for the next two weeks. I am paying for the help to ensure I don’t have to do anything that jeopadizes my recovery.
He picks up anything over 10 pounds, gets stuff I need from the grocery store, meds, clean house, walk the dogs and anything else I require.
I even paid to have a water wand installed in my main shower, support bars and a bunch of other stuff.
I am responsible for my care. I get whatever “I” feel I need for my care and chump at an insurance company is going to tell me I can’t have what I need.
“Not covered” and the word “No” are not acceptable answers.