Are most doctors willing to give a lower cash/no insurance price?

[Scuba]

DH has a high deductible plan that I'll be going on soon. I'm still on employer insurance but not for long. We are still in our 50's and healthy so we never come close to our deductible. I've heard many docs will give a lower cash price so they don't have to deal with insurance companies, delayed payment, etc. Is this something you've tried to negotiate and if so how successful has this been for you?


Sent from my iPhone using Early Retirement Forum

 

[razztazz]

I've heard that they almost always don't because:


A) They use cash payers to supplement the "lower payments from insurance companies

and...

B) It's a business. If they have the money you take it. Market rates and all that.

 

[Sue J]

DH tried this when he wanted to see last year's physician after we changed insurance companies in Jan 2016. He went to the appointment with a credit card and cash to pay at the time of the visit. The office staff told him they could not do it, it had to go through their billing office and be processed through an insurance company.

So they used last years insurance and, of course, it got processed as uncovered. We got a bill for the full amount of $178.00, called and asked for a cash price. The answer was, "give us your new insurance, we'll submit it and see what they say."

The new insurance is an HMO with no out-of-network coverage, when they processed it, they covered nothing.

That was in February and since then we've been expecting a bill from the doctor's billing center. We haven't gotten anything and if one comes we will call to try to get a discount (they mentioned a 10% discount when we called earlier) and just pay the bill.

Since the visit was in January and our current insurance rejected it in February and it's now August, I think the doctor told them to write it off. In that case, maybe it did work!

 

[Sunset]

Each ins. company has pretty much their own rate. Cash payers tend to be charged the most.
I once went for MRI, and I forget the exact numbers but it was something like this:
I asked how much if I come in and pay cash: $1,200
How much if I have X insurance (a lousy cheap one), and after a lot of looking up, they said $500.

I realized then, even lousy insurance was better than no insurance.

 

[RunningBum]

Also, what happens if you do have some big expenses late in the year and meet your deductible? You didn't file for those other expenses earlier, so they don't count toward your deductible. It could totally backfire on you.

 

[Animorph]

Even though you are still in the deductible you pay the insurance company's negotiated rate (in network). That should be much lower than normal, even paying cash.

The doctor should bill the insurance. The insurance will determine the cost they allow. The doctor will then bill you for that allowed amount, and it will be counted against your deductible.

Paying cash probably wouldn't count against your deductible, since the insurance company would never get the bill.

Out of network, then you want to negotiate your own lowest price.

 

[Silver]

There are some past threads discussing physicians who have decided to provide concierge medicine for cash only clients. There is no discount...that is for certain.


The physician I had been seeing just notified all of her clients that she has moved her entire practice into concierge. The annual charge per patient is $1,825.00 per year for unlimited visits. All test costs (labs, x-rays, etc) are charged to your insurance, so it is expected that patients still carry insurance.


I have happily moved on to a different physician.

 

[marko]

There are some past threads discussing physicians who have decided to provide concierge medicine for cash only clients. There is no discount...that is for certain.


The physician I had been seeing just notified all of her clients that she has moved her entire practice into concierge. The annual charge per patient is $1,825.00 per year for unlimited visits. All test costs (labs, x-rays, etc) are charged to your insurance, so it is expected that patients still carry insurance.


I have happily moved on to a different physician.

This is similar to the situation I have with my doctor. He charges me $1200 a year. I can see him within an hour, he can spend as much time as necessary with me vs the insurance dictated 15 minutes. My care is a whole lot better and personal and he's less stressed as well as he's gone from 2500 patients to a limit of 700.

Best thing I've done considering that many doctors in my area don't take Medicare patients (9 months away for me), it's worth the money.

 

[Sue J]

Also, what happens if you do have some big expenses late in the year and meet your deductible? You didn't file for those other expenses earlier, so they don't count toward your deductible. It could totally backfire on you.

In 2014 we didn't use our insurance for some of our prescriptions as the cash price (GoodRx coupon) was so much less than the insurance's Rx prices. Then I ended up having surgery. Before my surgery was billed I filed a claim form for all those Rxs. The insurance processed them and applied them to our deductible before the surgery bill so I had a smaller deductible by the time all those claim came in.

Most of those Rxs went through for the amounts we paid, a few were not for the full amount based on some price restriction, but it was worth the effort to reduce our remaining deductible for the year.


Sent from my iPad using Early Retirement Forum

 

[MichaelB]

"List" prices for physician and lab services are now so high, even with hefty cash discounts they remain unaffordable. Insurance is needed just to have access to the negotiated price.

 

[bmcgonig]

"List" prices for physician and lab services are now so high, even with hefty cash discounts they remain unaffordable. Insurance is needed just to have access to the negotiated price.

Things like blood tests can be gotten online for very cheap relative to where the doctor will send you or charge you.


Sent from my iPad using Early Retirement Forum

 

[galeno]

When will the USA join the rest of the world by having REAL universal health care? Your ACA was a good first step. Your country SHOULD offer Medicare for all.

 

[Just_Steve]

When will the USA join the rest of the world by having REAL universal health care? Your ACA was a good first step. Your country SHOULD offer Medicare for all.

At what cost and to whom?
Just more wealth redistribution.

 

[niven]

At what cost and to whom?
Just more wealth redistribution.

All government is about wealth redistribution, through taxes or seizure to the military, infrastructure, healthcare, education, politician's pockets, etc.

Doesn't mean I want to be without government.

 

[rodi]

As others have mentioned the negotiated rates are usually FAR lower than the cash discount (if any).

I'm on a HSA qualified HDHP with a very high deductible. Last year, my first year on such a plan, my kids decided to have a series of expensive sports injuries (broken elbow, broken wrist, broken face from a baseball to the face, short hospitalization.... you name it... it hit us, and we paid.) The pre-insurance prices were typically 3-5 times what the negotiated rate was. So we paid the negotiated rate.... and just missed hitting our deductible. But I was glad for insurance and the negotiated rates.

On the dental front I've heard several stories here where folks were able to negotiate a cash price.... I've had no luck with our dentist... He offers a 5% discount - if you pay in actual CASH (no checks/credit cards) - and when I tried to do that - they weren't well equipped to take the cash/make change. His office only takes high end dental insurance and we did the math - dental insurance isn't worth it if we want to keep him as a dentist.

 

[Amethyst]

Oww! Hope that face is all better and beautiful again

broken face from a baseball to the face

 

[razztazz]

At what cost and to whom?
Just more wealth redistribution.

That whole thing people refer to as "the economy" is all about how the wealth gets distributed. Now, the never ending story is about how, exactly, it does get distributed. There is essentially no such thing as wealth re-distribution. It's just distribution. There is no rule that says someone who is doing without ought to be made to continue to do without.

The economy is not weapon for the beneficiaries thereof to enforce a suicide pact on those it has left behind

 

[rodi]

Oww! Hope that face is all better and beautiful again

He's fine. He was lucky - despite multiple breaks in the orbital socket bones - he didn't have any issues except some SERIOUS bruising/shiners. But he had to see a few specialists (ophthamologist and facial bone doc) to confirm no surgery was needed. As I said - very lucky. But the day I was most happy to have insurance was the day I had an opthamologist appt at 8am... and the face/bone doc at 10:30 - was driving between the two clinics when my phone rings from my younger son's school.... he'd broken his wrist in P.E. Talk about an expensive day!!!!

 

[Winemaker]

In network costs are usually cheaper because the insurance company or employer in my case, guaranteed a # of patients and paid an upfront fee. This fee paid for x amount of services during the year, and was negotiated on a bi annual basis.

Cash customers, while some doctors and med. services accept them,( and even give a discount) others don't and charge the full price as dictated by regional standards. A rectal exam in NY does not cost same as one in MS, and is still a pain in the a$$.

 

[zinger1457]

I found my local Urgent Care center offers reasonable cash prices for services, I paid $80 cash recently to get a cut stitched up. I doubt I would have gotten out of the Emergency room for less than $250 with insurance. Unfortunately their services are very limited, minor illnesses and injuries only.

 

[Texas Proud]

My old doc suggested that since I pay 100% of cost that I just go with him and pay cash...

The problem was that the blood test he wanted me to have cost $330... that was HIS cost and he was just passing them on... he was going to charge me between $70 and $100 for a visit... my first visit was $70...

I paid when I left and they put it down as 'cash pay' so they would not submit to insurance...


Now, I did go to my PCP for the $45 copay and guess what? The blood tests are not covered!!! I have a bill for about $100 or so... still cheaper than cash pay, but now I do not have any more copay visits with the doc this year and will have to pay full boat if I need to go...


BTW, I have taken my DW to an emergency clinic twice this year for infections etc. where we could not get to our PCP for a week or more... we just paid the $75 copay and nothing else... seems this is the way to go if you want to pay cash... but, they do have a fee schedule that is more than this... but it is listed upfront and you can check it out if you want...

 

[Bamaman]

We live in a relatively poor state, and the state's very low tax structure cannot support their costs of providing Medicaid for children. A large percentage of children especially are on Medicaid in this state.

Our grandson's on Medicaid, and his physician was notified last week that Medicaid payouts are dropping 30% starting immediately. We have no idea what that's going to mean to the clinic's staffing, time to get an appointment, etc.

If I was going to have an almost 30% reduction in revenue, I'd be looking for a hospital to buy out my practice. They're the only ones dumb enough to want to own a pediatrician practice here.