Self pay VS insurance

[Cpadave]

Hi, We currently have HSA insurance with $5685/11370 deductible plan. I was wondering if it would be cheaper to pay for most medical expense as self pay (without submitting to insurance) ? If so, can the expenses still be submitted to insurance so it counts toward the deducible? Thanks

Wish we had medicare for all already so we didn't have to deal with all these issues.

[pb4uski]

I suspect so, but I have heard that some medical service providers will not allow you to self pay if they have a negotiated rate with your insurer... seems silly but I have heard of it.

[msieweke]

Yes, it can be cheaper to self-pay. A physical therapy session for my shoulder injury cost $85 for self-pay vs. $147 for the insured rate (Anthem). I was pretty shocked when I found out what a bad deal Anthem had negotiated. Over 24 therapy sessions it was a difference over $1000! It all came out of my pocket due to high deductible.

I don't know if you can submit self-paid claims. I think you would want to check with them before incurring the charge.

[Jerry1]

Quote:

Originally Posted by pb4uski I suspect so, but I have heard that some medical service providers will not allow you to self pay if they have a negotiated rate with your insurer... seems silly but I have heard of it.

Typically, that is a condition with their contract with the insurance provider. Most contracts have a clause that requires the provider to collect the coinsurance/deductible and to not discount it.

Quote:

Originally Posted by msieweke Yes, it can be cheaper to self-pay. A physical therapy session for my shoulder injury cost $85 for self-pay vs. $147 for the insured rate (Anthem). I was pretty shocked when I found out what a bad deal Anthem had negotiated. Over 24 therapy sessions it was a difference over $1000! It all came out of my pocket due to high deductible. I don't know if you can submit self-paid claims. I think you would want to check with them before incurring the charge.

Typically Anthem or other insurance providers negotiate a broad book of business. While you may have found one area where they did not get such a good deal, they most certainly get a better rate on some other services so that on average, they get a very good deal unless they are a very small player in that market.

It is not typical that you can submit a self pay claim. Because of the contracts mentioned above, that would conflict with the discounting provision. An insurance contract can't say no to discounting and then accept a discounted rate through self pay.

If you know you're not going to meet your deductible (like later in the year), then it would still be better to get the best rate, even if you can't submit it.

[growing_older]

Be careful doing this. Often the insurance will have a negotiated fee which is considerable less than the self pay rack rate. If you don't process through the insurance you may not be credited with the insurance negotiated rate.

With my HSA, I can pay $60 for a prescription (negotiated rate) or I can buy it for $10 without using the insurance but it doesn't count toward my deductible. So it can go either way. A lab test is $248 using insurance, but $660 if I self pay. There's is no easy answer. You have to check prices for every provider and every service.

[audreyh1]

Quote:

Originally Posted by msieweke Yes, it can be cheaper to self-pay. A physical therapy session for my shoulder injury cost $85 for self-pay vs. $147 for the insured rate (Anthem). I was pretty shocked when I found out what a bad deal Anthem had negotiated. Over 24 therapy sessions it was a difference over $1000! It all came out of my pocket due to high deductible. I don't know if you can submit self-paid claims. I think you would want to check with them before incurring the charge.

Part of the higher expense with insurance may be the paperwork required to submit claims and get reimbursed later.

Things have gone upside down!

[Cpadave]

Thank you. Very Helpful.

[Bir48die]

It's called rolling the dice

[PoorOldCountryBoy]

It doesn't hurt to ask, but usually varies greatly. Most billing people are sympathetic once they know why you are asking.

[hopefullyoneday]

I have HSA and united healthcare. my primary care doc was dropped from my network so I self pay him $60 for the office visit and he writes the rest off (he is one of the few HCP that are there to help the patients anyway he can). Then he sends my blood lab work off to a in network facility and charges the ins company which then the ins co charges me the neg rate. I just did this and between doc visit and lab work is under $100.

[rodi]

I have an HSA HDHP and have found the negotiated rates to be *significantly* less expensive than the "cash" rate. Having hit our Max out of pocket one year and maxing out deductibles 2 more years I have had a lot of medical bills to look at. I have teenagers who play sports and, unfortunately, sometimes break arms, get baseballs to the face, etc. We also dealt with a jaw surgery for my son.... Just the negotiated rate saved us over $6k on that surgery. (Before the Max OOP kicked in.)

[SteveNU]

Just picked up a 90 day supply of my favorite med. It was going to be $130 out of pocket if I submitted it to the insurance company Pharmacy. I ended up using a coupon code through GoodRX and only paid $20. In the unlikely event that I max out my deductible I'll be out only $80 for the year so it's worth it to just pay out of pocket and not submit it to the insurance company.