April 28, 2019 By: MARTINE EHRENCLOU, MA | PATIENT
Many of us now have high-deductible health insurance plans, which makes us “cash-pay” patients until we meet our deductibles.
According to a Health Affairs health policy brief, high deductible plans are now much more prevalent in both individual and group markets.
The higher the deductible, the lower the monthly premium. If you have a high deductible plan and don’t consume much medical care, you are most likely a cash pay patient. You might even avoid medical care because of the out of pocket cost. I know I have.
I talked with a friend yesterday who has a $9,000 deductible. She has a torn meniscus. She is avoiding the surgery because she isn’t even close to hitting her plan’s deductible. I suggested she try asking for a “cash pay” price from her surgeon and the hospital or surgery center where her procedure would be performed.
Negotiating cash pay prices for medical treatment has become a common practice. Often a cash-pay price for medical care can be much less than what you’d have to pay if you haven’t met your deductible.
But be aware, cash-pay prices only work if your provider does not submit your bill to your health insurance company.
According to the a Los Angeles Times article, “Even if you have health insurance, you may want to pay cash,” Gerald Kominski, director of the UCLA Center for Health Policy Research said, “If your insurance has a high deductible you should always ask for the cash price.”
After my family’s past health insurance company pulled out of the health insurance market, we chose a Blue Shield plan. They have already denied a medication I’ve been taking for years. Even after my doctor filed an appeal, they refused, and suggested I try similar medications that were obviously less expensive for them and not what my doctor prescribed.
I decided I was not going to let Blue Shield dictate my treatment if I could help it. I spoke to my pharmacist and asked for the cash-pay price for the medication if we didn’t submit to my health insurance. It was too expensive. I called a few pharmacies and asked for their cash price for my medication. I took the lowest price back to my pharmacy and asked if they would match it. They agreed.
You too can shop around for cash-pay prices and not just for medications, but for other medical services. For example, if you need an MRI, call a few imaging centers and ask for their cash-pay price. Be sure you make it clear you do not want it submitted to your health insurance. You can then negotiate with the provider of your choice.
Tips for a discounted cash price:
If you think that negotiating cash-pay prices for medical care has an unseemly quality, you might consider how unseemly it is for health insurance companies to deny medical treatment that physicians deem necessary for their patients.
The drawback to paying cash for medical services is that by not submitting your claims, medical bills won’t count toward your deductible. If you anticipate a major medical expense, such as surgery or a hospital stay, consider putting your medical services through your health insurance so that the anticipated expense has a better chance of being covered.
Martine Ehrenclou is a patient advocate. She is the author of the Take-Charge Patient and Critical Conditions: The Essential Hospital Guide to Get Your Loved One Out Alive.
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