Insurance in the United States is a for-profit industry, make no mistake.
And they’re quite good at it.
As we have previously mentioned, they continue to turn record profits, quarter over quarter, year over year.
How do they do that?
They simultaneously continually increase monthly premiums, increase deductibles and increase denials of services/prescriptions.
Keeping Costs Down
Given these constraints that will predictably only worsen with time, it’s incumbent upon us, the patients, to keep our own costs down.
We are trained in this country that we should just go along with the opaque pricing strategies, especially if we are using our insurance to cover services. But here’s a radical alternative: just ask about cash pay.
Just Ask for a Cash Price
I have never known a clinic, physician or imaging center to turn down a cash-pay patient. It’s simpler. It’s quicker. It’s more transparent.
Usually cash prices to bypass insurance billing are significantly less expensive, as much as 35-50% less. Why? Because these providers do not need to employ or subcontract multiple people to chase down the insurance payments, and because they are motivated to offer a discount for paid up-front.
Who Will Give Me a Cash Price?
Everyone. Clinics, surgical centers, imaging centers, labs, pharmacies and more.
You will be shocked at how some of these prices are exhorbitantly inflated to charge insurance. For example, Quest lab will bill medicare about $150 for a vitamin D test, but if you opt for up-front cash pay, it’s about $20.
Finding Cash Resources
There are some websites that can help patients navigate this process, but often it comes down to good old-fashioned working the phone. Pit them against one another — “I spoke with Standard Imaging and their cash price for an MRI is $600, can you beat that?” The worst possible outcome is they say “no.”
How it Pencils Out
Think about how many people have high deductible plans, anywhere from $4,000 to $18,000. These people who may not use insurance much, are motivated to keep that cash pay amount down. So instead of having an MRI done and billed to insurance for $1,800 that is entirely subject to the deductible, they opt for the up-front cash price of $600. Makes sense.
Here’s an example of how a Diabetes patient in our office, who has a high deductible plan can come out ahead on that deductible over the course of a year.
Cash Pay – 12 months
Follow up Diabetes visit ($250 x 4) – $1,000
CGM/Pump Reviews ($48 x 4) – $192.00
TOTAL: $1,192.00 out of pocket
Insurance Billing – 12 months
Follow up Diabetes Visit ($403.73 x 4) – $1,614.92
CGM/Pump Reviews ($100.30 x 4) – $401.20
Extended Visit charges ($41.25 x 2) – $165.00
TOTAL: $ 2,181.12 out of pocket
Surprised? I was too when I started looking into Direct Care. But it’s true, it’s cost-effective and never again will you open a surprise bill.
