There are times when it is less expensive to pay cash for medical procedures than submit claims having your doctor/medical provider seek payment from your health insurer.
WEST PALM BEACH, Fla. (CBS12) — When you go to the doctor, do you ever think about not using your health insurance?
Some patients are now negotiating the price and paying in cash. They say cutting out insurance is like cutting out the middle man.
As a consumer, when you think about negotiating costs, you probably think about buying a car or a home – not negotiating with your doctor.
But, as we found out, paying out of your pocket instead of going through insurance could save you money.
PAID THE CASH PRICE
When James Tow needed to pay for a tonsillectomy, he knew it would be expensive. Instead of just handing over his insurance card and trusting that would be the best price, James asked the doctor’s office if they had a cash price. “If I go through insurance, I’m going to have to pay the insurance price,” said Tow. “Whereas if I do the cash price, I pay less.”
That’s right. For example, if he went through his insurance, the anesthesiologist would have charged $656. James’ insurance would only pay $136, leaving him with an out-of-pocket bill for $520. While just paying cash, the anesthesiologist would only charge $464. So, by paying cash and not going through his insurance, James saved $56.
So why would the doctor’s price vary depending on whether or not a patient has insurance?
We took our question to patient advocate Kenneth Klein. He said one reason doctors charge more for insurance is that it costs them money to file the paperwork, and that can run as much as 20% more. “If they are presented with a situation where they can get cash up front and not do anything else, file any papers, that is great,” added Klein. Klein said there’s nothing in state law that requires you have to use your insurance. “In many situations, it may be disadvantageous to submit this through your insurance,” Klein explained. Although, paying cash isn’t a guarantee that you will always save money.
You will have to decide on a case by case basis. It can vary based on your level of insurance coverage, whether the provider is in or out-of-network and your deductible.
Klein said it pays to treat going to the doctor like any other consumer transaction, and ask, “How much is this going to cost?’ “You are not locked in, and one can always try to negotiate. The worst thing that can happen is the person on the other side says, ‘No’. You are no worse off than you were. In many cases, you may be surprised,” said Klein.
WHEN TO CONSIDER CASH
According to Klein, the best places to ask for a cash price are hospitals, imaging centers, sole practitioners, eye doctors, surgical centers and pharmacies.
James said he’s learned from this experience to always ask the doctor for both the cash price and the insurance price and to not assume using insurance is the financially prudent way to go.
“Just paying cash, it seems to me it’s far better,” said Tow. If you decide to negotiate a cash price, get it in writing with the full agreed upon price.
Also, ask for an itemized bill for your records. Klein suggests submitting that bill to your insurance. Some companies may apply it towards your deductible at a reduced rate.