How to Cut Your Health-Care Bill: Pay Cash

[Recursion]

Last edited Wed Feb 17, 2016, 11:27 AM - Edit history (1)

http://www.wsj.com/articles/how-to-cut-your-health-care-bill-pay-cash-1455592277

(Yes, I know, WSJ... it's still really interesting)

Not long ago, hospitals routinely charged uninsured patients their highest rates, far more than insured patients paid for the same services. Now, in the Alice-in-Wonderland world of health-care prices, the opposite is often true: Patients who pay up front in cash often get better deals than their insurance plans have negotiated for them.

That is partly due to new state and federal rules aimed at protecting uninsured patients from price gouging. (Under the Affordable Care Act, for example, tax-exempt hospitals can’t charge financially strapped patients much more than Medicare pays.) Many hospitals also offer discounts if patients pay in cash on the day of service, because it saves administrative work and collection hassles. Cash prices are officially aimed at the uninsured, but people with coverage aren’t legally required to use it.

...

ClearHealthCosts has compiled self-pay prices for dozens of tests and procedures in eight cities and found a vast range. In Houston, an MRI for the lower back can cost as little as $750 at an imaging clinic and as much as $1,961 at an academic medical center. A colonoscopy in San Francisco is $600 at one surgical center and $5,500 at another.

Finding the negotiated rates for those same services is tougher, since many insurance contracts bar payers and providers from disclosing them. But individual plan members can see that information on their Explanation of Benefit statements, so ClearHealthCosts has joined with public radio stations in New York, California and Pennsylvania, asking listeners to anonymously post what their health provider charged, what their insurance paid and what they paid out of pocket. Thousands have responded, showing that in many cases, while insurers had negotiated a big discount off the provider’s original charge, the negotiated rates were still higher than the service would have cost in cash at the same place or nearby.

[Warren Stupidity]

1. Completely broken system, ridiculous article.

When do you shop around for your stroke treatment?

[Recursion]

4. I've always found that argument ridiculous

When do you shop around for your stroke treatment?

Who in the world has ever suggested people shop around for emergency care? It's a stupid and lazy strawman, and you know that. The 99.9999% of medical care that isn't emergency care you absolutely should shop around for just like you do for everything single other good or service you buy.

[jamzrockz]

10. I shopped around for my orthodontist services when I needed braces

services and I think I saved $1600 from the place my dentist originally recommended for me. I think a lot of people are very resistant to any idea that they take any responsibility for the healthcare services. Lots of people hate the idea that in healthcare cost should ever be an obstacle.

But the reality is that for cost to come down, healthcare consumers must have to start price shopping for non emergency care cos if they don't there is nothing to pressure hospitals into reducing their prices.

[Warren Stupidity]

11. 99.9999 not ER? Care to back that up?

[Recursion]

12. Clearly 99.9999 was hyperbole; it's 2% of national costs

http://newsroom.acep.org/fact_sheets?item=29928

And that counts the trips to the ER that aren't actually emergencies (8%, according to ACEP).

So, if the actual emergency room doctors are to be believed, slightly less than 2% of national healthcare spending is on actual emergency care. I don't know anybody who has quantified what percent of treatments (which would be hard to define to begin with) are emergencies. You might ask yourself how many times you have gone to the ER vs. your other interactions with the medical system.

[dembotoz]

2. seeing the discounts associated with insureance this sounds like bs to me

[Recursion]

5. Our problem with healthcare is one of price discovery

I've been convinced of that for a while but this is a pretty good example of it.

[daleanime]

3. ........

[Orrex]

6. As always, the answer to financial problems is "have more money"

I'm sure that everyone in the country would love to be in a position where they can pay cash for their healthcare or their car or their college education, etc. The problem isn't a lack of desire, it's a lack of money.

[Recursion]

7. For some people, sure

For others, they pay more in premiums than the actual health care would cost if they paid cash for it.

[Orrex]

8. Of course that only works if they know about it in advance

That is, when you go to the ER for an injury, it might wind up costing you $200, or it might wind up being $60,000 or more. Until you're actually admitted, treated and released, you have absolutely no way to know.

If a person can't afford a $200/month premium (or whatever), then they sure as hell can't afford to squirrel away $60K. What happens in those cases?

And you know as well as I do that if they're saving $200 on insurance, then they're paying down their mortgage or their car loan or their credit cards, because that's how reality works.


Turns out that the advice is even more worthless than it appears at first glance: it's not "have more money" after all; it's "have more money, and know in advance what medical emergencies are going to befall you."

[Recursion]

9. People really overstate how much medical expenses are unexpected

Most medical care is for chronic conditions. It's where most of the money and labor are going.

[Orrex]

13. That's foolish. You're telling people to plan only for a best-case scenario

Even in your magically imagined land of financial stability for all, and even if we assume that people will have the wherewithal to set aside cash each month to pay for their chronic conditions et al, the average person would still need insurance to pay for unexpected emergencies. And if they're stuck paying for insurance anyway, then they'll have that much less money to set aside for chronic issues.

So as bad as the advice appeared at first and second glance, it's even more useless than that: "Have more money, know in advance what medical emergencies are going to befall you, but actually don't have medical emergencies at all."

That's very similar to the Republican healthcare policy of "Don't get sick. But if you do, then die quickly."


All it takes is one unforeseen medical issue to destroy a family's finances forever. This is irrefutable fact.

[Recursion]

15. The unexpected costs are why we have insurance

I think a big problem is that people started to think of health insurance as "pre-paid health care" rather than "protection against huge unexpected costs from a catastrophe".

All it takes is one unforeseen medical issue to destroy a family's finances forever. This is irrefutable fact.

Well, no: if you have a bronze plan your exposure to medical costs is limited to $6000. That's it. Paying back $6000 can suck, but it's not going to drive a family into eternal ruin like $175,000 can.

Why the hell is DU so resistant to the idea of the patient having any agency here?

[Orrex]

16. Again, the advice is "have more money"

Well, no: if you have a bronze plan your exposure to medical costs is limited to $6000. That's it. Paying back $6000 can suck, but it's not going to drive a family into eternal ruin like $175,000 can.

$6000 can certainly ruin a family--it is a lie to claim otherwise.

Here's how it works: while paying your $6000 bill, you fall behind on your rent and face eviction. Or you fall behind on your car payment and your car is repo'ed, so now you can't get to work, you lose your job, and then you lose your house.

All because of that $6000 bill that you pretended was easy to afford.

$6000 is for an individual, by the way. If two family members suffer health issues, it's $13,000.

Why the hell is DU so resistant to the idea of the patient having any agency here?

Bullshit. That's not the objection. The objection is that the reality of healthcare costs deny "agency" as a matter of course, and it is flatly dishonest of you to claim otherwise.

Also, before you trot out any nonsense about "healthcare shopping" or other bullshit Rightwing memes, we need to recall that such shopping is impossible, since hospitals won't or can't provide an itemized bill prior to service.

[Iggo]

27. .

[bemildred]

14. Insurers are not trying to save you money.

They are trying to figure out how to get more from you.

[Recursion]

21. They don't even seem to be trying to save *themselves* money

It just seems ridiculous that they would end up with a negotiated rate higher than the cash rate.

[bemildred]

23. High prices increase their cut. Duh.

High prices == high premiums == high profits.

The size of the money river determines how much you can divert.

[Wounded Bear]

17. So, I should pause my heart attack and negotiate prices first?

I suppose I should have the EMT's slow down so I can discuss treatment and transport rates before they go farther than I can afford?

Wow, I didn't know I should do that.

(for the challenged)

[Orrex]

18. Of course not.

Instead, you should carry $6000 in your pocket at all times even though unforeseen health catastrophes are apparently very rare or something.

[Recursion]

20. FFS this is such a ridiculous strawman

Nobody is saying you should price emergency care, and it's dishonest to keep bringing that up.

Emergency care is 2% of what we spend on health care. So, yeah, that 2% isn't amenable to price comparison. The other 98% is, and I don't see why health care is somehow exempt from price comparison unlike every single other good and service we buy.

[Wounded Bear]

22. If you can't see it...

there's probably no sense trying to discuss it with you.

[Recursion]

24. So, nothing?

You can't actually give me a reason that routine health care (which is the vast majority of health care) shouldn't be shopped for?

[LanternWaste]

25. I've read three specific answers to that particular question in this thread.

I've read three specific answers to that particular question in this thread. That you ignore or trivialize them is irrelevant.

[Recursion]

26. Can you point to them? I see "ZOMG PEOPLE ARE TOO POOR TO PAY FOR IT"

Which, for most people, isn't true. And for people for whom it is actually true, that's why we have Medicaid.

[jeff47]

28. My daughter cost $5,000 a pound.

My wife's pregnancy and daughter's birth by c-section cost more than $50,000.

If you think most people can pay out-of-pocket for non-emergency care, you're not paying attention.

[Recursion]

29. So, UCSF did a study last year

https://www.ucsf.edu/news/2014/01/111071/how-much-does-it-cost-have-baby-hospital

Without complications, a vaginal birth can range from $3000 to $37,000, and a C-section can range from $8000 to $71,000. And that's the insurance price, without the "cheaper if you pay cash" effect.

Why shouldn't that be something the hospital tells you when you're choosing a hospital? Not everybody can afford $8000, but then again a lot of people can for a one-time, known-in-advance cost like that.

[jeff47]

30. Because they are not known-in-advance costs.

That "without complications" is a massive qualifier. There's no way to know in advance that there will be no complications.

So suddenly that $8,000 from McHospital turns into a $200,000 NICU bill. Now what?

"Just pay cash" is utterly unworkable for anyone who is not wealthy.

[Recursion]

31. Well, hell, having insurance is also unworkable for anyone who isn't wealthy

I don't think you can reasonably read this piece and think it's "advice" to pay cash, can you? It's pointing out how opaque all health care pricing is.

[jeff47]

32. Golly, it's almost like we need a single-payer system. (nt)

[Recursion]

33. That wouldn't fix price discrepancies (in some ways it makes them worse)

Remember those two hospitals in El Paso that had a 300% difference in what they charged Medicare for the same treatments?

[jeff47]

34. Only if that single-payer system can not negotiate. (nt)

[Recursion]

35. If Medicare can't, why would a universal system be able to?

Will physician, hospital, and pharma lobbies just stop existing?

[jeff47]

36. Because Medicare doesn't negotiate much.

They're actually pretty hamstrung in pushing back on providers.

Will physician, hospital, and pharma lobbies just stop existing?

Yep! Just like they don't exist in Canada, the UK, and everywhere else with single payer.

[Recursion]

37. Did you even bother to google?

http://www.theglobeandmail.com/news/national/ontario-medical-association-suing-province-over-cuts-to-doctors-fees/article27030534/

[csziggy]

38. Before I had insurance I had to pre-pay for operations

When I got my left shoulder rebuilt, the MRI center, surgeon, anesthesiologist and surgery center all gave me discounts because I was paying in cash ahead of time. I think they gave me a 20-25% discount. One advantage of pre-paying was that when they found out that the damage in that should was much more extensive than the MRI showed and the operation took four times as long as expected, they did not bill me for any more costs. I know their costs were much higher the original estimates, but they didn't come back to me for more money. Maybe they felt sorry for me.

Even after I had insurance if I pre-paid my copays the various medical entities gave me discounts, usually not more than 10%. If I had needed to pay over time, the costs would have gone up more than the original estimates.

[GeorgeGist]

39. Personal experience says ....

B U L L S H I T