Cash Paying Medical Bills (Without Insurance)

[gpyros85]

So to be clear I have medical insurance with my company pay $160/month for High Deducible family cover. Deducible is $2,600 with 20% on top.

I know a lot of emergency rooms or even doctors REFUSE to give the cost for procedures up front. However, my wife is having a baby and we have the benefit of living in a border city so the rates for labor and delivery are posted in the front for the Mexicans families that want to have their baby delivered in US and given US citizen, it is a large business here. So the benefit to me is I see the cost up front for CASH Payment.

It is $2,800 for labor and delivery.

My wife had the baby early June and now the payments are coming in.

Hospital Bill #1
Hospital Billed $21,084.84        Planned Paid $3,973.88          I owe  $2,825.44
Hospital Bill #2
Hospital Billed $1,295.68         Planned Paid $0.00                 I owe  $476.94
                                                                               
Total I owe to Hospital $3,302.38

Then there is another bill in my son's name that is $10,369...

I feel what the insurance/hospital is doing is taking advantage of the 20% I pay and not giving me a fair rate and basically I am paying for the whole coverage with the 20% premium. I am paying $500 OVER the cash pay plan.... What gives? This is the state of our health care system...  My wife was telling me to pay the cash up front then I question why do we have health insurance....

[Peachtea]

Call up the hospital billing and point out that your insurance company already paid them more than the non-insured rate (phrase it this way rather than cash rate) and ask them to wipe out your balance. I have done this successfully after going up the chain to a manager (at a non-profit facility). If that’s a no-go, then ask how much extra it costs to process insurance payments vs non insurance payments and offer to pay the difference in cash. If that’s a no-go offer to pay the cash rate in cash rather than your billed amount. Point out then they get cash plus the thousands your insurance paid them.

[goatmom]

You might not be able to pay the cash rate if the hospital/doctor has a contract with the insurance company.   Doctors who run cash practices cannot choose to take cash rather than bill insurance if they are on the insurance panel unless it is for something specifically not covered by insurance.  I know if you want to bill medicare patients a cash price -  the doctor has to formally "opt out" of medicare and cannot bill medicare for two years.  The system is set up to discourage providers from allowing patients to pay cash.

[Trifle]

FYI -- The HIPAA Omnibus Rule of 2013 contained a provision that gives every US patient the right to restrict their information from their insurance company, as long as they pay in full up front.  https://www.worldprivacyforum.org/2014/01/wpf-report-paying-out-of-pocket-to-protect-health-privacy/

Note that this is not an insurance regulation per se -- it's a privacy right, and it's fairly complicated -- however some patients are leveraging this in order to pay cash and cut their insurance company out of a transaction.  All US healthcare providers are required to allow it.  If you think it's worth it, the way you ask for it is "I'd like to restrict disclosure of this service to my insurer, and I'll pay in full today."  The doctor/provider will have paperwork for you to fill out.  If I were to do it, I would ask to pay the posted cash pay rate.  if the doctor tried to get me to pay a higher rate the insurer would pay, I would kick up a fuss.

Note:  If you go this route, then I don't think you could later submit the expense to the insurer and have it count toward your deductible . . .

[FIREby35]

I've been uninsured since Obamacare was announced because of my position as a high earning, high net worth business owner. A couple thoughts, first a $2,600 deductible is actually a LOW deductible, not a high one. Also, your premiums are low, not high.

It wasn't your question, but we were given a $1,000 per month premium for a family of 5 with a 10k deductible and 50/50 split on other costs until I was out of pocket 20k! Haha, so we became uninsured.

Anyway, I am also a personal injury attorney. I negotiate medical bills all-day-long. Literally.

So, yes. You are seeing the actual scam that health insurance is. I have negotiated cash prices for everything my family has needed since Obamacare. That includes one baby. Dental work. Vaccines. Pediatric visits. Lasik Surgery, vasectomy and that is basically it. I've also negotiated cash prices for dozens of traumatic injuries related to car accidents and other various accidents. Insurance does not help nearly as much as people imagine and often it hurts. Some insurance companies are happy to pay high prices so they can justify higher premiums and, since they are capped at earning a profit that is based on the percent of premiums used for medical care, earning more money.

But yeah, cash is usually better. You can get people to tell you up-front prices (even away from the border). If you live near the border then you have even more incentive to simply cross the border and pay a 90% reduced price for medical care. I have traveled to Mexico for medical/dental tourism. You can save money and have a vacation.

So yeah, don't question what your mind is telling you. Our "insurance" industry really is scamming you to the point that you pay a monthly premium for the pleasure of paying more than cash and dealing with insurance companies managing your care. It would be unbelievable, but it's true!

[TheWifeHalf]

In this area, the times I've paid cash (no insurance) I've gotten a 25% discount.  This was 25 years ago though.

[gpyros85]

In this area, the times I've paid cash (no insurance) I've gotten a 25% discount.  This was 25 years ago though.

It is very confusing, my wife went to the ER back in December 2017 and we got a bill for $3,200! Then when we call them without even saying a word they had a cash payment of like $600. I feel bad for the people that don't have $600 in cash!! We paid the $600 and was done with that bill...

[Hargrove]

Wow. I would be on the moon to see bills that low.

Something something joke about a moonshot...

Sorry, it's late. 100k is possible on paper at fancypants hospitals in the Northeast. I think you did ok. :p