Author Topic: paying for doctor with cash  (Read 7854 times)

mozar

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paying for doctor with cash
« on: February 05, 2015, 07:24:03 PM »
I do have an insurance plan. I pay about $80 a month to my employer for a high deductible plan. Besides the yearly wellness visit (which is free) I have to pay $1500 to start getting reimbursed. I also have an HSA. A comparable plan in the health care exchange would be about $160 a month.

All I want is to have a wellness visit, have a doctor look at my toe and get a prescription for generic zoloft.  The doctors listed in my employer health plan have reviews that are so terrible its almost funny (for example charging for the wellness visit even though it's free).

There is a health care co-op that opened about 2 miles from my house. I would love to go there. I read that if I were to tell them that I had insurance they would be legally obligated to go through my insurance. Is that true? I figure it would be about $150 for the visit. Generic drugs are pretty cheap. My co-worker got generic zoloft for $8 for three months supply. I don't know if I can get a prescription from the pcp or if I have to go to a specialist but I could pay cash for that too. I want to use my hsa card if I am paying cash, so I don't want to have to tell doctors I don't have insurance. Or should I go to a nurse at Walgreens? Would I get decent care?

I haven't been to a doctor in about 5 years so I am totally overwhelmed. Help!

bacchi

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Re: paying for doctor with cash
« Reply #1 on: February 05, 2015, 07:41:40 PM »
Yes, if you tell them you have insurance, they're contractually obligated to go through the insurance.

Just tell them you're self-pay and will pay at the end of the appointment. Pay with your HSA card. I've done it many times and have often received a "cash" discount.

nanu

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Re: paying for doctor with cash
« Reply #2 on: February 05, 2015, 07:49:23 PM »
About using the HSA card - isn't it better to cover the cost out of pocket, keep the receipt, and reimburse yourself in the future? (assuming you can front the money for now)

bacchi

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Re: paying for doctor with cash
« Reply #3 on: February 05, 2015, 08:02:10 PM »
About using the HSA card - isn't it better to cover the cost out of pocket, keep the receipt, and reimburse yourself in the future? (assuming you can front the money for now)

Yes, if the HSA funds are or will be invested. It's a great emergency fund (with enough receipts).

mozar

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Re: paying for doctor with cash
« Reply #4 on: February 05, 2015, 08:05:26 PM »
I can front the money.

BCBiker

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Re: paying for doctor with cash
« Reply #5 on: February 05, 2015, 09:21:02 PM »
It is interesting to me how complicated we have made getting care in the US. In every other developed country in the world, these stories must sound ridiculous!  Obamacare has improved access for A LOT of people but the fact remain our system is still broken.  I hope for Single-Payer even though I don't expect it to ever happen!

gooki

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Re: paying for doctor with cash
« Reply #6 on: February 06, 2015, 01:12:20 AM »
They do sound ridiculous.

I go to the doctor, I pay the $50,  I keep the receipt and then once a year I fill in a form and my health insurance pays me back.

For my kids, I go to the doctor, and pay nothing.

mbl

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Re: paying for doctor with cash
« Reply #7 on: February 06, 2015, 06:46:17 AM »
If you haven't had a check-up in 5 years.....you need one.
Especially if you're considering taking Zoloft?

Find the best physician you can that will "take" your HDHP coverage.
Sounds like you also might consider finding some counseling.

MayDay

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Re: paying for doctor with cash
« Reply #8 on: February 06, 2015, 06:59:13 AM »
My experience has been that they will happily run a visit through your insurance, and if insurance denies it (due to being out of network) then you can still pay cash at that point.  I'm not sure what the problem is with having it run through your insurance is. 


mozar

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Re: paying for doctor with cash
« Reply #9 on: February 06, 2015, 08:45:12 AM »
I'm not against anything, I'm just clueless. I've been to counseling and it was great. I just want to take the edge off so I can fall asleep at night.

ZiziPB

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Re: paying for doctor with cash
« Reply #10 on: February 06, 2015, 09:10:56 AM »
I would still advise you to go through insurance.  Typically, the negotiated rate that any doctor has with the insurance company (which is what you will be charged if you use insurance) is lower than any cash discount that the doctor will give you.  As an example, my DD had some health issues a couple of years ago and needed a whole bunch of tests.  The labs bill was around $600, but the agreed prices with the insurance company brought it down to something like $80.  Yes, this was under a HDHP so I was paying out of pocket (it was not a co-pay).  Similarly, a specialist visit became $150 instead of $250 when put through insurance.  So with the HDHP plan (which I have had for 4+ years now), I make sure that I use in-network providers and that I run all expenses through insurance.

BTW, this is a common misconception with HDHP plans.  People think that they should be paying for their expenses totally on their own.  That is not the case.  You need to run all your expenses through the insurance so that you get the discounted rates and, more importantly, so that what you pay is counted towards your deductible.

epipenguin

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Re: paying for doctor with cash
« Reply #11 on: February 06, 2015, 09:11:13 AM »
Go to the healthcare coop. Let them claim on your insurance. If it's a high deductible plan, you'll have to pay cash anyway, and if they're out of network the visit may or may not be covered. The worst that can happen is that you are no better off than if you just paid cash and kept quiet about your insurance. Alternatively, you might find that insurance covers some or all of it, or at the very least, what you pay can go towards satisfying your deductible so if you do have to use more services later in the year, you'll pay less.

frugaliknowit

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Re: paying for doctor with cash
« Reply #12 on: February 06, 2015, 09:21:40 AM »
You need to study all of the details of your coverage.  This would include what doctors you can choose, whether you have an HMO or PPO, whether you can only choose doctors in the network (definitely the case with the HMO).  This is putting the horse before the cart instead of the "cart before the horse".  Usually this is available on-line.

I would stick with your insurance coverage and doctors within your plan.  You are paying for it, so why not.  For Pete's sake, manage your health; don't go 5 years without a checkup (that's actually "unmustachian" in the long run!).

mozar

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Re: paying for doctor with cash
« Reply #13 on: February 06, 2015, 10:23:40 AM »
I do deserve a facepunch for not seeing a doctor. In mustachianism you must consider tradeoffs.
 I could take the bus for two hours to get to the wealthy part of my state to get quality in network care, or I can easily get to the in network providers that provide terrible care, or go out of plan to get quality care thats easy to get to. So I made an appointment with the coop. I'll probably use my hsa card because I know I'll forget to reimburse myself. They don't take my insurance. Thanks for holding my hand!
« Last Edit: February 06, 2015, 10:25:57 AM by mozar »

forummm

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Re: paying for doctor with cash
« Reply #14 on: February 06, 2015, 11:24:29 AM »
If you have a condition where you need an SSRI like Zoloft, you'll probably be visiting the doctor a lot more frequently in the future. A good physician will evaluate whether you actually need this kind of medication, see if something else in your life can be improved so that you aren't just medicating to mask some more fundamental underlying issue, and then only prescribe medication as a last resort. In the US we have crappy healthcare, so many docs will just write you an Rx and let you deal with the consequences. A good doc will also slowly step up your dosage and see how you do with it. SSRIs are no joke. It's quite common for people to feel very ill, sometimes for a couple weeks, when they change their dosage (starting, increasing, decreasing, stopping). SSRIs are also not that effective for many people, and sometimes certain varieties work and others don't. You might get rotated through a few. And the side effects can be significant. So be prepared. If something in your life is causing you to feel interested in an SSRI, you should deal with the underlying issue. SSRIs can be helpful to deal with some things too. A good professional can help you with a plan for you. That person might be a psychiatric specialist, a therapist (who may not have prescribing privileges), or a generalist.

Blonde Lawyer

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Re: paying for doctor with cash
« Reply #15 on: February 06, 2015, 11:30:45 AM »
Keep in mind that people don't usually go online to write good reviews about their doctors.  You are seeing a skewed sample.  Also, people have some really weird ideas of what is good customer service in the medical world.  I read reviews too and I do take them into consideration but I also take them with a grain of salt.  If you don't like the doc after 1 visit you can find another one.

Lyngi

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Re: paying for doctor with cash
« Reply #16 on: February 06, 2015, 12:17:29 PM »
Go to a good doctor, whatever it takes. Start a relationship with them that lasts over the years.   If you go in for a preventative visit, BP, screenings, etc the visit should be coded preventative and you should pay $0.   A couple of years ago I went to a walk in clinic for DD strep throat because they had advertised a walk in visit for $80.  Well, I gave them my insurance card, expecting to be billed $80.  Nope, $150 dollars later,   I learned my lesson.  A coworker went to a different  urgent care clinic, did not give an insurance card at all, got charged $80.   Oh well

frugalnacho

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Re: paying for doctor with cash
« Reply #17 on: February 06, 2015, 12:36:43 PM »
My experience has been that they will happily run a visit through your insurance, and if insurance denies it (due to being out of network) then you can still pay cash at that point.  I'm not sure what the problem is with having it run through your insurance is.

The very fact that it is being run through insurance means an automatic mark up.  If you say you don't have insurance and are paying cash, you will get one price.  If you say you have insurance they will triple that price.  If you are in a situation where you have insurance, but your deductible is not met yet (and won't be met for the year), the insurance company will take that inflated bill and charge you the full amount (or the insurance negotiated "discount" amount [which is still higher than the cash price]).  I believe this is the ops intentions.  He is only anticipating one visit so he wants to pay cash instead of telling them it's insurance, having them inflate the price, bill insurance, who will turn around and bill him since his $1500 deductible is not met.  I think he is trying to end up paying less by paying cash than have it all officially run through the insurance.

mozar

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Re: paying for doctor with cash
« Reply #18 on: February 06, 2015, 08:29:22 PM »
what frugalnacho said :-) and yes I take ssri's very seriously and would consider seeing an in-plan psychiatrist.

My goal is to create a long term relationship with the clinic. My insurance changes frequently but I want to have a steady doctor.

Blonde Lawyer

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Re: paying for doctor with cash
« Reply #19 on: February 07, 2015, 12:36:18 PM »
My experience has been that they will happily run a visit through your insurance, and if insurance denies it (due to being out of network) then you can still pay cash at that point.  I'm not sure what the problem is with having it run through your insurance is.

The very fact that it is being run through insurance means an automatic mark up.  If you say you don't have insurance and are paying cash, you will get one price.  If you say you have insurance they will triple that price.  If you are in a situation where you have insurance, but your deductible is not met yet (and won't be met for the year), the insurance company will take that inflated bill and charge you the full amount (or the insurance negotiated "discount" amount [which is still higher than the cash price]).  I believe this is the ops intentions.  He is only anticipating one visit so he wants to pay cash instead of telling them it's insurance, having them inflate the price, bill insurance, who will turn around and bill him since his $1500 deductible is not met.  I think he is trying to end up paying less by paying cash than have it all officially run through the insurance.

This is actually incorrect.  I work in a job where I have to review a lot of medical records and bills.  The insurance discounted rate is much less than what private pay patients pay.  In many states, by law, a provider cannot charge private pay patients less than their lowest insurance negotiated rate.  It is fraud if they do.  Medicare/Medicaid is billed at the lowest of all of the rates.  A clinic can opt to write off a patients balance if they can't pay or offer a discount for same day payment or something like that but the base rate cannot be less than the lowest insurance rate.  This could be state specific but my work encompasses three states and they all operate like this.

mskyle

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Re: paying for doctor with cash
« Reply #20 on: February 07, 2015, 12:51:53 PM »
You're making this way too complicated. Call and ask the doctor what the price would be if you paid in full and if there is a discount for paying with cash/check. Get a quote from your insurance on how much a visit would cost you out of pocket. Pretty sure your insurance is required to do this for you under the ACA (I live in Massachusetts where we have stricter requirements so I'm not sure).

If there's a substantial discount for paying cash, pay cash, but make sure there's a discount: if you don't go through your insurance this visit won't count towards your deductible, so if you do end up having something bad happen and you meet your deductible, you lose.

Also, don't conflate "fancy office in a nice neighborhood" or even "good online reviews" with "high standard of care." Patient satisfaction is actually *negatively* correlated with good health outcomes. A doctor with old carpet and a flaky receptionist can still help you be well.

Oh and one thing to watch out for: tests. Ask the doctor the price of any bloodwork he/she recommends. They probably won't know, because doctors are trained to just do whatever with no regard to cost, and this is where a lot of the expense comes in. But tell them you don't want any outside tests done unless you know what they will cost.

bdoubleu

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Re: paying for doctor with cash
« Reply #21 on: February 07, 2015, 01:16:50 PM »
My experience has been that they will happily run a visit through your insurance, and if insurance denies it (due to being out of network) then you can still pay cash at that point.  I'm not sure what the problem is with having it run through your insurance is.

The very fact that it is being run through insurance means an automatic mark up.  If you say you don't have insurance and are paying cash, you will get one price.  If you say you have insurance they will triple that price.  If you are in a situation where you have insurance, but your deductible is not met yet (and won't be met for the year), the insurance company will take that inflated bill and charge you the full amount (or the insurance negotiated "discount" amount [which is still higher than the cash price]).  I believe this is the ops intentions.  He is only anticipating one visit so he wants to pay cash instead of telling them it's insurance, having them inflate the price, bill insurance, who will turn around and bill him since his $1500 deductible is not met.  I think he is trying to end up paying less by paying cash than have it all officially run through the insurance.

This is actually incorrect.  I work in a job where I have to review a lot of medical records and bills.  The insurance discounted rate is much less than what private pay patients pay.  In many states, by law, a provider cannot charge private pay patients less than their lowest insurance negotiated rate.  It is fraud if they do.  Medicare/Medicaid is billed at the lowest of all of the rates.  A clinic can opt to write off a patients balance if they can't pay or offer a discount for same day payment or something like that but the base rate cannot be less than the lowest insurance rate.  This could be state specific but my work encompasses three states and they all operate like this.

I will also vouch for this.  I worked in billing for a specialty pharmacy several years ago, and the price we billed the "self pay cash" patients was almost double what we billed the insurance companies (and then what you "bill" insurance for is reimbursed even lower).  Of course we were willing to "discount" the cash-paying patients, but not to the level that we billed insurance for.

mozar

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Re: paying for doctor with cash
« Reply #22 on: February 07, 2015, 09:19:07 PM »
on reviews y'all are just gonna have to take my word for it.

Quote
if you don't go through your insurance this visit won't count towards your deductible, so if you do end up having something bad happen and you meet your deductible, you lose.

i don't understand this part. Wouldn't it be ok if I met my deductible since that means the insurance kicks in?

Pelican123

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Re: paying for doctor with cash
« Reply #23 on: February 07, 2015, 11:11:15 PM »
Mozar,

You state you are having trouble sleeping and just need something to "take the edge off" at night.  May I suggest investing in a glass pipe ($10 at your local smoke shop) and trying marijuana out medicinally for sleep?

I suffered from sleep problems at night for years until I did this. Now after years and years of going to bed this way my body has become used to it on its own and rarely needs "help"

Also I would recommend marijuana any day over the pharmaceuticals in America.

Best of luck with your issue, bud.

mozar

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Re: paying for doctor with cash
« Reply #24 on: February 08, 2015, 09:18:00 AM »
Actually I once tried marijuana (7 years ago) for that reason and it worked. Unfortunately now I have a federal security clearance so every couple years I have to explain to an investigator why I tried marijuana once, that no I'm not a drug addict, no I can't be bribed for drugs, no I'm not involved in the drug trafficking trade...

I don't care to get high, but that's a good idea once the federal laws change.

mskyle

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Re: paying for doctor with cash
« Reply #25 on: February 08, 2015, 11:00:25 AM »
Sorry, I think I completely misunderstood your problem. Is the problem that the co-op doesn't accept your insurance? Or that they don't accept patients with insurance, period? Does your insurance pay for out-of-network providers at all - some of them will pay a small percentage?

What I was saying about the deductible is that if you go through your insurance and pay $150 for a doctor's visit, that $150 counts towards your deductible. So if you went to the doctor and paid through your insurance and next week you broke your leg and it required expensive care, you'd pay $1350, i.e. $1500 minus $150. If you didn't go through your insurance and just kept everything off the books, when you broke your leg you'd have to pay the full $1500 deductible. You probably know this but maybe not everyone does - medical insurance deductibles are for the plan year, not per incident like car insurance.

frugalnacho

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Re: paying for doctor with cash
« Reply #26 on: February 08, 2015, 11:11:18 AM »
My experience has been that they will happily run a visit through your insurance, and if insurance denies it (due to being out of network) then you can still pay cash at that point.  I'm not sure what the problem is with having it run through your insurance is.

The very fact that it is being run through insurance means an automatic mark up.  If you say you don't have insurance and are paying cash, you will get one price.  If you say you have insurance they will triple that price.  If you are in a situation where you have insurance, but your deductible is not met yet (and won't be met for the year), the insurance company will take that inflated bill and charge you the full amount (or the insurance negotiated "discount" amount [which is still higher than the cash price]).  I believe this is the ops intentions.  He is only anticipating one visit so he wants to pay cash instead of telling them it's insurance, having them inflate the price, bill insurance, who will turn around and bill him since his $1500 deductible is not met.  I think he is trying to end up paying less by paying cash than have it all officially run through the insurance.

This is actually incorrect.  I work in a job where I have to review a lot of medical records and bills.  The insurance discounted rate is much less than what private pay patients pay.  In many states, by law, a provider cannot charge private pay patients less than their lowest insurance negotiated rate.  It is fraud if they do.  Medicare/Medicaid is billed at the lowest of all of the rates.  A clinic can opt to write off a patients balance if they can't pay or offer a discount for same day payment or something like that but the base rate cannot be less than the lowest insurance rate.  This could be state specific but my work encompasses three states and they all operate like this.

I have heard a number of people tell me that when they pay cash they get a substantially reduced rate over what they would pay via insurance.   I have never paid in cash because i've always had insurance so I can't confirm that first hand, but I did have an experience at the podiatrist last year that also supports this theory.  I created a thread about it:

http://forum.mrmoneymustache.com/welcome-to-the-forum/my-$645-ingrown-toe-nail/

In short: I went to have ingrown toenail removed, they billed insurance, but my insurance no longer covers "specialist" until my $1k deductible is met (I had paid exactly $0 up to that date), so 100% of the bills got bounced back from insurance and sent to me.  I didn't get any "negotiated" insurance rate, and the rate I paid was substantially more than what my insurance covered for the exact same procedure the previous year.  I didn't realize my insurance had changed and no longer covered "specialist", otherwise I would have not gone to that particular provider.  I also think I could have told them I had no insurance and paid a cash price of less than $645 (this is speculation on my part based on what I have been told by others, and the fact that my explanation of benefits for the previous year only showed about 1/3 of that payment for the previous year).   If I had to have the procedure done at the end of the year and hadn't paid anything towards my deductible I would absolutely try to leave insurance out of it and negotiate a lower cash rate (actually I would just go to my primary care physician so I would just be responsible for a copay, but that's beside the point).
« Last Edit: February 08, 2015, 11:15:47 AM by frugalnacho »

Davids

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Re: paying for doctor with cash
« Reply #27 on: February 08, 2015, 12:40:58 PM »
About using the HSA card - isn't it better to cover the cost out of pocket, keep the receipt, and reimburse yourself in the future? (assuming you can front the money for now)

Yes, if the HSA funds are or will be invested. It's a great emergency fund (with enough receipts).
Pretty much that is what I am doing. My plan is to only reimburse myself from it if there is a legit large bill, otherwise if it is small i'll just pay it on my cc and not remove funds from the HSA. Pretty much I just go anyways annually for my wellness visit which is 100% covered. So far (knock on wood) my baby has only gone just for his wellness checkups as well. Heck I have not even called the bank that where we have our HSA debit card to activate them.

mozar

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Re: paying for doctor with cash
« Reply #28 on: February 08, 2015, 08:11:09 PM »
The co-op doesn't take my insurance for in network or out of network. They take other insurance.

goatmom

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Re: paying for doctor with cash
« Reply #29 on: February 08, 2015, 08:54:40 PM »
Curious why you want to take zoloft? If you think you are depressed, you should really get appropriate treatment for it. Best of luck!

ZiziPB

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Re: paying for doctor with cash
« Reply #30 on: February 09, 2015, 06:04:33 AM »
on reviews y'all are just gonna have to take my word for it.

Quote
if you don't go through your insurance this visit won't count towards your deductible, so if you do end up having something bad happen and you meet your deductible, you lose.

i don't understand this part. Wouldn't it be ok if I met my deductible since that means the insurance kicks in?

Here is an example of how it would work and why it's not good to pay outside of insurance.

Scenario 1: You go to the doctor and pay $150 outside of insurance.  Then you get seriously ill and the total cost of your treatment is $2000.  So you pay $1500 (your deductible) and the insurance covers $500.  You spent $1650 on your medical care.

Scenario 2: You go to the doctor and put the claim through insurance.  You pay $150 after your claim goes through insurance.  Then you get seriously ill and the total cost of your treatment is $2000.  You pay $1350 (because together with the $150 you paid previously, you have now reached your deductible of $1500).  Insurance pays $650.  You spent $1500 on your medical care.