Cash Pay Health Care Isn’t Rocket Science

By Bill Rusteberg

PROPOSITION: Members never generate claims for 60–80% of care. Plan intercepts as many health care encounters as possible before becoming a claim and routes into a cash-pay pathway. Everyone wins. Patient wins, plan wins and providers win.

Cash Pay Pricing:

  • Imaging: 100–120% of Medicare
  • Surgery bundles:100–150% of Medicare
  • Labs: 80–100% of Medicare
  • Inpatient hospital: 100-150% of Medicare

NOTE: It’s been our experience cash payment in deep South Texas averages 110% of Medicare for 50% savings over PPO allowed amounts. The savings over billed charges is enough to make a full-grown man cry or cackle in delight.

Cash Pay Transaction:

Cash payment is made through a single use virtual card funded (or by other means) through an escrow account.

How It Works:

  1. Member needs care
  2. Contacts navigation (mandatory or incentivized)
  3. Navigator:
    • Identifies need
    • Prices episode
    • Schedules provider
  4. Virtual card issued
  5. Provider paid upfront
  6. Member shows up – $0 or minimal copay
  7. No claim generated

Expectations:

50% savings or more on health care spend, elimination of medical trend, better health care experience for plan members.

Summary:

Advantages to Plan Members

  • All financial barriers to health care are eliminated
  • Improved patient experience
  • Never a balance bill
  • Concierge service sets appointments, identifies high quality providers

Advantage to Plan

  • Savings up to 50% and more
  • Reduces retail claim dollars to wholesale cash priced claim dollars
  • No additional cost to the plan, current funding does not increase

Advantage to Community Health Care Providers

  • Payment in full at the time of service
  • No chasing patient financial responsibility
  • No claims to file
  • Elimination of third party intermediaries – restores patient / physician relationship

Members decide between Free Care vs Not-So-Free Care at the Point of Service

How It Works

Plan members have a choice between traditional cost sharing benefits or free care at the point of service.

Prior to seeking health care services plan members call the number listed on their I.D. card to determine if FREE CARE service benefits are available for their immediate health care needs. Examples include MRI’s, surgical procedures, pregnancy, and other medical services. Medical appointments and related services are coordinated on behalf of the member with appointments set at the member’s convenience. At the point of service the member pays nothing and receives the care they need.

Tutorial:

BUCA Bucks vs MedSave Bucks

Every self-funded plan maintains a money pot to pay claims as they occur. Monies leaving the pot are often paid in BUCA Bucks.

BUCA Bucks have low purchasing power. Transaction fees of all sorts are charged by third party intermediaries as BUCA Bucks begin their journey to provider bank accounts. That process takes weeks and months.

BUCA Bucks are comingled with People Bucks in the form of deductibles, co-insurance and copays.

MedSave Bucks have more purchasing power. Low transaction fees make purveyors of BUCA Bucks blush with envy. Third party intermediaries are eliminated. MedSave Bucks journey directly to provider bank accounts in a process that takes 24 hours or less, not weeks and months.

MedSave Bucks are not comingled with People Bucks. Gone are deductibles, co-insurance and copays.

MedSave Bucks have a 2-1 advantage in purchasing power over BUCA Bucks.