Cash Pay Plan Option Produces Significant Savings For Texas County


Cash pay reimbursement strategies should be an integral part of any self-funded employee health insurance plan………..

By Bill Rusteberg

A Texas county recently incorporated a Cash Pay Option to their self-funded employee health insurance plan effective January 1, 2016. Since it is commonly understood medical caregivers often reduce their fees by as much as 50% and more in exchange for cash at the point of service, the county engaged Asserta Health to assist in managing a Cash Pay Plan option for plan participants.

Although the plan was implemented only four weeks ago, three claims have already come under Asserta management.  The first case has been completed and has produced impressive results.

This case involved a total knee replacement. The patient had knee replacement surgery in 2015 followed with another knee replacement under the Asserta program in January of this year. Let’s compare the cost differences.

In 2015 the county’s plan paid approximately $29,400 for the surgery/hospital/anesthesia through a direct contract the county negotiated several years ago with a local hospital system. This payment approximates 110% of Medicare allowable.

The cash price negotiated by Asserta Health for the same procedure and services under the cash pay arrangement was $17,184 which is less than Medicare reimbursement levels.

According to the cost of a total knee replacement in this country averages $57,000.

Cash pay reimbursement strategies should be an integral part of any self-funded employee health insurance plan. Building a benefit plan that incorporates (1) direct contracting, (2) cash pay options and (3) reference based pricing provides plan sponsors the tools needed to lower health care spend while improving benefits at the same time.

About is a specialty company in the benefits market that, while not an insurance company, works directly with health entities, medical providers, and businesses to identify and develop cost effective benefits packages, emphasizing transparency and fairness in direct reimbursement compensation methods.

The shared vision of and clients who retain our services is to establish and maintain a comprehensive employee health and welfare plan, identify cost areas that may be improved without cost shifting to any significant degree, and ensure a superior and sustained partnership with a claim administrator responsive to members needs on a level consistent with prudent business practices.

Plan costs, in all areas including fixed expenses and claims are open for review on a continuing basis. Cost effective plan administration and equitable benefit payment to providers are paramount to fulfilling our mutual fiduciary duties. As we proactively monitor and manage an entire benefit program we are open to any suggestions members may make or the dynamic health benefit market may warrant in order to accomplish these goals.

Duty of loyalty to our clients, transparency and accountability are essential to the foundation of our services. To that end, we expect our clients to realize a substantial savings based upon the services that we will deliver.

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