Asserta Health assists employers with Cash Pay strategies
Hospitals and other providers increasingly are offering cash prices far below what they charge through insurance………….“I’m paying $530 a month in premiums and I get charged more than someone who just walks in off the street?
By MELINDA BECK – Wall Street Journal
Feb. 15, 2016 10:11 p.m. ET
As consumers get savvier about shopping for health care, some are finding a curious trend: More hospitals, imaging centers, outpatient surgery centers and pharmacy chains will give them deep discounts if they pay cash instead of using insurance.
When Nancy Surdoval, a retired lawyer, needed a knee X-ray last year, Boulder Community Hospital in Colorado said it would cost her $600, out of pocket, using her high-deductible insurance, or just $70 if she paid cash upfront.
When she needed an MRI to investigate further, she was offered a similar choice—she could pay $1,100, out of pocket, using her insurance, or $600 if she self-paid in cash.
Rather than feel good about the savings, Ms. Surdoval got angry at her carrier, Blue Cross Blue Shield of Arizona. “I’m paying $530 a month in premiums and I get charged more than someone who just walks in off the street?” says Ms. Surdoval, who divides her time between Boulder and Tucson. “I thought insurance companies negotiated good deals for us. Now things are totally upside down.”
Deep discounts
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.
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Hospitals, meanwhile, have sought ever-higher rates from commercial insurers to make up for losses on other patients. Insurers pass those negotiated rates on to plan members, and given the growth in high-deductible plans, more Americans are paying those rates in full, out of pocket, than ever before.
“When you had just a $20 copay, you didn’t care what rate your insurer negotiated with your doctor. But it only takes one $3,000 MRI bill for people to say, ‘Wait a minute—where did this come from?’ ” says Jeanne Pinder, founder of Clearhealthcosts.com, one of several startups that publish hard-to-find health-care prices for consumers.
Shifting relationships
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.
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