Paying Doctors is Fun

It is a really weird mental block we have against paying out of pocket for medical bills, particularly since this is probably the most, not the least, important thing we can spend our money on.  Having a high-deductible health insurance plan has been a real eye-opener for me.  As in this post from Maggie's Farm, I too have found doctors will very often give a discount for cash.  My son has a great sports medicine guy (he plays 3 varsity sports so we seem to be at the doctor a lot for one injury or another) who gives us a $40 cash rate for a visit.  Further, when he needs X-rays, the radiology place downstairs usually does 2-3 films of the injured appendage du jour for around $35.  The X-ray place has a special cash price book they pull out when I show up.  I shudder to think what rate they charge insurance companies.  And t just think of the piles of infrastructure from my doctors office to the insurance company to Washington DC that would have had to come into play had I sought 3rd party payments for these bills.

And when it comes to the expensive things, it is amazing what price cuts you can find with just a little shopping.  Previously, I had spent less time in my whole life shopping medical care prices than I had price-shopping my last hard drive.  But when my son had to get a CT scan on his head (yes, another sports injury) we saved hundreds of dollars just calling a second place for a quote.  In fact, even mentioning that we were going to price shop the first quote got a few hundred dollars knocked off.  The lack of any rigor in health care pricing is just appalling, and will only get worse as government / single payer solutions crowd out approaches like mine under Obamacare.


  1. Bart Hall (Kansas, USA):

    I'd encourage you *not* to pay cash for medical services below the deductible amount. This is because of the insurers' ability to negotiate a better price than you can as an individual.

    We have a $10K-deductible from Blue Cross which costs the two of us about $160 per month, and my wife has a cancer history. It had been $120 per month, but recent legislation required them to cover mental health services too.

    As a consequence of that thyroid cancer my wife undergoes annual blood work with a sticker price over $200. We always felt good about having negotiated a 20% cash discount for payment at the time of service.

    One time she forgot the checkbook and ran it through on our BCBS account. Because of *their* discount with the lab, our out-of-pocket was under $40 -- an 80% discount, compared to the piddly 20% we'd been getting.

    Even better, BCBS covers her "well-woman" annual exam (and associated labs)regardless of deductible, as well as a mammogram every other year. Netted out, we get three months' premium back in direct benefits. What's not to like about that?

    Of course these high-deductible policies are a prominent target of ObamaCare because they're preferred by healthy self-employed people and it isn't "fair" that healthy people have the ability to choose such a low premium and thus avoid their responsibility to "share" with those less fortunate than themselves.

    The key thing, however, is to run your medical expenses through the insurance. You'll be amazed at the savings that generates.

  2. Jay:

    In my experience, the cash price is higher than the insurer negotiated price, because that is how they make up for the insurer and government low rates being perhaps marginal. OTOH, if I am paying cash, it is normally because I am below the deductible, and the rate I am charged IS the insurer rate. Not sure what might happen if it were purely cash. And cash, not simply "send me a bill." I recall going to a clinic, before I had either insurance or a primary doctor, and getting a $5 discount for cash. But that was long enough ago that a visit was $55, rather than $130. (A more comprehensive class of visit is $195. That's the one where you get more than a couple minutes of face time with the doctor.)

    In any event, I haven't been going to the doctor this year, since I can't afford to pay.

  3. ColoComment:

    Also. Unless you run your claims through your health insurance company, you won't get "deductible" credit for the medical services for which you've paid in cash. If you pay cash outside of the insurance system, when do you get your deductible amounts credited?

    I also figure that a small portion of my premium for my catastrophic coverage actually is allocated to pay for various expected, mandated, usually preventive, services, i.e., my flu shot this month was 100% covered.

    It's like at a restaurant: if a salad and side dish are included in the price of the entree, why would you offer to pay extra cash out of your pocket for them?