It’s hard to believe that even if you have health insurance, you may be better off if you pay cash for outpatient healthcare services. If that’s the case, why do we have health insurance at all?! We have health insurance to cover very prolonged illnesses or major trauma. Basically, catastrophic issues. But when it comes to screening tests or basic health maintenance, patients could save a lot of money if they pay cash!
My wife’s procedure
Recently, my wife had a strange sensation of food getting stuck at the bottom part of her esophagus, before going into the stomach. This is a different concern than symptoms of reflux which can be easily treated with over-the-counter Pepcid or Zantac.
When someone complains of a feeling of blockage when swallowing, you don’t take a “wait and see” approach. You take a “don’t wait, and see now” approach. The appropriate test to check out the esophagus and stomach is a gastroscope. Also called an esophagogastroduodenscopy, or EGD for short. This is the lighted tube a gastroenterologist puts into the patients mouth under sedation, down the throat, into the esophagus, then finally into the stomach and first part of the intestines. It allows the doctor to get a clear view of what’s going on, if anything. Luckily in my wife’s case everything was fine. She may have reflux that causes that sensation but there’s no tumor or abnormal tissue blocking that area.
Why pay cash for outpatient healthcare services
Aside from the medical decisions, this scenario also requires a financial decision. If the facility, anesthesiologist and gastroenterologist submits their bills through insurance, this is what would happen. They would submit a very large bill. Because the provider (doctor/hospital) knows the insurance company will pay them less than what they bill, they aim high! In other words, if the doctor charges $100 and they only get paid $80, then what if the provider charges $150…maybe they’d get $120 in return. That’s more than the $80 you were going to get paid. And that’s the game providers play with the insurance companies.
If you let the provider submit those higher bills to the insurance company and you have not met your deductible, the insurance company will turn around and say, “hey, you owe this amount!” And then you’re stuck paying this higher bill out of pocket.
But if you go into this situation knowing the game, don’t let them submit the bill to insurance. Since the facility doesn’t have to go through the process of submitting paperwork to the insurance company, getting denied, filing an appeal and back and forth, they’ll gladly charge you less to avoid that whole process. And in that case, the anesthesiologist may only charge $200. The doctor may only charge $600. And the facility may only charge $1200. A total of $2000 out of pocket.
In contrast, if your bills were sent to the insurance company, the charge could be closer to $5000. And if you have a high deductible of $5000, you’ll have to pay $5000 out of pocket instead of $2000 for the same procedure!
So if you haven’t met your deductible, call the facility or doctor’s office performing the test first. Ask them what the cash pay rate is. Yes, it’s a shame that you have to pay anything before your health insurance steps in to help. But better to pay less than more if you’re having to pay out of pocket regardless.
If you’re tired of calling around asking about healthcare prices – for cosmetic or medically necessary services – check BuildMyBod.com/pricing to make your life easier!
Click here for the original blog post written by Dr. Kaplan for BuildMyBod.