Self-Medical Care Part III – Negotiating Doctors, Hospitals & Clinics With Cash Pay
This last part of my series is a bonus post! It has to do with handling those rare cases where you DO have to go see a professional. I do as much self-testing & holistic healing as I can, but some things (e.g. yearly dermatology visit for my moles) or when I do something stupid (e.g. splitting open my head…I’m good at this kind of stuff) then I have to go see a real doc. Given we carry a $10,000 deductible on our insurance and most of what I need (e.g. dermatology) is not included in “free” preventative care, I try to do as many of these things as I can on my own $$. Also often I can get significantly cheaper pricing by going “direct” than by taking the procedure through my insurance (seriously…and I’m not the only one who’s discovered this!). For this reason alone cash-pay is usually my #1 choice for anything “non-catastrophic”.
Negotiating this mess is non-trivial. I’ve had my good share of these kind of incidents over the last 4 years so I figured I would share what I’ve learned along the way.
Shop Around, Shop Around
If there’s one tip I can give you that trumps all others when it comes to self-pay medical care it’s to shop around. You will be surprised….no scrap that…you will be ASTOUNDED at the differences in price for standard procedures across the board. There is no (NONE) standardized cash pricing on healthcare in the US, so there are literally no limits to what you can be charged. I’m not talking brain surgery here (although I’m sure price varies alot there too), I’m talking run-of-the-mill straight-forward standard procedures. Here’s my 5-step process for getting the right price:
- Get An Estimate Of Fair Pricing: If you’re going in for a new procedure and have no idea what to expect, it’s worth checking the Health Care Blue Book (they also have an app) for “fair” pricing on standard procedures in your area. This is not a definitive guide, but it sure can help to narrow your range. If what you need is non-critical you can even use this resource to check cross-country for potentially cheaper spots along your RV travels. Fair Health Consumer offers a similar price comparison list. I use both before I ever get a real quote from a doc.
- Narrow Your Selection: Once you’ve chosen a specific location Google local docs & select the ones that have the largest number of positive reviews.
- Call Around For Cash Pricing: Call each of your selected docs and ask if they offer fixed “cash pricing” for what you need done. Often you will need to talk to the “billing department” to get this info since the front desk may not have a clue. If they can’t give you a fixed cash price, cross them off your list.
Check For Additional Fees: If you’re getting surgery done ask the billing department if they cover all aspects of the surgery or if there are separate fees for facility, doctor, blood/lab-work, meds and anesthesiology. Often you will need to deal with 2-4 different billing departments to get the full picture of your costs. Also, if you’re going to have more than one doc in attendance for your surgery you may well be charged for each one individually. Ask and confirm.
- Ask For Extra Discounts: Ask if you can get a discount for pre-paying the procedure. Often there is a discount for cash services and an additional discount for pre-payment.
Here are two personal examples:
1/ Dermatology – every year I shop around for a dermatologist to give me the once over and remove any suspicious moles (I’m a dermatologist’s dream when it comes to these). In this case I’m looking for cash pricing for a skin-check PLUS mole removal PLUS sending it out for pathology. I specifically ask the office if they have a fixed cash price for all 3 of these in one. I called 5 well-rated spots in Palm Springs when I got here a few weeks ago. Three of these could not give me a fixed price (one couldn’t even give me a range!!), but one of them had a fixed $350 price for the three-in-one. I know from experience that that’s a good price so that’s who I went with.
2/ Surgery – In 2012 I needed some very standard surgery done. I called around to 6 hospitals in San Diego and got prices varying from $2,000 to $12,000 (and that last one was just an estimate!) for the exact same procedure. Delving into the details revealed I would need to pay a surgery fee (which included the doctors fee and all blood/lab-work), an anesthesiology fee and a facility fee. Two of these gave me an additional 20% discount for paying up-front. As a side-note, I had to take some prescription meds as part of my surgery. Calling around to 5 different pharmacies gave me 5 different prices on the exact same meds (in the end Costco was the winner). It was a bear to figure out, but I saved thousands (literally) by taking the time to wade through these calls.
For Minor Issues Go To Urgent Care Clinics
One of the costliest things you can ever do is go to the emergency room. Prices seem to sky-rocket to around 10 times the norm whenever you do. There are times you can’t avoid it, but for the minor issues (flu, minor injuries, general illness etc.) look for an Urgent Care clinic. There are ~9,000 of these all over the country and they are fairly inexpensive. Most of these clinics will have fixed prices to see a doc (~$100-$200) and they are “walk-in” ready. Some clinics even have “nationwide” networks & pricing programs.
For example USHealthCare has clinics in 16 states and offers special discount coupons for cash-pay patients. Next Care has clinics in 8 western states and offers special discount pricing on office visits & procedures if you buy their $50/year Value Care program (if you have kids that often need visits or you’re the clumsy type this kind of program could make sense for you). We went to an Urgent Care clinic in Kentucky in 2010 when I suspected we had Lyme Disease. It cost $100 to see the Doc and another $4 (see below) to get the antibiotics to treat us. Easy and inexpensive.
Negotiate, Negotiate, Negotiate
What if you end up with a bill where you didn’t do the due diligence? In 2011 I ended up in the emergency room in Astoria, OR after splitting my head open on the RV slide (a classic Nina moment). As a result of the fountain of blood spewing out of my skull I wasn’t thinking straight, didn’t go to an urgent care, accidentally gave them my insurance card and didn’t ask up-front about cash pricing. Three weeks later, the $1,500 bill I got for the 15 mins I spent in the emergency room while they put 2 staples in my head nearly caused me to split the wound open all over again. So, I called and told the hospital I couldn’t pay. After 30 minutes of negotiation (“I want to pay you now, but I just can’t afford this bill”….”If this goes to collection you won’t get your money for years. Give me a cash price I can pay now”…”Surely you can do better than this. Let’s settle this now and get it off your accounts” etc. etc.), I got the bill reduced by 50% if I agreed to side-step my insurance and pay the hospital directly on the spot. Still bloody expensive (pardon the pun), but a lot better than the first price.
P.S. For those of you who hate the thought of direct negotiations there is also the option of hiring a professional Medical Billing Advocate to handle your bills for you. For a price and/or commission of the savings, these folks will work directly with hospitals, find errors and reduce out-of-pocket costs. Definitely worth it if you’re facing huge bills and don’t know where to turn.
Go Abroad, Go International
For those of you who’ve never traveled abroad the thought of getting medical care outside the US can be scary. However, the truth of the matter is that medical care can be both excellent and inexpensive in foreign countries. Many countries cater to Medical Tourism (for example, the large hospitals in Thailand -> I would not hesitate to use these) and specialize in fixed pricing for even complicated procedures. You’ll need to spend alot of time doing due diligence and research if you chose this route, but it can save you a ton of $$. Last year Paul and I went to Mexico for our dental work and got some basic work done for ~30% of the price we would have paid in the US. This will likely be our choice from now on. I haven’t (yet) found a primary care doctor or dermatologist I can trust in Mexico, but it’s on my list for the future. Also, for folks on prescription meds you can often save hundreds by buying them across the border.
Just a few, additional cost-saving links:
- The $4 List -> If you’re on prescription meds or being offered a med and don’t know about the $4 List, go check it out. Using this list can save you hundreds. Walmart, Walgreens, Costco etc. all have them. Costco even has a special prescription price list for cash-pay patients which saves $$ on meds outside the $4 list. Bottom line -> if you’re on meds shop around!
- County Health Departments -> If you’re uninsured or your insurance doesn’t cover it many County Health Departments across the country will offer very low-cost vaccinations/immunizations from childhood through to travel or flu. For example San Diego offers this service for $10 regardless of how many shots you get. Thanks Doug for this tip.
- Dental Schools -> If the thought of going to Mexico for dental work works makes you shudder, you may want to look into Dental Schools that offer free or very low-cost dental care all over the US. Be ready to spend some time here (these are often multi-day visits), but if you plan ahead they can be an outstanding deal.
- GoodLuckDuck -> My blogger buddy Roxanne has excellent, additional links on healthcare for poor people.
- The Truth About Health Care -> This is a rather “sensational” site, but does contain some gems of information especially regarding hospital billing and prescription medication. It helped me understand the financial side of healthcare in alot more detail.
That’s about all I can come up with for this series (at least for now). Hope it’s been educational & that I’ve encouraged you to take charge of your health & save some $$ in the process.