Navigating the World of Cash-Pay Healthcare
How to Take Charge of Your Health Without Insurance Roadblocks
Many Americans feel trapped in their health insurance with high deductibles, denied claims, confusing bills, and long wait times. Fortunately, when there is a health emergency, few healthcare systems in the world can compete with ours. This article will empower you with great care without health insurance dictating your options.
I’ll discuss how cash-pay healthcare works, why it might be a better option for some, and where to find the best resources.
Why Consider Cash-Pay Healthcare
Having options is one of the greatest luxuries of modern living. I would love for every American to have their health insurance for big, unexpected health events while having options to pay for cash-pay services to fill in the gaps left by traditional health insurance.
1. More Control Over Your Health
In the cash-pay world, transparency is kind & queen - you know whom you’ll see, when you’ll see them, what they’ll deliver, and how. That’s because for cash-pay doctors like myself to compete in this system, we must define how we stand apart from mainstream healthcare.
2. Transparent Clinical Care Pricing
Cash-pay means that you’ll be offered an exact breakdown of the cost upfront. You can negotiate which services are necessary and which you can put off. It’s a patient-doctor discussion that takes your health and pocketbook into account.
A cash-pay doctor will never send you a surprise bill.
3. Faster Clinical Access
Doctors allow for more time in their cash-pay healthcare models because it’s the one thing the health insurance companies are deprioritizing. Unfortunately, Faster clinical visits lead to more prescribing and testing, resulting in data dumps that lead to unnecessary interventions.
4. Better Clinical Quality of Care
When you have more time with your doctor, you get to tease out the nuances. Both the patient and the doctor identify their biases through ongoing discussions to focus on what matters most - the patient's overall health.
5. Protection From Overbilling
When you pay cash, clinicians have no incentive to inflate prices or run unnecessary tests because the health insurance system highly reimburses them.
How Much Does A Visit Really Cost?
Most Americans don’t have a good barometer for the cost of the clinical services and procedures they receive. Unlike an oil change or timing belt replacement, where we have well-established guidelines, healthcare remains a bit unchecked.
The Cost of Primary Care Services
The primary care doctors have had a strong start in this space with the Direct Primary Care movement. They believe it’s important for the primary care doctor to get to know their patients over a long time, so they charge them an ongoing monthly subscription - around $100/month.
One-off visits might cost around $75-110. Remember, these are often at least 30-minute-long appointments.
Lab & Imaging Costs
Direct-to-consumer lab testing can be had through LabCorp, Quest, and Rupa. You might pay around $100 for the average blood panel if you purchase these directly from the laboratory centers. If you get them through your DPC, it’s often much cheaper because they negotiate bulk pricing which they pass on to their patients.
RadNet, American Health Imaging, and Green Imaging are just a few examples of radiology networks and centers that offer cash-pay options. A good strategy is to search for an imaging center near you, call them, tell them that you’d like to pay cash for an MRI or CT scan, and inquire about the cost. You’ll find that many are quite ready to negotiate prices with you.
My hand MRI, which was initially quoted at $700, was completed for $365. I drove to the location, had the study done, got the MRI read by the radiologist, and had the report and images emailed to me.
Specialist Visits & Procedures
You can call different institutions near you, such as teaching hospitals, university affiliated hospital networks, and various specialty groups, to ask about the cost of seeing an orthopedic surgeon, oncologist, or gynecologist for an IUD placement.
I did that for a sports orthopedist and was quoted anywhere from $1,200 for single visit to as little as $140. I paid $90 for a hand surgeon working at a prestigious hospital group in one city over. He reviewed my MRIs, discussed surgical options with me, told me when to follow up, and was relatively easy to communicate with. And he was a traditional in-network surgeon, not even cash-based.
Prescription Medication Costs
We have lots of pharmacy options available for patients who prefer to pay cash for their medications. CostPlus pharmacy is a popular one. Others include Blink and Honeybee.
Some medications may not be available or might still be quite unaffordable. There are ways still to get access to such medicines through cash-pay options but it’s more complicated and may require a patient navigator to help you through that process.
Surgery Center & Infusion Costs
Many fear the cost of an unexpected surgery. Fortunately, most surgeries are elective and only a few are true emergencies. When they are done in a hospital, it’s possible to negotiate prices. A great resource on this topic is the book Never Pay The First Bill.
There are several surgery centers in the US that are cash-based. A favorite pick for my patients is Surgery Center of Oklahoma. There is also Texas Free Market Surgery and Pacific Surgical Center in WA.
I won’t mention international options, often referred to as medical tourism. But due to the lack of malpractice scene overseas, surgical care is often much cheaper with similar outcomes as what we enjoy here in the US.
When it comes to getting specialized infusions such as chemotherapy or medications for autoimmune diseases, there are many infusion centers that aren’t hospital-affiliated. They will have cash-pay options and are much cheaper than what you’d pay if you were in the inpatient setting.
Common Myths About Cash-Pay Healthcare
“It’s Only For The Wealthy”
Cash-pay services are often more affordable than the out-of-pocket expenses associated with health insurance. The MRI that would cost $2K with yoru PPO plan would be $500 if you pay cash.
The surgery that would cost you $12K out of pocket with your health insurance would cost zero with your cash-based surgeon because they would might advise you not to have the surgery in the first place. I know, this one is a bit unfair but I see it enough that it’s worth mentioning.
“It’s Impossible to Find a Doctor”
Cash-pay options have been around for a long time and are growing. True, most of these services don’t spend too much time marketing or advertising but if you know where to look, they aren’t hard to find.
Companies like Sedera and Crowd Health, which offer an alternative to health insurance, are often a good resource for such cash-pay options.
“I Already Have Insurance, It’s Not Worth It”
Health insurance isn’t guaranteed to every American, but fortunately, many states are offering more and more affordable options. A time may come when it will be tough for you to afford certain care which is why having access to cash-based doctors who may not even accept health insurance may pay off.
“It’s Risky”
With the right planning and research, cash-pay healthcare might be just as good, if not better, than your high-deductible health insurance plan. It might even save you from unnecessary medications, surgery, testing, and interventions.
Final Thoughts: Taking Control of Your Health
The good news is that you have lots of options. If nothing else, these resources I shared should empower you to shop around for the right care and know your options. They definitely shouldn’t cause any fear that your health insurance is inadequate or is trying to take advantage of you.