Black Friday Deals on Medical Visits?

In this video @macyschrock shares her experience with health insurance and the medical system. 

Similarly, in late October, I had to go to urgent care to receive care for a tick bite. I have a very high deductible that I am not going to reach by the end of the year. Because of this, I chose to pay out-of-pocket for the visit. I was told I would get a 39% discount on my bill for not going through my insurance. So, I went from having to pay $561 through insurance to be put towards a deductible that I would not meet, to a $219 bill that I was able to pay over the phone. 

How could both of these situations occur? How could they charge more for someone’s MRI with insurance? And how could they decrease the rate of my visit by 39% when I paid with cash?

Providers will jack up the prices that they bill to insurance companies for a few reasons. Prices for services, such as an MRI or a doctor’s visit, are negotiated between a provider and an insurance company. Each insurance company will negotiate and reimburse a provider at a different rate which means that the provider never really knows how much they will get paid for treating a patient. So, the provider will then increase the price in hopes of getting paid an adequate amount from the insurance company. There is also something called a reimbursement schedule. Insurance companies will only reimburse providers a few times a year, and again, each insurance company has different times in the year that they will pay providers. So, providers also have to wait longer to get paid through insurance.

 On the other side of this, most patients are paying an insurance premium and then also have to pay per visit, at least partially, until they reach their deductible. It can be frustrating to the patient to pay monthly and then have to cough up more money for medication, an unexpected visit or an imaging scan. Depending on access to care, there can also be long wait times between vitis or imaging that are necessary to receive proper care.

So again, we ask the question, why is out of pocket cheaper than paying through insurance? Well, providers know that when they offer an out of pocket price to a patient they will get reimbursed fully for the high quality of service that they are providing. Secondly, they will get paid in a timely manner versus having to wait for a scheduled reimbursement from an insurance company. For the patient, it may be beneficial if they are not going to reach their deductible or they need services in a timely manner. 

The out-of-pocket/cash pay healthcare field is growing and more and more places are offering this as a first option. It is a great idea to continue to learn more about your options and ask the clinic that you are at to see what their out-of-pocket pricing is the next time you need to see a medical professional. It’s almost like a Black Friday deal on a medical visit! 

-Dr. Amanda