As a Samaritan Ministries member, you’re a cash-pay patient. If you previously had health insurance, that means you need to learn a different way of navigating the health care world.When my wife, Lynn, and I joined Samaritan, I started putting my experience as a hospital billing and patient account auditor to work. I’d like to share what I discovered, in the hope that you’ll find something to help you.First, I started gathering information on direct primary care practices, even before there was one available in our area. Every month I searched the direct pay sites for a local DPC physician, and one month there finally was one.Direct Primary Care was a significant change for my wife, but after we interviewed the doctor, she was on board. Now we have a doctor working for us, not a third party, with whom we can discuss price and quality.
We find the DPC membership to be well worth it for the unlimited access to the doctor, and it also results in savings on services our DPC can provide or connect us to. Our DPC doctor has found us hundreds of dollars in savings on imaging services, prescriptions, and routine procedures.
Over time I have developed a process for finding health care at the best price.
For outpatient and orthopedic surgeries, I go to the Surgery Center of Oklahoma website (surgerycenterok.com) and use their pricing tool to find out what the true cash price would be.
I also use Healthcare Bluebook (healthcarebluebook.com) and search for the price of a procedure in my ZIP code. Healthcare Bluebook then provides me with what the hospital would receive if I had insurance. This is good gauge of the “retail price.”
I open a search using Medibid (which members can access inside the Samaritan Dashboard) to see if any local cash providers would be lower than the Healthcare Bluebook price.
Finally, I have been calling hospitals in my area to see what their price estimate would be for a procedure, telling them that I do not have insurance and also asking what their cash discount percentage would be.
I followed this process in 2015 when I needed a routine outpatient procedure. I was able to get the procedure, originally priced at over $31,000 at the highest priced hospital, performed locally for $5,300 after discounts.
Shortly after this need, I decided to call all the hospitals in Kansas City and capture their cash-pay discounts in a spreadsheet. It was an eye-opening experience as I documented discounts as low as 25 percent and all the way up to 75 percent. I also was able to get some information about average prices from a consulting company, so the spreadsheet shows the effect of average prices combined with the cash-pay discount and ultimately the best value for the Samaritan members that will be sharing in our burden.
Knowing ahead of time what a hospital’s cash discount is allows you to have a more honest conversation with the folks in registration. I tell them I am a cash-pay patient and ask them to confirm that their cash discount is X percent. They usually don’t have a script for someone who says they are cash-pay, so then we can have a conversation about how I will be paying the bill.
Some providers are very receptive to cash-pay patients, seeing them as a new market, and some are not. We are certainly seeing it in Kansas City, where three different health systems offer cash discounts of 70 percent or more for cash payers.
Because of the fallout from the Affordable Care Act—plans with high deductibles and other out-of-pocket costs—hospitals are actually having to learn more how to deal with cash payment from many of their patients.
In fact, hospitals are seeing patients presenting at registration and claiming to have no insurance, when they actually have a high-deductible plan, because the word on the street is that if you tell the hospital you have no insurance, you’re potentially going to get a better price. If you tell the hospital you have a high-deductible plan they won’t give you a cash-pay discount and you’re going to wind up owing a big dollar amount for your deductible.
In general, the more progressive organizations and the organizations that face a lot of competition in their markets are more open and receptive to larger cash discounts. Smaller markets, not so much.
Keep in mind that in the hospital industry, those who are “self-pay” are often viewed as the population that doesn’t pay their bills. That’s why it’s a good idea to start by presenting yourself as a “cash-pay” patient.
I encourage Samaritan members to shop around for good health care prices and discounts, and, if possible, to do it before medical care is needed. That was something Lynn asked me to do before we joined Samaritan, because she wanted to be sure where we would go and how we would pay in the case of an emergency.
It was a good exercise to go through. At first we were concerned about how we were going to handle payment to providers. Now we are both very comfortable being part of the Samaritan family.
Ron Drummond is a member of the Samaritan Ministries Board of Directors and also is an auditor for hospital billing and patient accounts systems. He lives with his wife, Lynn, near Kansas City.