Most options for the uninsured self-pay patient involve going out on their own and finding healthcare providers willing and able to treat them fairly and give them a real price. While there are a multitude of tools that can help them to do that (MediBid comes to mind, an online services that allows you to list your medical treatment needed and providers bid on it), there generally hasn’t been much in the way of an organized community of self-pay patients working within a defined network of providers similar to what health insurers put together.
That appears to have changed, at least in Nevada. National Public Radio reports:
Shelley Toreson, who lives near Reno, Nev., had health insurance for years — but not anymore. Instead, she is part of an unusual Nevada nonprofit that helps connect 12,000 uninsured residents to doctors and hospitals that are willing to accept a lower, negotiated fee for their services…
…instead, the 62-year-old signed up with the Access to Healthcare Network, a medical discount plan that helps uninsured residents with low and moderate incomes get care from 2,000 providers around the state. In addition to the provider charges, members also pay $35 a month to the network. That fee buys them ongoing help in finding providers and navigating complicated medical bills.
Toreson says that now that she has signed on with Access to Healthcare, she knows the cost of a mammogram or other procedure upfront, so the charges for her medical care no longer catch her off guard…
“I started by asking the hospitals for the [discounted] rates,” recalls [Access to Healthcare founder Sherri] Rice, who now serves as the network’s CEO. “I asked the uninsured to pay cash at the time of service plus a membership fee. I asked the providers to lower their rates. I asked the government to put money in to help sustain the network…”
“Our rules are very strict for our members,” she says. There’s a swift and straightforward penalty for any member who doesn’t pay a medical bill, or who is a no-show at a medical appointment more than once without calling to cancel. “I kick them out of this network,” Rice says, “and they can’t ever come back.”
It’s hard to say whether this sort of nonprofit could translate easily into another state or region, in part because the prices for healthcare services charged to self-pay patients apparently don’t actually cover the cost of the services provided, according to the story.
But it’s not to difficult to envision a community of self-pay patients organizing themselves and developing what in the insurance world would be called a network of providers who agree to give self-pay patients a real price that reflects the cost of services rendered as well as the benefit of not having to deal with the bureaucratic insurance reimbursement system. In the past some cash-only doctors have attempted to organize into a network under the SimpleCare banner, although I’m not sure if that is still actively maintained.
The medical discount network in Nevada is worth keeping an eye on, and considering whether something like it might be an option elsewhere in the country. As the linked story below demonstrates, at least one community in Georgia is considering replicating the program.