Two readers of the blog commented on separate posts over the weekend, thanks to both!
More importantly, they did what I was hoping people would do – provide more information that can hopefully be of help to other self-pay patients! One thing that I know is that there are a huge number of options available to the uninsured or those with high deductibles seeking health care services, and the best way this blog can be an effective resource to self-pay patients is if readers share their own experiences for others to read about as well.
The first comment is from an old friend of mine from the Health Benefits Reform discussion group that I’ve been part of for nearly a decade, Richard Matthews. He writes in with the following suggestions for self-pay patients:
…For years prior to my arrival on Medicare, I had a high deductible health plan and HSA. My personal physician is cash only and I have regular need of prescriptions and lab work.
For prescriptions I have used BidRx. They provide an online “reverse eBay” solution – one provide the prescription parameters and then open a 72 hour bid among pharmacies throughout the country. The real savings in on generics of course, since that is where the highest markups are. Once you select the winning bid, you provide the pharmacy with a fax copy of the Rx and they mail the meds to you (shipping costs included in the bid)…
For labs, I am aware of two services. The one I use is Direct Labs and again this is an online solution. You go online and choose the labs you need to have done and one of the Direct Lab physicians writes the order. You take the order to a Lab Corp facility and YOU receive the results – NOT your physician. Typically it takes 24 to 48 hours for you to receive the results. Of course it makes sense to be certain that your physician sees the results (especially if they requested that you have labs done), but the key is that YOU get the results before they do and you don’t have to wait for them to call you a week or two later with same.
I’m not sure but I think Richard may have accidentally used the name of the second lab service in place of the one he uses when he referenced Lab Corp, short for Laboratory Corporation of America. Either company is a great option for self-pay patients needing lab work, as both of these companies are very friendly to those paying cash.
The second commenter prefers to remain anonymous, but made some excellent points and suggestions as well:
I am a “self-pay” patient… I was a public employee and got excellent benefits through PacificCare that cost me all of $27 a month. When I quit public service my COBRA payments jumped to $384 per month, and that was back in 1995. After my COBRA ran out I had no insurance at all due to pre-existing conditions like Type II diabetes and other minor issues that I treat with diet, exercise and medication…
Ever since I have paid for my own health care, and I’ve been moderately successful in negotiating good rates because I’m willing (and able for now) to pay cold, hard cash for service.
In one case I suffered a kidney stone attack that required a visit to the ER. They did a CAT scan but when I got the bill it was for TWO CAT scans, one for the “upper abdomen” and one for the “lower abdomen/pelvis.” I reviewed the scan, which was actually one continuous scan, and objected to the $6000 bill for “windowing” the scan into two different films when a simple shift of the film window on printout by less than two inches up (for the LA/P shot) would have covered everything they needed to see in one image.
I talked to the billing department when I got the bill and used the words “fraud”, “medical ethics board” and “consumer protection department” liberally and they not only took off the bogus $3000 charge, they reduced the entire bill to 45% of its original amount because I slapped greenbacks down on the desk.
Three important lessons jump out of these comments.
First, a big part of keeping your health care expenses in check is by taking responsibility for your own health and including diet and exercise in your life. This is especially crucial for those with chronic diseases like diabetes.
Second, always review your medical bills closely! This commenter found that the hospital tried to effectively bill him for two medical scans when in truth they only performed one. Lots of hospitals and other medical providers have people and policies that are there to maximize bills submitted to insurers by doing exactly the sorts of things that this hospital tried to do, billing a single scan as two separate scans. Needless to say this can leave self-pay patients with a bigger bill than is justified!
Third, and perhaps most importantly, don’t just accept the prices listed by the hospital on the bill! In almost every case, those bills are wildly inflated “chargemaster” prices, which hospitals typically “discount” by 50%, 75%, even 90% or more for insurers. By offering to pay cash, you can often get a hospital or other provider to give you the same or an even lower rate than what the insurance companies pay.
Thanks again to Richard and our unnamed commenter for sharing their experiences and advice, and please keep the comments coming! If you’d prefer to share a story or experience with me privately, feel free to send me an e-mail at firstname.lastname@example.org.