The Affordable Care Act mandated that most Americans carry health insurance. Although many more people have purchased insurance or applied for Medicaid programs, others have asked their doctors and hospitals if they can pay in cash. Without the insurance companies involved, there are benefits to both medical providers and patients who pay at the time of service. However, the pay-as-you go system is not without risk when emergencies pop up. Health insurance companies have instituted higher deductible plans to encourage their members to reduce their overall health care expenses. Deductible and co-insurance plans force the subscriber to be aware of the costs of health care, especially tests and procedures.ìThe days of the neat $200 co-pays seem to be waning,î said Sheri Lasater, director of revenue cycle for Penrose St Francis hospitals in Colorado Springs, Colorado. ìThey do still exist, but those plans come with higher premiums.îHospitals and doctors aren’t seeing an increase in uninsured patients or people opting to pay the fine for not having insurance, but they are getting more questions about the option to pay cash for services, despite having insurance. ìWe do have folks that are interested in finding out how much we charge for services (to find out) if they can afford to pay out of pocket and not use insurance,î Lasater said. ìThey have varied reasons. Technically, everyone is supposed to be insured, but that’s not a mandate that people are adhering to 100 percent of the time.îEven if a patient has medical insurance, they might ask to pay their doctor directly without involving insurance companies, especially if they don’t expect to meet their deductible during the plan year. ìWith insurances trending toward reducing benefits, increasing deductibles and reducing physician reimbursement, there is a growing trend of patients electing for cheaper, higher deductible plans; and physicians discontinuing insurance contracts,î said Dr. Jared Heathman, a psychiatrist from Cypress, Texas. ìHigh deductible plans have a lower monthly premium, which may be more cost effective with a limited number of physician visits per month, even when paying 100 percent out of pocket.îPatients paying cash up-front for service can sometimes negotiate rates similar to or better than their out-of-pocket expenses if they used their insurance. ìMany people pay cash because they’re less expensive than their co-pays, and another reason is their deductible is so high that they will never meet it,î said Dr. Mandi Miedema, chiropractor at Rock Solid Chiropractic in Falcon.The co-insurance and deductibles of new insurance plans can be a surprise for members who might have had low co-pay plans in the past. ìI don’t think we’ve seen a trend of more uninsured,î Lasater said. ìWe’ve seen a trend of people becoming insured and then struggling with the high deductibles.îWhether the cash price is better or worse than the negotiated insurance rate depends on the insurance provider, Miedema said. ìActually, with a lot of them, the contracted rates are lower than our cash payment rate, so the patient will put it towards the deductible because our in-network rate is lower,î she said. ìOn the flip side, there are some that are higher priced than the cash rate. Then the decision is theirs if they want to apply it to their deductible or skip the insurance company.îCash-paying patients also benefit the doctors and facilities. The insurance companies’ reimbursement rate to doctors and providers is sometimes less than the doctor’s cost to treat the patient. ìSometimes, we’re technically paying the patient to come into the office,î Miedema said. ìPeople pay a lot of money for their insurance, so you want them to be able to use the benefits, and we want to be available for those patients. But if we’re losing money to see a patient, we have to drop the contracts.îA large amount of paperwork, phone calls and troubleshooting goes into collecting even routine payments from insurance companies, Miedema said. ìFifty percent of the time, my billing person has to call and go through the unbelievable number of insurance company mistakes,î she said.Negotiating time-of-service payment options allows patients to use providers that aren’t in-network with their insurance company. ìIf you’re uninsured, you may need to shop around on price and compare facilities,î Lasater said. ìIf you can afford to pay, you can choose your provider. When you have an insurance plan, you’re given a narrow network.îLaboratories and diagnostic imaging companies are seeing this comparison shopping trend as a way to increase market share. ìAs consumers realize the hospital may be the most expensive place to get a lab test or X-ray, they’ll start to research the costs of the services at other outpatient facilities,î said Dr. Jonathan Kaplan, a plastic surgeon who created BuildMyBod Health. Kaplan practices in San Francisco, and his online marketplace is designed to help patients and doctors connect to negotiate pricing for non-surgical services.Centura Health, parent organization for Penrose St. Francis, lists the estimated costs for about 65 of the most common procedures on the http://centura.org website, Lasater said.Health care providers can also help patients by making sure they are aware of all the programs available to them, rather than just negotiate a cash payment rate, Lasater said. ìWhen we are aware that a patient is uninsured, it is our hope to help them find insurance or apply for a program that they may not realize they’re able to apply for,î Lasater said. ìSometimes we find that people qualify for Medicaid and do not know it.îBudgeting for routine care and negotiating payment at the time of service still leaves patients open to significant financial risks. ìWith any procedure there could be complications,î Lasater said. ìAnd some other kind of emergency can happen. If someone is seen in the ER it’s not something they were planning and budgeting for.îEven if paying for routine or expected care out of pocket makes financial sense rather than paying for mandated insurance, people shouldn’t plan on being able to pay for unexpected or emergency care, Lasater said. ìPeople need to think about the what-ifs. That’s why we have insurance.î
