How to Get the Best Possible Cash Pricing for Health Care

My family and I have had a few medical issues over the years – and I remember in each case how frustrating it was trying to get accurate pricing from the different health providers we were working with.

Fortunately, recent federal price transparency rules are finally starting to change that. The Healthcare Transparency Act and subsequent regulations now require hospitals to make their pricing for all medical procedures they provide public. This includes any discounts they provide to cash payers

What Is Cash Pay? 

A “cash pay” patient, or “self-pay” patient, is simply a patient who will be paying cash or the equivalent out of pocket for health services, rather than routing a claim through an insurance company.

Providers benefit because they don’t have to deal with bureaucratic delays or endless back-and-forth correspondence with an insurance company just to get paid on a claim – which could eventually get denied.

With cash pay patients, the provider knows they will get paid immediately, and with certainty, with no transaction costs other than maybe a credit card processing fee.

For this reason, most providers readily offer a cash discount on most services. For example, an American Medical Association study found that for routine obstetric care for cesarean delivery, 68.5% of hospitals set their cash price below the average negotiated price with insurance companies.

They have to put the information right on their websites, and make them easy for consumers to read.

That means consumers no longer have to operate in the dark. And hospitals finally have to compete for your business. Patients and hospitals are finally operating on a level playing field.

This article will explore how consumers can use these new rules to their advantage, and provide some tips for navigating the complex world of healthcare pricing.

Start a Health Savings Account (HSA) and fund it. 

 We’re huge believers in HSAs – a powerful tax-advantaged savings account that lets you save and pay for healthcare with tax free dollars – at any provider you choose. You aren’t limited to your insurance company’s chosen “in network providers.” 

This means you are free to shop around with any and all providers who offer the medical services or procedures you need. 

This is a powerful negotiating advantage: When you’re paying with an HSA, providers immediately know that you aren’t captive to whatever price they quote you. You can take your money and walk away to a provider who treats you better and offers you a better value.

Learn how to start and fund your own HSA

Check the Hospital’s Website for Pricing Information

 The new Hospital Price Transparency Final Rule is already in effect. Under this rule, hospitals must provide prices for all items and services provided by the hospital, including drugs, supplies, and diagnostic tests.

In theory, this makes it possible to compare pricing at multiple different hospitals and other providers in your area.

Unfortunately, you may have to work at it. That’s because hospitals have been dragging their feet on compliance with the new law.

In other cases, hospitals have been making the information difficult for consumers to find. They do this by hiding their data from search engine results, or by requiring you to click through multiple links to find their price disclosures, slowing down your search. Some require you to download a multi-gigabyte file to view their pricing information.

And in some cases, they’ve failed to post the information at all. A February 2023 report from Patients Rights Advocate found that 75% of large hospital systems are still not fully compliant with the Healthcare Transparency Act and Final Rule. And 116 hospitals (5.8%) did not post any usable pricing information at all, and were in total noncompliance. 

What to do if your hospital doesn’t disclose

Contact the chargemaster’s office at your hospital. That’s the office in charge of pricing and billing. They should be able to direct you to the exact page you’re looking for on the website, along with all the rest of that hospital’s pricing data. 

Alternatively, you can get pricing data from sites like Healthcare Blue Book and Fair Health.  

If you’re a healthsharing plan member, your healthsharing organization’s concierge department can also be a valuable resource. They have access to their negotiated pricing at thousands of hospitals across the United States.

Get a quote before receiving care

Until recently, “surprise billing” was routine: patients often thought they had settled their hospital balance in full – only to get another bill from physicians or outside providers.

Today, hospitals are required to provide patients with a price estimate upon request. This estimate should include the amount that the hospital is charging for each item or service, as well as the estimated amount that your insurance will pay. 

Asking for a price estimate before receiving care can also give you an opportunity to shop around and compare prices between different hospitals and providers. It also preserves your bargaining power: you have much more walk-away power before you have the procedure done than afterwards.

For the best results, try to find out the specific Common Procedural Billing Code for the procedure you’re interested in.

Reduce the potential for billing surprises by asking about physicians’ charges as well as hospital charges. For example, you can ask, “Will there be any additional charges for reading or interpreting the MRI, X-Ray, or lab results? Will there be any bills from outside labs or technicians from you or from anyone else?”

Also be sure the hospital chargemaster includes estimated costs for follow-up care and outpatient visits, as well.

That way, you can do an apples-to-apples comparison across multiple providers – and limit the possibility of getting hit with a surprise medical bill after you have the procedure done. 

Negotiate with the Hospital

Most providers are willing to provide a handsome discount for cash payers. 

According to a study from Patients Rights Advocate, cash prices reported by hospitals are lower than the highest insurer-negotiated price 87% of the time, and lower than most major insurers’ negotiated prices 55% of the time.

Multiple studies confirm the Patients Rights Advocate findings. 

This means that you may be able to save money by negotiating directly with the hospital as a cash-pay patient. 

Be sure to ask for the hospital’s best price for cash-pay or self-pay patients. You probably won’t get the discount unless you ask for it specifically.

Manufacturer’s Coupons and Patient Assistance Programs

If you’re uninsured or underinsured and cannot afford your medication, there are various drug assistance programs (PAPs) offered by pharmaceutical companies, non-profit organizations, and state programs that provide assistance accessing free or low-cost medicines or other treatments.

Use a manufacturer coupon or patient assistance programs for prescription drugs or medical equipment. Some manufacturers offer programs that can help you afford your prescription or medical equipment.

Here is a list of state pharmaceutical assistance programs.

Condition-specific organizations like the American Cancer Society or the American Lung Foundation can also help by connecting you with patient assistance programs and other support programs. They are a great place to start if you are diagnosed with a debilitating or chronic condition. 

Enroll in a Healthsharing Plan

Healthsharing plans are affordable alternatives to traditional health insurance policies. 

Among their advantages is that with health share plans, you can present yourself as a self-pay patient, and ask for a cash discount on the entire procedure. 

Some healthcare providers offer discounts to cash payers as an incentive to pay upfront and avoid the administrative and processing costs associated with insurance payments. The amount of the discount can vary, but it is not uncommon for providers to offer discounts of 10% or more for cash payments.

Also, since healthsharing plans typically do not impose narrow provider networks, but allow you to use your health sharing plan at any provider in the United States, you have complete freedom to shop around, and get the best pricing possible.

Learn more about healthsharing plans.

Note: While most healthsharing plans don’t support HSAs (meaning that you can’t make new contributions to HSAs while enrolled in anything other than a high deductible health plan (HDHP), there’s one notable exception: tThe HSA SECURE plan.

This unique and innovative healthsharing plan is specifically designed to provide the cost savings of a healthshare plan while still preserving your eligibility to make tax-advantaged HSA contributions.

However, you must be a business owner, independent contractor, or have self-employed income to be eligible to enroll. 

Learn more about HSA Secure. 

Take Advantage of Your Healthsharing Plan’s Concierge Program

Most healthsharing organizations have a team of professionals with access to a lot of price and quality information that is not generally available to the public. 

They can help you locate great providers who offer superior value. They can also often help you negotiate a better deal on healthcare than you could negotiate on your own.

So take advantage of them!

These are just a few of the ways patients are asserting new-found negotiating power in this new era of increased price transparency and information. But to get the most value for your healthcare dollar, you’ve got to put in some work, as well.

That’s why it’s important to educate yourself (by reading the HSA for America blog, of course!) and to become an informed healthcare consumer and advocate for yourself and your family. 

Click here to schedule an appointment, or call 800-913-0172 to get started.    

To your health and wealth,

Wiley P. Long, III
President - HSA for America

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