Posted by admin | Posted in Self Pay Resources | Posted on 28-02-2014
Whether you have health insurance or not, you may find that you are asked to pay for some procedures in advance, or at least a percentage of it. This used to be something that self pay patients had exclusive rights to, but now with Obamacare policies having such high deductibles, more and more hospitals are asking patients with insurance to prepay a portion of a major surgery or procedure knowing that huge deductible exists and there’s a risk of the hospital not being paid the remainder. Self pay patients have known this for a long time, and have worked with the system accordingly. Those who are members of a healthcare sharing ministry are considered self-pay, so they also sometimes have to prepay and if you’re relatively new to the ministry that may be an adjustment (although not a hard one as I will demonstrate).
How do you handle this?
First of all, I don’t suggest being angry or combative. Think of it from the hospital’s point of view (or the doctor’s since he/she is a person and the hospital is an entity). They are looking at you wondering if you are going to pay them for the services they are being asked to provide. It’s reasonable to assume that with either a high deductible or no insurance, you could be a payment risk. They want to treat their patients and get them the services they need, but doctors also need to feed their own families and pay their own mortgages. Healthcare isn’t a free system, real people work within that system and have families. By realizing this request is realistic and reasonable it can strip away some of the anger or shock.
Second, have a friendly conversation with the billing department to find out how much the procedure will cost and what minimum amount they want paid up front. If you are a self pay patient (such as a member of Samaritan Ministries) ask them what the self pay discount is. If you don’t feel the discount is enough, remind them you are reducing their paperwork load by removing the insurance headaches they would normally deal with and you will likely pay the balance faster than any insurance company would. Hospitals have huge overhead dealing with insurance companies, they should reward the cash patient for saving them the time. You may be able to get a bigger discount if you offer to pay more up front, with the balance soon after. Each provider will be a little different, but don’t be afraid to ask for the discount and don’t back down if they try to stick with a full chargemaster price. Use healthcarebluebook.com and pricing from a cash only medical facility (like the surgery center of OK) to get reference numbers for what a fair price is. Even though you may be nervous about this conversation it’s one you must have. You will likely find that the people you are talking to are friendly humans, too, and your discount will save you thousands of dollars. That’s worth asking a question or two. Whenever I have mentioned I’m self pay I get a couple of raised eyebrows, but stating that Obamacare was too expensive for the low value it offered and was too big for our budget garners great sympathy (understanding and agreement, too). That leads to a discussion about Samaritan and how we are actually better “covered” by being self-pay and relying on the ministry. Everyone in medical billing is dealing with the issues related to Obamacare, and that sympathy can go a long ways.
If the billing department isn’t willing to work with you, point out that the ACA exempts you from being required to have health insurance by being a member of a healthcare sharing ministry. The provider is required to provide you with reasonable options for treatment and payment. You are offering to give them a good faith prepayment, but you would like a similar consideration with a discount at least matching what they give the insurance company, more would be better (depending on the rates you find from those other sources). If you live in a more metro area or are willing to travel a reasonable distance you should price around to other facilities to get comparison quotes. Hospitals will assume you haven’t done your homework and try to overbill. Don’t let them make you a billing victim. 🙂 If necessary, speak with a supervisor.
Most people find they get even bigger discounts than they had hoped for. Hospitals don’t want headaches, they want to be paid for their services and the uninsured and underinsured tend to leave them holding the bag; they are usually uninsured or underinsured for a reason and ability to pay often isn’t there. As a member of Samaritan Ministries you do have the resources to pay thanks to fellow members. You can help them understand by explaining Samaritan’s payment process, give them solid timelines, and prepay a portion on your credit card or from savings. If you have a good credit history with the hospital point that out. They need to remember you are someone who has paid in the past and will pay again. You just want a fair price and a fair timeline.
Once your shares come in from Samaritan members you will pay off the balance of the hospital bill and pay yourself back for the prepayment portion you did.
Overall this process is methodical and once you’ve done it you realize it’s absolutely your right to ask for a better deal. The mystery surrounding healthcare pricing needs to go away. But it won’t happen until patients step up and ask what something costs and why the price is so high.
I recently learned of a fellow Samaritan member who has a child needing surgery, something another of their children had gone through a couple years before when they had a regular insurance plan. For this child’s surgery she is now a Samaritan Member and she got a huge self pay discount (something like 70%) and the amount she was left to pay basically matched the left over amount they paid out of pocket after their former insurance had covered everything. Think about that. Insurance didn’t help them with that first surgery. Insurance paid an inflated rate, and stuck them with thousands in out of pocket expenses (lets say $6000). Now she’s being quoted the same $6000 after discounts, and Samaritan members are going to share that entire amount with her ($300 responsibility is now gone since her discounts were way over $300). She will be left with basically ZERO to pay out of pocket and she’s a self pay/uninsured patient with the backing of a membership in Samaritan Ministries. Which would you rather be?