Telling the doctor you are self/cash pay


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Maybe you’re nervous about how to tell the doctor’s office you are self pay. This could be a new experience for you and you want to know how to handle it and what to expect. My experience so far is that it hasn’t been hard at all. I’ve found that any concerns I had were unnecessary and all in my head.

Receptionist: “I need to see your insurance card.”

You: “I don’t have insurance, I pay cash. Do you have a cash pay discount?” (you could even edit this to say, “I am paying cash today, do you have a cash pay discount?”)

Receptionist (smiling): “yes, we offer XX% off for cash pay and we would like payment today.” So far every single one has seemed almost relieved, and certainly very friendly about our cash pay status. (cash doesn’t have to be greenbacks, they usually take check/credit card)

At one office I didn’t even have to ask for the discount, she offered it immediately when I told her we didn’t have insurance. Others will make you ask for it. Definitely ask.

I’ve never had insurance for dental, and had vision coverage only for a few years. I got quite used to telling those places that I was paying cash and got my discount, either paying with check or credit card depending on the bill size. The type of office I’m entering shouldn’t matter for my comfort level about saying “I don’t have insurance…”, in fact there is one theme I have found that makes the conversation even easier. Obamacare.

When I’m at the doctor’s office and especially if they initially raise an eyebrow at my non-insurance status then I add:

Me: “I didn’t want anything to do with the Obamacare mess, and  the premiums were way too high for the terrible plan they offered. We got smarter with our money and joined something even better.”

Those two sentences have opened up the floodgates to a great conversation about Samaritan, health care sharing ministries, and the ease and speed with which we can get our bills paid. I’ve spoken about it to nurses, doctors and billing people. I tested the waters before we joined Samaritan because I wanted to know how this would work in my real life environment. It went beautifully! The nurses were initially surprised, but when I explained my story, one of them said, “well then you are covered, just in a better way.”  The staff at these clinics seem to hate insurance nightmares as much as I do, and love hearing about successful options. One of the billing people was so intrigued she took the information to share with her own family! Talk about a warm reception! 🙂 Every one of them agreed that people are being financially harmed and surprised by their terrible insurance plans, and knowing that we have a better solution in place made them smile. It was wonderful.

In a hospital setting the above conversation is generally had with a billing person instead of a receptionist. In an ER setting it could be with the nurse. They will ask for your insurance card and upon finding out you don’t have insurance may offer to get you financial assistance forms. You can proceed with that however you choose, but Samaritan doesn’t require you to sign up for any government or other financial assistance type program. We personally wouldn’t qualify most of the time for any of those, and I would simply tell them we wouldn’t qualify or don’t wish to signup for it. Some charity hospitals require their own internal financial form before giving a discount. Some of them may immediately jump to saying they require payment right away.

Me: “Of course, I’d be happy to talk to you about that. What is the minimum monthly amount I can pay to assure you that we are good for the bill until our Samaritan shares arrive in the next 2-3 months? What is your discount for self pay/cash pay patients?” — “Also, I’d like to get the full itemized bill sent to me as soon as you can, we would like to submit the bills to Samaritan as soon as possible so we can pay you even faster.”

When I checked with our local hospitals I was told they give a discount matching what they give to the insurance company (I think it varies depending on the procedure) and one had 90 days interest free with a small payment expected each month, while another one had 18 months interest free with payments required each month. I found out each hospital is a little different in how they handle cash pay, (some of them offer the discount, others wait for you to ask) but in all cases they had a plan and really just want to know they aren’t going to be short-changed. All I had to do was explain that we are good payers, we have a plan in place, and they would be paid quickly. What is their process for that situation? Conversations went well, smoothly and without any angst.

If you don’t feel like the discount is enough, for instance if they say they give a 10% discount and they confirm the discount for insurance companies is more, politely explain that you are saving them the tremendous headache of dealing with insurance, and your support system will allow you to pay them even faster than insurance would, (and lightyears faster than medicaid). Would they be willing to give you more than the 10%? Perhaps match insurance discount, or go even deeper? If they say no, we don’t have to be angry, but also don’t pay the bill in full on the spot. Samaritan will have Karis contact the hospital upon receipt of your bills and go for a deeper discount. We should always try to get something, but don’t turn it into a battle with the billing department. Be polite, gentle, firm in your reasoning and reaffirm your commitment to paying the bill quickly and in full. More about Karis and how they help us here.

It’s possible you won’t have those billing discussions until after the bills have been sent to you (instead of right away upon treatment), and those bills will be high, full rack rate most likely. (Don’t have a heart attack! That price is just the starting point and always remember that Samaritan members and Karis are in your corner.) If that happens call the hospital right away when you get the bill. Let them know you are self pay, explain how the timing of Samaritan works and politely ask for the discounts. If there are lots of bills you may find that some offices will offer to match what another one is offering. You may also be able to use one as leverage with another. “Well Mercy Hospital offered us a 40% discount if we pay within 90 days, would you be able to match that?” It can’t hurt, and many times you will get a “yes” response, or maybe “40% is too much, but we can do 30%.” It will all vary on the location. If they want payment right away, suggest a payment plan. If their monthly amount is too high for you, say, “I understand why you would want that much, but it’s simply more than we can do right now.” Explain again that Samaritan shares will be arriving in about 2-3 months, would they be ok if you paid $X as a good faith amount? And we will of course pay each month until our shares arrive. I saw it suggested to include a note with your payment thanking them for working with you and detailing your plan to pay. All the billing people want to know is that you’re good for the money and that they won’t have headaches. You are a good credit risk, a cash pay patient who will save them all the headaches of insurance companies so be proud and smile.

So the moral of this story is that you should hold your head high when you tell people you are cash pay and get comfortable with saying it. For one thing, how do they know you aren’t a millionaire? 🙂 For another, you have a network of 36,000+ families ready and waiting to help you, so there is no battle. Just support, friendliness and the ability to get the care you need. Be proud. You are doing something much smarter with your money and you’re spending it wisely without waste. And every conversation is a chance to share the joy of Samaritan with someone who may really need to hear it. Those billing people may have their own insurance nightmares and could be looking for exactly what you have. 🙂


Comments (3)

What happens when the doctor’s offices tells me they don’t accept Samaritan Ministries nor do they take self-paying patients. (I’ve not been to my GYN since 2004 and really don’t want to start over again with a new one even though I’d be considered a “new” paitient. Partly because I have no idea where to go. This is the only office I ever went to when I had my babies and the youngest is now 22.)

Hi Martha. That can happen, but it no longer seems to be that much of an issue given how expensive insurance has become, as people are becoming cash pay with or without ministry membership. Just like some insurance patients have to go somewhere else when their insurance plans are rejected or their doctors are now out-of-network, the same can happen in the cash world. At that point we must make a choice about affordability vs availability. Sometimes the system puts us in the position of making those difficult choices. I always recommend that people do a little scouting locally to see what their facility policies are regarding cash pay, payment plans, cash pricing, etc. If you already know your doctor don’t take cash patients I would suggest speaking directly with the doctor to tell him/her your situation as they often don’t know what the front office policies are, and they could even help get that changed for you. Not every location is familiar with how health care sharing plans work (although many do now), so sometimes explaining that process and showing them the membership card, website and flyers can help. Since ministry members are cash pay, none of them will accept Samaritan like an insurance option, because the bills have to be submitted by the member not by the clinic. So the only questions worth asking are related to their cash and payment plan policies. Around here it’s very common and many hospitals and clinics even post their cash policies online. If you get absolutely no help from your doctor’s office, then ask your doctor for a recommendation of another OBGYN, and ask area friends/family, too. There are usually very cash friendly options around, but it does sometimes require some scouting. I did my research before we joined the ministry because I don’t like surprises. 🙂 The only feedback I got was positive (and we live in a low choice area), but I know that isn’t always the case. If I hadn’t I would have kept asking around until I found that positive feedback because I simply cannot afford $2000 a month for high deductible insurance. Samaritan has saved us a fortune and it was worth doing a little legwork to get that savings. Samaritan also offers free medibid access to get quotes/bids on procedures (mammos, surgeries, etc) which may lead you to a good OBGYN option, as well as a free nurse help line and $25 doctor help line. Hopefully that helps a little, I wish you the best as you navigate your options. God bless!

As a side note, if you really dislike the idea of asking for discounts, you don’t have to. Samaritan is a loving supportive organization and they care about you. Needs of $1000 and higher will automatically be reviewed for discount potential by Karis and the discounts they obtain still count toward your $300 personal responsibility. The discounts benefit you and other members, because the whole group is required to pay less and money goes farther. But sometimes pushing for bigger discounts just isn’t in you. That’s ok. Other members may enjoy asking because they’ve learned how easily they are able to get big savings. You may be more motivated to ask during a preventative visit for a discount because you are 100% responsible for that cost, asking could save you money on the spot. Do what you are comfortable with, enjoy the process, and share your story. 🙂

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