How to Handle Paying for Medical Care Up Front


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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 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?

Using the Health Care Blue Book


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I should probably create a separate static page for this information, but for now I’ll just do a blog post. Are you aware of the It’s a great site for figuring out fair pricing for medical procedures. I had no idea something like this even existed before I become a Samaritan Ministries member. You can search out various procedures in your area, by zip code, and it will spit out a price based on what providers in your area are accepting as full payment from insurance companies for those services. This is useful because if you call for a quote of a non-emergency procedure and it varies a lot from what is listed at you can begin the conversion about the discrepancy.  Why should you pay more than what insurance is paying? The hospital agreed that the insurance price was acceptable payment, so you should at least get that rate, if not better (for saving them the hassle of dealing with insurance paperwork and paying them faster).

I spot checked a few procedures that I had already asked the hospital billing department about just because I was curious. For most of them the pricing was pretty close to what I was quoted (because our hospital gives self-pay patients the same discount that insurance gets if you ask for it), with the exception of the colonoscopy quote. That one is off by $2000. HCBB says it should be just over $1500 for everything (outpatient, no complications, no biopsy) including facility fee, doctor, and anesthesia. However the hospital quoted me a typical price of $3500. That’s crazy different and $3500 is pretty high from what I’m hearing about other quotes around the country. I haven’t revisited this with our hospital yet, but I plan to before scheduling that procedure. I may have to travel elsewhere.

Pointing the billing staff toward HCBB is something that may help explain why we ask for certain pricing on procedures which is often much lower than their chargemaster rate. Being an empowered patient means we have choices about how we spend our money (non emergency) and we should not be taken advantage of. We also want to pay a fair price for the services received as these doctors, nurses and other staff work very hard and should be paid fairly for it. Getting off scott free should not be the goal. Fair pricing is the goal, and we should handle ourselves accordingly. Gentle, but firm.

So shop around, ask questions, don’t be afraid to push for a fair price. This will take some getting used to if you are used to just accepting whatever bill you get. Whether you have insurance or not you should get in the habit of asking what it costs. Because even with insurance you can be stuck with a very high bill and being aware of the charges makes you that much more prepared.

Before finding I wouldn’t have had a clue what a fair price is for any given procedure. (Since I like to think in 1980’s pricing I’m sure everything would sound high to me.) By having that website as a resource I have a good knowledge base and won’t have to feel like an idiot or a pushover when speaking with the billing department.

January Growth is Largest Yet


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Samaritan’s membership growth during the month of January is their largest yet, about 2 1/3 times larger than Decembers from what I can tell. The rollout of the ACA and resulting loss of affordable insurance plans as of January 1 is probably what drove a lot of people to look for other options, not to mention those who absolutely refuse to pay for abortions. As a fellow member I’m so glad these people were able to find a solution with a health care sharing ministry.

I feel so blessed every day to be a part of this ministry. The relief at knowing we aren’t contributing to abortion coverage, we’re avoiding the dangerous ACA website, we know exactly where our monthly share goes each month and what it’s specifically for, and praying for the health of fellow members is all so rewarding. There are also the many financial rewards. Every day I read another review of a member who had their need fully paid for through member shares. They routinely talk about the blessings of cards and prayers, in addition to checks in the mail. They talk about getting discounts on their bills and the satisfaction of paying everything in full within a couple of months of submitting their bills.  Samaritan membership covers both a practical need and offers tremendous spiritual benefits, the likes of which I didn’t know existed outside the traditional insurance realm. I wish we had known about this sooner, but I’m also so grateful to know about it now. Thanks be to God.