Hospitals posting their cash discount policies online


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Here are some of my favorite examples of hospitals that have clearly stated their discount policies online.

1.  — Union Hospital in Dover, OH

Look at their rates. 30% discount for self pay, PLUS another 20% if you pay same day (like for tests), or 15% discount if paid within 30 days. So you could get a 45-50% discount straight off the bat, that’s incredible. No questioning or wondering what they’ll offer, it’s right there for all to see.

2.  — Huntington Hospital, Pasadena, CA

This place will charge 110% of medicare pricing for inpatient costs, which means 10% over whatever medicare would reimburse them for. That’s impressive, because medicare reimbursement rates are low, too low sometimes.  For outpatient costs they will charge 35% of expected costs, which means effectively a 65% discount if I’m reading that correctly. To offer such a huge discount for cash patients probably means their chargemaster rates are super high, but hey, we’ll take it!

3. — St Joseph Hospital, Orange, CA

Short and sweet, cash patients get 45% off without even blinking. No forms to fill out. Just 45% off with an additional 10% for prompt pay.

None of the discounts shown above are based on income. Most hospitals have sliding scales based on your income and it’s relationship to the federal poverty level. Earlier I had found a hospital that promised discounts if your income was 700% above federal poverty levels. That means a family of 4 could earn over $100,000 a year and STILL get a discount based on income and it had nothing to do with joining medicaid.

I wish more hospitals would publish their self pay discounts and policies online. It would be so helpful when researching and also make the conversations with billing that much easier. Rest assured, your area hospital has a plan for cash patients, you will just have to ask. And there’s no problem with asking, and even asking for more. Use these hospitals as an example. 110% of medicare pricing? 65% off? Granted not all hospitals start at the same price point so it’s all kind of relative, but that 110% of medicare offer is pretty clear cut. I would take that in a heartbeat.

If your hospital is this transparent with their self pay policies, please post a comment about them here. I’d love to develop a good list that members could reference as examples.

Looking for (and finding) Pricing Transparency in Medicine


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As a Samaritan Member I am motivated to find my medical services at a fair price, because ultimately I am responsible for the bills, and while Samaritan members will share in that cost I certainly don’t want them to overpay. I have mentioned in other posts about asking for self pay/cash pay discounts, but how do we find out what a procedure is going to cost in advance? Obviously this doesn’t work in an emergency situation, but for scheduled procedures we should be able to find out pricing, in fact we should really WANT to know what it costs. I’m still baffled that health care is about the only service I can think of which is purchased without any idea of the costs. I can’t think of any other product or service that is purchased or contracted for without first asking, “and what is the cost?” or “Can I have a quote?” — in medicine we are often hit with partial answers, half truths, and “we don’t know what it will cost until we’re done.”

It is beginning to get a little easier to find out in advance what something should cost and will cost.

One method is using the healthcare blue book, which I’ve touched on in an earlier post. That website will show you the zip code specific pricing that hospitals are accepting for payment from insurance companies. Really there’s no reason the cash pay patient should pay over those prices, but I’m sure it happens all the time. we should reference the healthcare bluebook when quotes are high, but I can see how the billing person could try to excuse away the information. Another reference should be other hospitals. But how do we know what other hospitals charge for something?

While it’s not always possible to get pricing for a specific hospital, there are some out there posting their prices online. My favorite is the surgery center of Oklahoma, and now I’m learning that several other facilities in Oklahoma City have followed suit due to that competitive pressure.

Some of them are:

Also, you can do a search on google for “hospital pricing estimator” or some variation of that, and come up with a bunch of hospitals that have started posting their prices online. You may have to do a little digging on each website to find it, but I picked out a few and found a wide range of prices for identical procedures. The most accurate way to find out pricing is to be sure you’re search by the CPT codes. These are the billing codes used by medical facilities in order to track billing and bill insurance companies. Every procedure has a code. Some require multiple codes because of the way procedures are broken down into various steps. If you are needing a procedure soon, be sure to ask your doctor what the CPT code is so you can correctly hunt for pricing info. Also ask if multiple codes are common for the procedure you’re needing so nothing is left out. This works for tests, screenings, surgeries, anything you can think of.

Once you’ve looked up the published prices for hospitals in your area, (or called them), then you can start asking the tough questions to the hospital. “You are stating that your price for a gallbladder removal, CPT code 47562 or 47563, is $15,476. But I see that the surgery center of Oklahoma offers the exact same procedure for $5865. Would you be willing to match their price?” — If you factor in the price of  plane ticket ($400) and a couple night hotel room ($300), you would be fairly even if you negotiated your cost down to about $6500. If you are willing to travel and your local hospital isn’t willing to budge, then take a trip and save a fortune.

I believe it is our responsibility as patients to make these providers explain their prices. A huge problem in the medical world is they make more by being wasteful with time and supplies. They are motivated to take longer and use more products in order to bill you more. They are not motivated to reduce waste or be efficient (not all of them do this, but it’s definitely a problem at some locations). Of course we still demand high quality, but better quality doesn’t have to mean being wasteful. Insurance companies do not help the problem. They are not motivated to reduce costs, as they like being able to convince customers of how much money they saved. But if the procedure cost $10,000 (inflated), and your after insurance cost is $3000, but really the hospital would have made a healthy profit charging only $2500, you actually came out worse by having insurance “negotiate” a rate for you.

As a member of SMI, I am considered self pay which means I can freely negotiate my pricing without worrying about insurance contracts. I can actually get BETTER deals than insurance company rates. Especially if I’m willing to pay quickly. I wouldn’t pay sticker price for a car, I never do. We are expected to haggle over a car’s price, and the better educated we are about what the car should cost, the more likely we are to get the price we want. Health care shouldn’t be any different, and slowly but surely we will change the model. It starts with us. We must be educated, informed and we will not back down. If we are being overcharged for something we can take our business elsewhere. At first I thought finding out this information would be really hard (sometimes it’s tricky), but by knowing a few key things ( and CPT codes) you can make quick work of getting pretty close to what any given procedure should cost. From there we politely negotiate what we need. Even if you can’t find a nearby hospital with their prices online, you can find a good representation of what other facilities are charging and can use that when you call.

For instance, if I am seeing that mammograms typically cost $200 for a self pay patient, and I am quoted $450, I would say, “wow, that’s really high. I’ve been researching and the typical price is about $200, are you quoting me the chargemaster rate or the self pay rate?” — We should be polite, but we should definitely inquire about pricing and let them know we are aware that we’re being overcharged.  The good news is that I have freedom of choice because Samaritan doesn’t restrict me to any networks, I can see any doctor I want. While a routine mammogram isn’t shared anyway, it would be if I was having symptoms and I love having the freedom to choose where I spend my dollars.


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. 🙂