Home
About Us
Welcome Video
Company Overview
Our Purpose
A Message From our CEO
Giving Back
Locations
Testimonials
Leadership
Executive Team
Legal Team
Contact
Diversity & Inclusion
Privacy Statement
Technology
Careers
Services
Learn - Independent Consultation & Evaluation
Plan - Phia Document Management (PDM)
Plan - Plan Drafting Services
Save - Subrogation & Recovery Services
Save - Claim Negotiation & Signoff (CNS)
Save - Phia Unwrapped
Save - No Surprises Act (NSA)
Protect - Plan Appointed Claim Evaluator (PACE)
Protect - Balance Billing Resolution
Phia International
Media
Webinars
Newsletters
Publications
Blog
Press Releases
Podcasts
Industry Articles
Guide to Understanding Subrogation
Moving To Self-Funded Health Plan Guide
Referenced-Based Pricing Explained
Hospital Price Transparency Guide
Balance-Billing: What Patients Need To Know
Employee Rights With COVID-19 Vaccines
The No Surprises Act Explained
Mental Health Parity and Addiction Equity Act Explained
Understanding Non-Quantitative Treatment Limitations (NQTLs)
The Insulin Cap Bill Offers Hope for Americans With Diabetes
In-Network vs Out-of-Network Claims
Industry Terms
Members Area
FAQs
FAQ - Subrogation & Reimbursement
FAQ - Mass Tort Subrogation & Reimbursement
Questionnaire Response
Make A Payment
|
Login
GO
X
Home
About Us
Welcome Video
Company Overview
Our Purpose
A Message From our CEO
Giving Back
Locations
Testimonials
Leadership
Executive Team
Legal Team
Contact
Diversity & Inclusion
Privacy Statement
Technology
Careers
Services
Learn - Independent Consultation & Evaluation
Plan - Phia Document Management (PDM)
Plan - Plan Drafting Services
Save - Subrogation & Recovery Services
Save - Claim Negotiation & Signoff (CNS)
Save - Phia Unwrapped
Save - No Surprises Act (NSA)
Protect - Plan Appointed Claim Evaluator (PACE)
Protect - Balance Billing Resolution
Phia International
Media
Webinars
Newsletters
Publications
Blog
Press Releases
Podcasts
Industry Articles
Guide to Understanding Subrogation
Moving To Self-Funded Health Plan Guide
Referenced-Based Pricing Explained
Hospital Price Transparency Guide
Balance-Billing: What Patients Need To Know
Employee Rights With COVID-19 Vaccines
The No Surprises Act Explained
Mental Health Parity and Addiction Equity Act Explained
Understanding Non-Quantitative Treatment Limitations (NQTLs)
The Insulin Cap Bill Offers Hope for Americans With Diabetes
In-Network vs Out-of-Network Claims
Industry Terms
Members Area
FAQs
FAQ - Subrogation & Reimbursement
FAQ - Mass Tort Subrogation & Reimbursement
Questionnaire Response
Make A Payment
Home
+
About Us
Welcome Video
+
Company Overview
Our Purpose
A Message From our CEO
Giving Back
Locations
Testimonials
+
Leadership
Executive Team
Legal Team
Contact
Diversity & Inclusion
Privacy Statement
Technology
Careers
+
Services
Learn - Independent Consultation & Evaluation
Plan - Phia Document Management (PDM)
Plan - Plan Drafting Services
Save - Subrogation & Recovery Services
Save - Claim Negotiation & Signoff (CNS)
Save - Phia Unwrapped
Save - No Surprises Act (NSA)
Protect - Plan Appointed Claim Evaluator (PACE)
Protect - Balance Billing Resolution
Phia International
-
Media
Webinars
Newsletters
Publications
Blog
Press Releases
Podcasts
+
Industry Articles
Guide to Understanding Subrogation
Moving To Self-Funded Health Plan Guide
Referenced-Based Pricing Explained
Hospital Price Transparency Guide
Balance-Billing: What Patients Need To Know
Employee Rights With COVID-19 Vaccines
The No Surprises Act Explained
Mental Health Parity and Addiction Equity Act Explained
Understanding Non-Quantitative Treatment Limitations (NQTLs)
The Insulin Cap Bill Offers Hope for Americans With Diabetes
In-Network vs Out-of-Network Claims
Industry Terms
+
Members Area
+
FAQs
FAQ - Subrogation & Reimbursement
FAQ - Mass Tort Subrogation & Reimbursement
Questionnaire Response
Make A Payment
Posts
Media
>
Posts
Webinars
Newsletters
Publications
Blog
Press Releases
Podcasts
Industry Articles
Guide to Understanding Subrogation
Moving To Self-Funded Health Plan Guide
Referenced-Based Pricing Explained
Hospital Price Transparency Guide
Balance-Billing: What Patients Need To Know
Employee Rights With COVID-19 Vaccines
The No Surprises Act Explained
Mental Health Parity and Addiction Equity Act Explained
Understanding Non-Quantitative Treatment Limitations (NQTLs)
The Insulin Cap Bill Offers Hope for Americans With Diabetes
In-Network vs Out-of-Network Claims
Industry Terms
Phia Group
Phia Group Media
In God We Trust; All Others Pay CASH…I wish…
On September 25, 2017 in
Blog
,
Cost Containment
,
Health Insurance
,
Healthcare Costs
,
Hospital Bills
I love calling a provider before medical services are rendered to settle on financial terms, and I love it when they have a reasonable cash price ready for me – but it’s all too rare to get a reasonable price easily. Usually, I need to wade through concepts and terminology like “regular rates,” “commercial contracts,” and “networks,” and excuses like “I’ll see what I can do,” “our clients don’t process claims that way,” and plenty more. It never ends.
I want to pay a cash lump-sum for a service you’ve provided hundreds (or thousands) of times, and you really can’t tell me the price?
However, with the steady emergence of more consumers being responsible for paying for their medical care (in the form of higher OOP) and perhaps continued provider frustration, more providers are now offering cash discounts (thanks to transparency pioneers like Surgery Center of Oklahoma). Consider these other examples:
[This clinic] does not accept any third-party payment and makes no apologies for this. In order to keep costs down for the uninsured and the increasing number of patients who have high copays and deductibles, we choose to not assume the massive overhead involved in billing third-party payers. This has the added benefit of eliminating bureaucratic hassles and intrusions into the doctor-patient relationship, ensuring confidentiality of patient information and keeping our typical charges usually between the costs of an oil change and a brake job.
1
* * *
[This health system] offers cash pricing for selected services. Cash-pricing packages must be paid in advance of receiving services. Insurance will not be billed and claim forms will not be provided. If you would like information on cash packages, please call …
2
* * *
Does [this hospital] offer a discount if I self-pay for services? [This hospital] offers a 75 percent discount on eligible services to patients who pay out of pocket for medical services — whether it’s because you don’t have insurance, your insurance doesn’t cover the services, or you’d prefer not to bill through your insurance provider.
3
Swedish Health Services may have seen the writing on the wall when they decided to lower their charges for certain outpatient services (bear in mind these are ordinary charges, not cash rates). On their old billing platform, an MRI of the brain was billed at $6,143; the new billing is $1,810 (70% less).
In many ways, cash rates are a type of network unto themselves. Providers are basically saying, “If you can pay cash at the time of service, these are the rates, and they are good. If you want us to bill an insurer, have the claim repriced, pended, denied, re-coded, covered, denied, covered, we will bill you our much maligned chargemaster rates, and the claim will be paid with our equally maligned network rates.”
We are truly only at the beginning of this trend, and it is difficult to assess how many providers are now offering cash rates and how many are publicizing that fact; offering cash rates can be viewed as a form of direct-to-consumer contracting.
The American Academy of Private Physicians estimates there are about 6,000 physicians in the US who contract directly with their patients without an intermediary. That is roughly 1% of physicians, but this number has reportedly been growing at a rate of 25% per year for the last four years
4
, and despite the fact that this is decimal dust compared to the market at large, the trend is likely to continue.
All things considered, we need more providers to step up and post their cash prices for consumers to consider. The providers who pioneer in this area will be rewarded with business from a large market that is getting increasingly desperate for honesty and transparency.
1
Sean Parnell, “The Self-Pay Patient”, January 2014, pg. 28
2
https://www.uclahealth.org/pages/patients/patient-services/cash-pricing.aspx
3
https://www.elcaminohospital.org/patients-visitors-guide/billing/faq
4
Sara Rosenbaum, “Additional Requirement for Charitable Hospitals: Final Rules on Community Health Needs Assessments and Financial Assistance”, http://healthaffairs.org/blog/2015/01/23/additional-requirements-for-charitable-hospitals-final-rules-on-community-health-needs-assessments-and-financial-assistance/ (January 23, 2015)
Tagged With:
,
Healthcare Costs