Ask for a cash discount. To avoid insurance paperwork and mandated treatment regimens, doctors and testing facilities sometimes offer discounts for cash-paying patients. You might pay anywhere between 10 and 90 percent off the sticker price, says Jeffrey Rice, M.D., founder of HealthcareBlueBook.com, a free website that helps consumers compare prices for medical procedures in their area.
His advice: First, gauge the fair-market price at HealthcareBlueBook.com, FairHealth Consumer.org or similar websites. Then ask several providers for their "cash rate." Be prepared to pay immediately — with cash, check or credit card. "Some patients with cash-in-hand find success negotiating even lower prices," Rice says.
Ensure that all your health care providers are in-network. "Staying in-network means your insurer has prenegotiated fees and benefits, and will cover a larger percentage of costs. But out-of-network providers can charge whatever they want," Rice says. Typically, that's about 20 percent more for front-line doctors and laboratory testing facilities — money you have to pay yourself.
But the real sticker shock comes with elective surgery. "You really need to ensure that the 'Big Three' are also in your network — the hospital, the surgeon and the anesthesiologist," Rice says. Remember: Referrals are often made by physicians connected to certain facilities and to their colleagues. Double-check with your insurance company that the referred physician is "in-network."
Rethink the emergency room. Of course, if you face a life-or-death emergency, head to the nearest emergency room (ideally by ambulance, so you get faster treatment). But less serious conditions — fractures, sprains and the like — can be treated at urgent care facilities for a fraction of the cost, and often with less waiting time because ERs first treat patients with the most severe conditions. Rice offers an example. When his son needed foot surgery, "the local hospital would have charged $20,000. But I called a nearby ambulatory surgery facility, where the one-hour procedure cost only $1,500."
Get schooled about teaching hospitals. Whether it's for emergency room treatment or routine procedures, know that prestigious and teaching hospitals affiliated with medical schools often charge premium prices that may not be fully covered by insurance. "Teaching hospitals tend to have higher expenditures because they're set up to deal with the most complicated cases — organ transplants and the like — even though their doctors also handle less serious conditions," says David E. Williams, of the Health Business Group, a Boston-based consultant to the health care industry. "The very same treatment at a nearby community hospital, by an equally qualified doctor, may cost much less."