When it comes to medical procedures and treatment, it pays to shop around. Recent changes in health insurance laws allow patients to choose whether they want to pay for services out of pocket — also known as self-pay — or if they want those charges submitted to insurance. And a patient can make that choice each time they visit.
According to a recent study by the Centers for Medicare & Medicaid Services, there are significant variations across the country and even within communities of what medical providers charge for common inpatient and outpatient services.
As health-care costs continue to tick up as wages remain stagnant, patients have to be their own advocate to find the best care for the right price. Thankfully, the internet has made it a lot easier to review doctors and prices. Having the knowledge of how much a particular procedure should cost will enable you to negotiate a fair price and avoid excessive health-care bills.
Not that long ago, health insurance often involved small co-pays, a set amount of the medical bill that the patient would pay at the time of service. A patient might pay $10 or $15 to see a doctor and the insurance company paid the remainder of the bill. The world of health insurance has changed, and those plans with low co-pays have given way to plans with deductibles — an amount the patient must pay each year before health insurance starts covering costs — some of which can run as high as $15,000 for a family.
“They can be huge,” said Dr. Dharam Mann, Medical Director for Garden State Medical Center. “Some of the deductible plans could just about bankrupt somebody with one surgery or hospital stay.” For individuals or families with very high deductibles — deductible amounts that they’re unlikely to reach in a calendar year except in the circumstances of catastrophic medical situation — that discount for “self pay” or “cash pay” may be an attractive option.
It may also be appealing to patients with “vanishing deductible” plans, which lower the deductibles over time if a patient doesn’t reach them. These are similar to car insurance plans that lower the deductible if the insured doesn’t have any claims that require the insurer to pay out.
Patients can choose to submit to insurance for one visit and then decide to self-pay the next visit. The law allows patients to decide each time, Dr. Mann said. But if you do choose the self-pay route, make sure that’s clearly outlined for the provider, especially if there’s insurance already on file, he said. It’s important to let providers know up front each and every time you opt for self-pay; reminding when you make the appointment, when you check in, and during your visit with the provider, he said. When choosing the self-pay option, it is important to note that self-pay services are not submitted to your insurance and therefore, do not apply to any deductibles.
This is especially true when it comes to diagnostic imaging.
Garden State Medical Center makes their diagnostic imaging services very affordable. Self-pay patients, could receive a significant discount off of standard rates for services by settling the bill at the time of service. In some cases, the pricing may be lower than if it went to insurance.
Before making the decision to go the self-pay route, patients should gather all the facts. It is important to know their insurance policy and benefits; including whether the service is a covered benefit, does the service meet the medical necessity requirements, and what their actual out of pocket cost would be. This will help them determine if self-pay is the best option for them.
All of the changes with health care laws and insurance can be confusing and, frankly, overwhelming. But at Garden State Medical Center, we’re closely monitoring the health insurance landscape and working to provide the very best patient care environment.