r/HealthInsurance • u/Liface • Jul 09 '25
Claims/Providers In my experience, "paying cash is cheaper than paying with insurance" is a myth
In the United States, I'm sure some of us have been told at least once that we can pay cash at doctor's offices to get some sort of magical discount.
I've had both high deductible United and Blue Cross Blue Shield over the past few years. Every time I've needed care, I've checked the negotiated rate vs. the doctor's cash pay rate. I live in New York City.
Every single time, the negotiated rate has been lower than the cash pay rate. Sample size of over 100.
As a patient, I'm financially incentivized to create more work for the practice with the additional billing paperwork and more work for me dealing with my insurance. What a nonsensical system!
I've even tried explaining this to practices and asking them to cash match my negotiated rate or give me a discount for saving them the time with billing. They won't.
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u/elevenstein Jul 09 '25
In instances where the self-pay price is lower, its almost always intended for people who are actually uninsured.
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u/Sea-Swimming7540 Jul 10 '25
This right here! It’s usually not worded as “cash pay discount”
It’s “self pay discount” meaning those who don’t have insurance
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u/anntchrist Jul 09 '25
My $330,000K in hospital bills after a bike crash cost me $7500 out of pocket. There’s no cash discount that even comes close. The amount I paid was toward my surgery, the ER and ambulance bills were all just automatically paid. Now I have cancer and it is way more expensive but the same cost to me. Not to mention that I’m being billed by at least 20 different companies for imaging, biopsy, genetic testing, etc that I’d have to negotiate with individually. FWIW, I’m an otherwise healthy person, good food, very active, non-smoker but very glad to have insurance. If you are lucky and have low health costs you can come out on top by risking it, but one car crash or unexpected illness can ruin you.
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u/HedgehogOk3756 Jul 10 '25
So do you have insurance or not?
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u/anntchrist Jul 10 '25
Yep, I just pay my OOP max, the rest is covered. Otherwise I’d be out at least a million over the last three years. No cash discount is even close to that.
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u/lifeisabowlofbs Jul 14 '25
Most hospitals have a financial aid program in place to help uninsured people in these situations. You most definitely would not have paid a million, because you don’t have a million and the hospital knows that.
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u/anntchrist Jul 14 '25
They also would never settle a million in bills for $15k, and they’d also ruin my financial future. Insurance is a good value when you really need it. Keep in mind I am still relatively young.
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u/Ok-Lion-2789 Jul 09 '25
What I think people forget is that if you do all this cash paying you are essentially betting you won’t have a big bill. If you do end up having something that you need to run through insurance, you wasted a bunch of money on the cash pay stuff.
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u/MNrunner19 Jul 09 '25
This exactly! You won't be able to go back and have any of that applied to your deductible or meeting your out of pocket max.
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u/DCRBftw Jul 09 '25
In general, the cash price is usually very close to the insurance rate. But there are many instances where it's slightly less because the provider gets paid instantly and doesn't have to deal with potential denials or delays. So it's not a myth. There's also a prompt pay discount in many cases, which makes it cheaper to pay cash instantly versus setting up payment plans. For a healthy person, this may make sense versus paying large monthly premiums and still having to meet a significant deductible.
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u/hbk314 Jul 13 '25
A healthy person can get hit by a car or get diagnosed with a serious medical condition like cancer. As u/anntchrist said, there's no self-pay discount that's going to come close to capping your bills at $7500 or whatever the plan OOP max is.
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u/DCRBftw Jul 13 '25
If a person gets hit by a car or gets cancer, they aren't healthy.
I never said a self pay discount capped bills.
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u/hbk314 Jul 13 '25
Just addressing the massive potential downside to your scenario.
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u/DCRBftw Jul 13 '25
It's not my scenario. The question wasn't why do people carry insurance or is having insurance better than not having insurance when something catastrophic happens. OP asked about the difference between cash and insurance and if it was a myth. But yes, if something bad happens, you absolutely want to have insurance and since no one plans for a catastrophe, carrying insurance in general is a good idea.
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u/anntchrist Jul 13 '25
You are healthy to the moment either happens. If you don’t buy insurance because you’re healthy, you may be surprised like me. I had perfect bloodwork even a month before my cancer dx. My doctor wrote in my checkup notes “good work on your excellent health.” I was healthy before and through my hip replacement, which was necessary because of an injury not an illness.
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u/DCRBftw Jul 13 '25
Clearly. Everyone knows you carry insurance in case, not because. If you read OP's post, it's a question of cash vs insurance and whether or not it's a myth. It's not a question of why you carry insurance. Sorry about your bad news.
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u/_DOA_ Jul 09 '25
I needed an MRI for my L-spine: Price with insurance (Cigna)? $1,960. Cash price? $272. Afterwards they recommended a nerve block epidural procedure. Insurance price: $2,700. Cash price: $1,026.Back brace insurance price: $900. Cash price: $400. I could give more examples, but that's enough, I think. Had the same experience with BCBS back in 2020 when I had them.
Your experience doesn't match mine, which is fine. But saying "it's a myth" just reflects that you only have your own anecdotal experience to draw on, and you've drawn a false conclusion.
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u/Specialist_Dig2613 Jul 10 '25
Very different in NYC than Texas. My experience is that cash pay is lower than "discounted" rate in 75% to 80% of all situations.
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u/_DOA_ Jul 10 '25
Wait, how is that different? My cash price is *waaay* lower in every case here, too.
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u/Liface Jul 09 '25
Fascinating. Where in the country was this, and what sort of provider? Hospital?
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u/_DOA_ Jul 09 '25
East Texas. MRI's are done by radiologists. L-spine injection by a pain management doctor. Medical specialty doesn't appear to matter, though - I could have listed very similar previous experiences with my shoulder a few years ago, or my hand/wrist a couple years prior to that.
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u/Liface Jul 09 '25
I wonder if it's a lower insurance covered demographic area so cash-based practices are more prevalent. It would be interesting to explore geographic trends around this.
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u/_DOA_ Jul 09 '25
Not sure. I have insurance, but having seen others' experience with this, I made sure to ask the cash price before paying. Some places are squirrelly about giving this information out; these couple providers had no issue with it, just said, "Hang on a second," and came back with the cash price.
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u/Chefsbest27 Jul 09 '25
My experience has been the opposite for both Urgent care and Hospital visits. I guess it all depends on your insurance. I have up high deductible plans with blue cross and Cigna.
My wife got rushed to the hospital for something and they did not get her insurance information, so we got billed as if we did not have insurance. Then when i had them run it through our insurance, the amount I owed was doubled. Same with Urgent care, the place near me charges $150 cash for a regular visit. Running through my insurance is $250-300.
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u/Echostart21 Jul 09 '25
The problem with doing this is that what you pay in cash is not reflected in the amount paid toward your deductible. So now if you do need an emergency room or other health issues you will be paying toward your deductible twice.
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u/Chefsbest27 Jul 09 '25
Correct. It is a “gamble”. Personally, I have never even hit my deductible in my adult life. Even though my wife has hit hers.
But the way I read OPs post was that OP was saying a service is never cheaper with cash than it is with insurance. My experience with a high deductible plan has been that that is not true.
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Jul 09 '25
[deleted]
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u/murse_joe Jul 09 '25
If there was one event with a couple hundred thousand dollars, then you would’ve gone above the deductible regardless if you could through this $250
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u/Chefsbest27 Jul 09 '25
In which case it would be extremely wise to send that through your insurance…
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u/harperdove Jul 09 '25
Me neither. I've had them for years, too. They function as medical bankruptcy protection for catastrophic events, basically. The high deductible health insurance plans paired with health savings accounts (where money is invested for the long haul of life) are a good idea for young people in good health, in my opinion.
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u/NysemePtem Jul 10 '25
High deductible plans are absolutely the issue when it comes to this kind of thing. The plans don't care if their negotiated rate is crazy high, because they almost never end up paying it, you do.
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u/Historical-Egg3243 Jul 09 '25
The whole system is corrupt. Hospitals purposely overcharge so that they can be negotiated down to a more reasonable price
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u/KushKiitten Jul 12 '25
This. Just had a hospital stay and 4 of the claims aren’t even approved yet but so far the hospital has billed my insurance $121,000
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u/MikeUsesNotion Jul 09 '25
I don't know all the details, but in network contracts usually have some kind of provision that the amount submitted to insurance A is the same they would have submitted to insurance B or C. So if a hospital did more precise initial billing to insurance, they likely are violating their contract.
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u/roth1979 Jul 09 '25
It is legalized tax evasion. They knowingly overcharge and write it off as charity.
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u/Careless_Home1115 Jul 10 '25
The whole system is corrupt. Hospitals purposely overcharge so that they can be negotiated down to a more reasonable price
This. I don't even know how people are calculating or estimating anything in regard to healthcare. Like I have no idea what the actual cost is. I have no idea what the negotiated rate should be to be fair or reasonable. I have no idea if I pay in cash if I am being gouged compared to other providers. No idea at all because with the inflated pricing, and the lack of transparency, they could literally charge me or my insurance anything they wanted to and I wouldn't know better.
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u/Reason_Training Jul 09 '25
I’m an insurance biller and can only talk about my experiences but self pay is usually cheaper with the facility I work for.
Our insurance charges are 3X the Medicare allowed amount while our self pay rates are exactly set at what Medicare allows for services. This allows us to help offset the costs for things like Medicaid reimbursement as they don’t pay near operating expenses. Whereas commercial insurances generally pay at a percentage of billed charges.
This means if your insurance contract reimburses at 85% of charges and you have a deductible plan you are paying more than our self pay rates for billing your insurance.
Due to working in healthcare of course I have a high deductible plan and usually do self pay as with my PCP’s office it’s cheaper for me to do self pay since I don’t meet my deductible. Only with preventive care do I file with my insurance.
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u/Calculated_r1sk Jul 09 '25
I dunno.. I think paying cash is cheaper as in yeah maybe I pay 200$ for an office visit and 500$ labs. I now have paid 700$ yes, but I am also not paying 1000+month just to HAVE insurance to run it through and be billed on top of it.
I have 4 doctors visits and 2 sets of labs for the rest of the year, but I have to pay 1000$month for insurance. (COBRA at the moment, just quit job). So for 4 20$ visits and a set of labs for free, that's June-DEC 7000$ + 80$ in copay. Vs 800$ for 4 office visits, and 500$ cash for labs and I am saving 5780$
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u/Liface Jul 09 '25
When people perpetuate this myth, they're talking about the compared direct cost of each service, not counting premiums.
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u/super_bigly Jul 09 '25
Why would you not count premiums…that’s still money you’re paying every month.
I will say NYC and other VHCOL areas may be outliers as places know they can charge quite high cash rates and some people will end up paying it. Otherwise they’ll just collect from insurance.
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u/murse_joe Jul 09 '25
Because you have to pay the premiums either way. It’s not like you have a choice to pay cash for healthcare or to get insurance. You have to get insurance and then sometimes you also have to pay cash for healthcare.
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u/Calculated_r1sk Jul 09 '25
heck yeah, at 1000$month I am absolutely including them in the equation.
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u/Liface Jul 09 '25
The myth applies specifically to people who already have insurance. It goes something like:
"Get catastrophic health insurance for emergencies and pay cash for everything else. You'll save money."
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u/Shadow1787 Jul 09 '25
Many have deductibles that you must pay before they even touch it. Mine is smaller and $1000. But a simple urgent care was $300+130$ monthly premium after insurance, cash payment was $100.
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u/Asher-D Jul 09 '25 edited Jul 09 '25
They're not perpetuating a myth, they're stating a fact incorrectly (because of course paying for something with insurance is going to be cheaper, for me its $0 every time, it's not free of charge without insurance, but its not FREE, its free of charge, very big difference).
The only place that I know for a fact you're not paying for more than what you receive (on average) is insurance in my country. At the very best your premiums and any other copays (co insurance doesn't exist here) is EQUAL to what you'd pay without insurance. And that's the absolute best deal you will get. The point of insurance is not to save money, it's protect against risk.
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u/YesterShill Jul 09 '25
What you are seeing is that insurers underpay non emergency or non surgical providers.
That is why people with insurance sometimes complain about not being able to find providers. We certainly have dumped all insurance except for the two highest paying in our region, and everyone else pays our cash rate which better reflects the value of services they receive along with the actual costs associated with providing that care.
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u/Turbulent-Pay1150 Jul 09 '25
It's actually logical - your insurer negotiates in bulk - not for one thing but millions of dollars worth of things at a time and has buying power over you.
That paperwork you speak of isn't the insurer. They may be the enforcement of it but CMS requires that the provider document exactly what you are diagnosed with/billed for and for many claims in the US they get the data (not with your details but in general) which is very handy for public health to understand what's going on and how things are being treated. Long ago at health insurers we collected only what we required to adjudicate a claim and it was minimal. CMS regulations required that we collect all of it - and that the provider accurately provide all of it for very good rules.
If the provider is unable or unwilling to document the care they provided I'd be worried about the provider providing adequate care.
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u/super_bigly Jul 09 '25
The paperwork is absolutely the insurer. There is limited government regulation of private insurance plans unless they’re administering a government insurance product (ex Medicare advantage plans, Medicaid plans, CHIP plans). The private insurance company sets their own often very arbitrary rules about what documentation they want, what codes they’ll cover, what medications they’ll cover, etc. This also differs from plan to plan. It can also take months to get paid from insurance plans.
So yes there’s quite an advantage and often a bit of a discount to seeing someone who will pay upfront, not having to worry about insurance questioning your documentation/refusing coverage, not having to pay a biller to submit the forms and codes and followup on if you got paid or not.
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u/Turbulent-Pay1150 Jul 09 '25
Not in the real world.
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u/super_bigly Jul 09 '25
lol my cash rate is less than a typical insurance billed rate so yes in the real world
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u/Jodenaje Jul 09 '25
The provider is still going to have to accurately document the visit - the documentation itself is not an insurance thing. It's a legal record of the visit. Other medical providers the patient sees may need to review it. It could potentially be used in legal proceedings.
The only thing that wouldn't be done is generating a claim form.
The documentation itself wouldn't change.
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u/super_bigly Jul 09 '25
Documentation is for billing and for record keeping. If I don't have to worry about billing through insurance, documentation can simply reflect medical record keeping and not trying to justify to an insurance company what you thought or did so they don't come back later and try to downcode or claw back money.
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u/Jodenaje Jul 09 '25
The documentation standards are the same either way.
If you're being less thorough on documentation for your self-pay patients, then you're doing it wrong, and you should hope those records aren't needed in a court case down the road.
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u/super_bigly Jul 09 '25
There is literally nobody enforcing any type of documentation standards in a private cash pay practice unless I'm worried about my documentation holding up in a malpractice suit. Which is a pretty low bar to clear.
Go grab an Epic note from an insurance based family medicine practice and compare it to a note from a DPC cash only family medicine practice. They ain't gonna look the same buddy.
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u/picasaurus365 Jul 10 '25
Yes. Sounds like a biller vs doctor argument. Biller has limited view of the medical side and doc who generates income based on cash pay doesn't care about billing documentation which is wildly different than "record keeping". Docs who either understand billing or just do cash pay don't need middle men. Patients will absolutely benefit
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u/Turbulent-Pay1150 Jul 10 '25
Billers are employed by the doc to maximize profits for the doc. You are talking about the same entities here.
And if your doc is not meeting documentation standards within their profession they, technically, don't deserve to be paid by you as the patient or anyone else on your behalf. It's part of the job by definition.
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u/pymreader Jul 09 '25
My experience is just the opposite. I had a colonoscopy that got coded incorrectly so my insurance was refusing to pay. It was somewhere in the neighborhood of five grand. When I told the office. I guess I'm paying It was $1,500
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u/Liface Jul 09 '25
Important distinction: was the $5K the rate the office charged to insurance, or the rate that you were ultimately responsible for (negotiated rate)?
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u/pymreader Jul 09 '25
They initially billed $5k, Insurance declined, I talked to them and said I would have to pay cash and I think it was something $1567. Then the coding got resolved and insurance paid their negotiated rate $3500
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u/MikeUsesNotion Jul 09 '25
Why didn't you do the insurance side first?
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u/pymreader Jul 09 '25
It was initially submitted but denied, appealed and denied, I went into to discuss how to pay and got the cash price. Then 2nd appeal was approved
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u/Savings-Breath-9118 Jul 09 '25
Maybe that’s true in New York and with your practitioners, but here in San Francisco at least, working with local hospitals, cash payment for some tests that we’ve had over the years is much much cheaper than the Insurance negotiated settlement. We’re talking 250 versus 2000.
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u/janepublic151 Jul 10 '25
NY Metro. 20 years ago it was cheaper to pay cash for medical visits. That is no longer the case.
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u/Asher-D Jul 09 '25
No, no, no paying cash when you have insurance isn't cheaper than using the insurance, foregoing insurance and paying directly is cheaper. Eliminating the middleman and waste saves money.
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u/Liface Jul 09 '25 edited Jul 09 '25
In some cases, but not all.
My employer provides catastrophic Blue Cross Blue Shield and they actually pay me to do it. My premiums are $588/year but they contribute $1250 to my HSA a year.
So I get coverage in case of emergencies and end up coming out ahead due to getting negotiated rates with insurance as well.
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u/super_bigly Jul 09 '25
I mean even for a high deductible plan $588 a YEAR is an incredibly good deal for insurance. Especially in NYC.
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u/messick Jul 09 '25
> They won't.
Because they can't. A agreement between a practice and the insurance company to accept a certain negotiated rate for that insurance company's customers works both ways, chief.
Cancel your insurance policy if you want the "joys" of the cash rate.
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u/Fin-Tech Jul 09 '25
But they can. The contract between the practice and the insurance company only applies if the patient chooses to utilize their insurance for this encounter. The patient is free to choose NOT to utilize their insurance at any time.
One is not required to cancel one's insurance policy in order to experience the joys of the cash rate. One simply need ask.
Guidance from CMS for compliance with the Good Faith Estimate requirements of the No Surprise Act recommend that the practice asks each patient if they want to use their insurance for every individual encounter. If the patient chooses not to use insurance, the practice is required by law to provide a Good Faith Estimate of costs.
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u/hbk314 Jul 13 '25
The provider is also under no obligation to give you the usual cash price if you opt out of using your insurance for the visit.
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u/sanityjanity Jul 09 '25
I think that, when they say that self-pay is cheaper, it's not comparing your insured rate to the *posted* self-pay. But, if you talk to billing, sometimes there's some way that they lower the cost.
Even so, I would certainly expect that your insurance's negotiated rate would be similar or lower.
But I've definitely had prescriptions where the self-pay cost was lower than the insurance copay -- maybe it was a cheap antibiotic?
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u/Sad_Researcher_8521 Jul 10 '25
I think it just depends on the visit and plan
Obviously a massive ER/hospital bill or people who require multiple appts or meds will not benefit. But for an urgent care visit it may actually math out. Or let’s say you’re in a jam and have to go out of network due to location or availability. Our self pay discount is 65% and OON may be only covered 50%. It can be a better financial option in some situations—certainly not always
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u/domtheprophet Jul 10 '25
Cash pay discrepancy between insurance & cash is for the people that aren’t insured
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u/Emulated-VAX Jul 10 '25
The US system is screwy. Hospitals will bill a self pay patient like 4-5 times the "negotiated rate" of an insurance carrier. Same with a doctor's office.
Its utter madness. Now that I am on Medicare, its even lower. A $150 doctors charge becomes lime $19 or something on my Medicare statement.
Its nuts because if I was a doctor, I'd give self-pay patients the lowest rate. Its way less work for me (no dealing with insurance carriers). I guess the main reason they don't do this is, the overwhelming chance you never pay at all.
Edit: Its even more bizarre. Recently I had some routine tests and a local hospital. They billed the wrong carrier, as I recently started medicare.
When it was rejected they quadrupled the bill and sent it to me to self pay.
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u/80jen1 Jul 10 '25
I was quoted 3.5k for a chalazion removal using my high deductible insurance plan. It was $400 paying out of pocket…
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u/Sad-Object3365 Jul 11 '25
I only got this to work at the dentist when I got a crown. I paid cash and it was $200 less than I would’ve paid after the insurance.
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u/MountainFriend7473 Jul 15 '25
Yeah Self Pay is really for folks who don’t have other insurance or when they may have a non-contracted plan and still want to receive care. Plus those rates can change even month to month.
Where I live we have good faith estimates. So we do our best to ensure people have an idea of what the cost of treatment is. Plus some folks may pool money just for health expenses but not controlled by insurance HSA and etc. Because sometimes circumstances are that employer based insurance is not helpful or costs way more in the end or income variances are enough like in a self employed situations where the number crunching ends up the way it is. Especially if you’re not eligible for medicaid in terms of assets and such.
In my own experience when someone is self pay it is not nearly the same for what is contracted or negotiated with insurances.
So it just depends but HDP you’re on the hook for a majority of things if it’s beyond that if an annual wellness check/physical.
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u/Quiet_Invite8421 10d ago
My health insurance costs me $8,400 Yearly. I haven’t needed anything more than a monthly appointment for my 3 prescriptions, both appointment and meds run me about $200 monthly. This year I needed blood work, $59 from an outside testing facility. A primary care doctor (cost $150) evaluates your blood work. This year - $2,609 for the year. IF I have a big bill, the hospital and docs are required to take payments (is that correct?) based on your income and financial obligations. Which would certainly be under $8400 per year for the average blue collar individual. ????
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u/Creative_Spread_6277 Jul 09 '25
OP is just shilling for insurance.
It's cheaper to not have insurance and pay cash. Case closed.
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u/Turbulent-Pay1150 Jul 09 '25
So no broken arms, cancer, heart surgery, appendicitis, etc. for you? ON day to day you may beat the insured negotiated rate. On the big stuff you'll declare bankruptcy long before you get through treatment.
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u/Creative_Spread_6277 Jul 09 '25
And if it comes to it, yeah, you would be better off declaring bankruptcy and paying back a fraction of what they "charged" you for any "big stuff".
Everyone is going to come screaming about credit ratings and the consequences of bankruptcy blah blah blah. Save it.
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u/Turbulent-Pay1150 Jul 10 '25
Generally speaking insurance is for the big stuff. Due to enlightened self interest and regulatory controls they cover some of the basics as well - preventative care, maintenance medicines, inoculations, etc. You pay what you pay so when you have the 20,000-1,000,000 incident the insurer is there for you and pays the balance leaving you with a tiny fraction of the overall cost you would have incurred if you didn't have insurance.
You can buy a policy (where offered) that would cover absolutely everything - big, small, in between. Of course, you'd pay for it about what it would cost for an average person in your demographic to pay for their care with their negotiated provider reimbursement rates in a year plus a small bit of overhead and profit. The basis is pretty straight forward. You won't get more out of insurance than you put in to it (this goes for car warranties as well - same math). The insurer brings negotiating power with the providers to the table as well as the ability to aggregate many thousands/millions of paying members to spread the cost among everyone.
An example of the relativistic and over simplified math: When your insurance won't pay for the latest GLP1, which honestly may increase your life span and make your life better but for which the insurance would pay $1,200 a month for on your behalf on top of your other risk factors it is because they would need to increase everyone's premiums a bit - and if they did that for 30% of the population that could math out to everyones premium going up $400 a month (roughly 1/3 of the 1,200 per month). If they can't bury that by discounting with the PBM's or rebates from the pharmaceutical companies they won't cover it as a benefit. Someone pays for it. That's for all insurers - same math. Not for profit insurers go out of business if they don't collect enough premiums to pay all the claims plus enough for processing charges and a tiny bit of overhead - just as for profit insurers.
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u/Ooofy_Doofy_ Jul 10 '25
What kind of lifestyle do the people in here have that you keep using breaking bones as an example? I can’t imagine a scenario where I would break my bones.
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u/hbk314 Jul 13 '25
It's not like people do it on purpose.
You could slip/trip and fall, get hit by a car, injure yourself playing a sport, etc. You can also be diagnosed with a serious medical condition out of the blue.
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u/Creative_Spread_6277 Jul 09 '25
If you have money, you're still better off fighting for a cash price. You can leave the country for cancer treatment and get first-rate care for a fraction of what American providers will charge you, as a foreigner, paid in cash.
You're literally stupid if you believe that all this "big stuff" actually costs hundreds of thousands or even millions of dollars. It doesn't. Insurance companies just decided it costs that much and has fleeced this country for decades based on that absolute fucking lie.
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u/Turbulent-Pay1150 Jul 10 '25
Oddly enough - hospitals, pharmaceutical companies and doctors set the prices for what it costs. Insurers negotiate a cheaper price - sometimes as high or higher than a 90% discount off of what those for profit entities have as list prices (yeah, docs are for profit, hospitals may or may not be but still pay their execs pretty well and have to show a "surplus", and of course pharmaceutical companies are for profit). Your insurer doesn't - and can't legally - set those prices.
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u/Spirited_Concept4972 Jul 09 '25
Do you have a question?
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u/pinedesign Jul 09 '25
Not every Reddit post is a question.
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u/Liface Jul 09 '25
I think this is a bot. Two users commented the exact same thing. Join me in downvoting and reporting them as spam.
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