Self pay vs insurance

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Cpadave
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Self pay vs insurance

Post by Cpadave » Mon Jan 15, 2018 3:57 pm

Hi, We currently have HSA insurance with $5685/11370 deductible plan. I was wondering if it would be cheaper to pay for most medical expense as self pay (without submitting to insurance) ? If so, can the expenses still be submitted to insurance so it counts toward the deducible? Thanks

Wish we had medicare for all already so we didn't have to deal with all these issues.

123
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Re: Self pay vs insurance

Post by 123 » Mon Jan 15, 2018 4:03 pm

The primary value of medical insurance is often the negotiated prices for services. If you self-pay they may want you to pay the "list price", often an extraordinary high amount that no one really pays. In many prices the "insurance" price may be better than you can negotiate yourself though discounts for cash payments are not unheard of. It largely depends on how much time you've got to deal and how large the medical entity you're dealing with is, private practitioner versus hospital.
The closest helping hand is at the end of your own arm.

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dm200
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Re: Self pay vs insurance

Post by dm200 » Mon Jan 15, 2018 4:16 pm

123 wrote:
Mon Jan 15, 2018 4:03 pm
The primary value of medical insurance is often the negotiated prices for services. If you self-pay they may want you to pay the "list price", often an extraordinary high amount that no one really pays. In many prices the "insurance" price may be better than you can negotiate yourself though discounts for cash payments are not unheard of. It largely depends on how much time you've got to deal and how large the medical entity you're dealing with is, private practitioner versus hospital.
Yes - this is my understanding and belief as well.

Rupert
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Re: Self pay vs insurance

Post by Rupert » Mon Jan 15, 2018 4:17 pm

Cpadave wrote:
Mon Jan 15, 2018 3:57 pm
Hi, We currently have HSA insurance with $5685/11370 deductible plan. I was wondering if it would be cheaper to pay for most medical expense as self pay (without submitting to insurance) ? If so, can the expenses still be submitted to insurance so it counts toward the deducible? Thanks
No, if you self pay you can't also submit it to your insurance so that it counts against your deductible. In fact, it has been my experience that if a provider finds out you have insurance, they won't let you self pay. I think it violates their contract with the insurance company, at least if they're an in-network provider.

fabdog
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Re: Self pay vs insurance

Post by fabdog » Mon Jan 15, 2018 4:21 pm

For us, health insurance, as others have noted really comes in handy normally for getting the negotiated rate, which saves us a bunch.

On those rare years when we hit the deducible, it's because something major went wrong and it's nice to have the backstop when you have a very large expense year

Mike

Cpadave
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Re: Self pay vs insurance

Post by Cpadave » Mon Jan 15, 2018 7:09 pm

Thank You. Very Helpful.

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gasdoc
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Re: Self pay vs insurance

Post by gasdoc » Tue Jan 16, 2018 8:17 am

Rupert wrote:
Mon Jan 15, 2018 4:17 pm
Cpadave wrote:
Mon Jan 15, 2018 3:57 pm
Hi, We currently have HSA insurance with $5685/11370 deductible plan. I was wondering if it would be cheaper to pay for most medical expense as self pay (without submitting to insurance) ? If so, can the expenses still be submitted to insurance so it counts toward the deducible? Thanks
No, if you self pay you can't also submit it to your insurance so that it counts against your deductible. In fact, it has been my experience that if a provider finds out you have insurance, they won't let you self pay. I think it violates their contract with the insurance company, at least if they're an in-network provider.
We will sometimes ask for and receive the self pay price when either the charge is not covered or the deductible means the charge will not be covered. In these cases the charges were filed, and AFTER that the self pay discount was applied. I usually will call and simply ask if any discounts would apply.

Gasdoc

birdog
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Re: Self pay vs insurance

Post by birdog » Tue Jan 16, 2018 10:05 am

I ask the provider what their self-pay price is. It is often lower than the insurance contracted price. If it is, I simply tell them I want to self-pay. I have a very high deductible that we have only met one year. Providers that I have dealt with like self-pay because they don't have to file with insurance and often offer a substantial discount for it. If I would ever get push-back about "we are required to file with insurance if you have it" then I guess I could just say I don't have it anymore. I've never run into that since most places prefer me to pay them on the spot rather than them have to bill insurance and I prefer that as well since the self-pay rates are often much less.
Last edited by birdog on Tue Jan 16, 2018 1:31 pm, edited 1 time in total.

LiterallyIronic
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Re: Self pay vs insurance

Post by LiterallyIronic » Tue Jan 16, 2018 10:10 am

123 wrote:
Mon Jan 15, 2018 4:03 pm
The primary value of medical insurance is often the negotiated prices for services.
Not in my experience. I have insurance, but I always ask them the cash price first, before informing them that I have insurance. The hospital near me (and its associated branches of doctors offices) will give you a 40% discount of the list price if you pay in cash at the time of service.

Doesn't really help if you have a $200,000 hospital bill, but I use the cash method for everything small.

runner3081
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Re: Self pay vs insurance

Post by runner3081 » Tue Jan 16, 2018 4:33 pm

LiterallyIronic wrote:
Tue Jan 16, 2018 10:10 am
123 wrote:
Mon Jan 15, 2018 4:03 pm
The primary value of medical insurance is often the negotiated prices for services.
Not in my experience. I have insurance, but I always ask them the cash price first, before informing them that I have insurance. The hospital near me (and its associated branches of doctors offices) will give you a 40% discount of the list price if you pay in cash at the time of service.

Doesn't really help if you have a $200,000 hospital bill, but I use the cash method for everything small.
The question posed by the OP will have an answer that varies by 1) benefit plan and 2) healthcare facility.

The contracted rate for our network is 65% of the charges. Due to this cut, we have had a hard time finding places that give a big enough discount to essentially "increase" our deductible for the year by not running all charges through.

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dm200
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Re: Self pay vs insurance

Post by dm200 » Tue Jan 16, 2018 5:14 pm

LiterallyIronic wrote:
Tue Jan 16, 2018 10:10 am
123 wrote:
Mon Jan 15, 2018 4:03 pm
The primary value of medical insurance is often the negotiated prices for services.
Not in my experience. I have insurance, but I always ask them the cash price first, before informing them that I have insurance. The hospital near me (and its associated branches of doctors offices) will give you a 40% discount of the list price if you pay in cash at the time of service.

Doesn't really help if you have a $200,000 hospital bill, but I use the cash method for everything small.
From previous insurance plans, it is very common that the amount paid (under the contracts) by insurance on the EOBs I would see were commonly well in excess of 40% "discount"

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