List Price Bypass

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Dr. Jeffrey Singer writes a nice piece in the WSJ about how his patient saved $17,000 by NOT using his insurance.  The details are there for you to read and I highly recommend it.   The patient had what seemed to be a high deductible plan and was given a quote by the hospital about what cost was going to left for him.   It was insane.  Then, the surgeon got involved and here is what transpired:

So we canceled the surgery and started the scheduling process all over again, this time classifying my patient as a “self-pay” (or uninsured) patient. I quoted him a reasonable upfront cash price, as did the anesthesiologist. We contacted a different hospital and they quoted him a reasonable upfront cash price for the outpatient surgical/nursing services. He underwent his operation the very next day, with a total bill of just a little over $3,000, including doctor and hospital fees. He ended up saving $17,000 by not using insurance.

Most people are unaware that if they don’t use insurance, they can negotiate upfront cash prices with hospitals and providers substantially below the “list” price. Doctors are happy to do this. We get paid promptly, without paying office staff to wade through the insurance-payment morass.

This is disturbingly common.  Insurance companies have to now pay for screening colonoscopies but if they pull a polyp then they call it diagnostic and pay nothing.  How is that fair?  You are left negotiating with the endoscopic center and good luck with that.

My only hope is to spread the word.  Hopefully we can get to the point that even if you have insurance, that the hospitals, urgent cares, and endoscopy centers will allow you to negotiate.  Until then, if you have a high deductible plan, then it just may be better to lie.  How sad is that?

** If you have more examples of this scam please leave a comment so others may learn.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  3 comments for “List Price Bypass

  1. Marc Whitacre
    August 29, 2013 at 11:42 pm

    I used to run a surgery center in a region where BCBS paid the local hospital very well for cataract surgery — so well that it was cheaper for a patient on a high-deductible plan to pay the surgeon and ambulatory surgery center our cash price rather than pay the co-pay and deductible for just the hospital facility fee! Of course, by not paying the deductible and co-pay the patient was gambling that he/she would not have another major medical expense that fiscal year, but most patients were willing to take that chance. We also ran into issues with colonoscopies and biopsies, which our GI docs had not sorted out by the end of my tenure.

  2. cgknoxmd
    August 28, 2013 at 12:00 pm

    Rather than pay the extra $450/month pregnancy rider, I elected to pay out of pocket for all three of my children. I negotiated with the obstetricians and the hospital, who gave me a flat, discounted rate for paying out of pocket in advance. The amount spent was less than I would have paid in insurance premiums. So when patients tell me they can’t afford a relatively small charge because they don’t have insurance, I think “No, you can afford it, because you don’t have insurance.”

  3. J. R. Johnson
    August 28, 2013 at 10:06 am

    One would think that health insurance companies would exert market forces to keep healthcare costs down- but that doesn’t happen. Here is a good column on how insurance companies actually increase healthcare costs. I highly recommend it as a companion piece to Dr. Singer’s WSJ article.

    http://opinionator.blogs.nytimes.com/2013/08/13/the-cure-for-the-1000-toothbrush/?_r=0

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