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Nearly 28 million people in the United States do not have health insurance, and more people than ever are including HealthShare membership in their healthcare strategy. What that adds up to is a lot of people claiming self-pay when they visit a medical provider. All patients have the option to claim self-pay but being a cash-pay patient is much more manageable when you are a HealthShare member.
When a potential member is just beginning to shop for a HealthShare, making the transition to claiming self-pay instead of providing proof of insurance may seem risky, especially if they’ve used insurance most of their life. But, claiming self-pay, especially when patients have the backing of a HealthShare organization, has many benefits.
When a patient claims self-pay or cash-pay, they will receive a discount ranging from 10-50% off the retail price of medical services. This can add up to significant savings over time, especially if the patient requires frequent medical care. Discounts may be negotiable especially if a patient can prove that they will pay in a timely manner.
When a patient is able to pay in advance (many HealthShares will pay in advance for well-planned services) or pay within 30 days, they may be eligible for an expanded discount. Even if a patient has already received a bill from a doctor or hospital, they may still be able to negotiate the price.
For HealthShare members, any self-pay discount a patient receives for a shareable expense will feed into the community savings. When one member saves, everyone saves. And even if a bill is not shareable, the member will still benefit from the cash-pay discount.
Being a cash-pay patient means not being limited to seeing providers that accept a certain insurance. Additionally, most HealthShares do not use a provider network since that provides the most flexibility and is quickly becoming best practice in the industry. So, members have the freedom to shop around and see the providers of their choice. If a HealthShare does have a provider network, members may still have the option to go out of network with a lower shareable amount. If a sharing organization uses a provider network, their member guidelines should outline how they handle out-of-network providers.
HealthShare may help their members shop for the best prices, or even negotiate on behalf of members. But there are plenty of other tools that can help members shop around for the best cash-pay prices. T
Another benefit of claiming self-pay or cash-pay is that members can avoid billing disputes between providers and insurance companies. These disputes often happen because the insurance company disagrees with how much the provider billed for a service or procedure. When that happens, patients can get caught in the middle. Even worse, they can end up being stuck paying for services that they thought would be covered by insurance. However, when patients claim self-pay or cash-pay, they can avoid these billing disputes altogether. Bonus: the time saved may result in faster service and turnaround times.
Self-pay patient may be presented with the option to pay by credit card. It might be tempting to pay for a medical bill with a credit card, especially if the credit card provider offers rewards for spending. It may make sense for patients to use their credit card, particularly if they receive a cash-back percentage and they can pay the bill in full and on time. However, unless a patient can pay that bill in full, any self-pay, cash discount may be entirely eaten up by interest charges. For the cash-pay discount to be truly strategic, a patient must actually have the cash to pay with.
When a HealthShare member has insurance coverage, it is highly likely that their HealthShare will require them to get all the help they can from the insurance company first before sharing in any eligible medical expenses. The administrators of the HealthShare have an obligation to help manage costs for the entire community. The more help each member can get with their medical expenses, including obtaining cash-pay discounts, the more cost savings feed into the entire membership community.
There may be some medical services that a member needs, but their HealthShare won’t share in. In these cases, being a cash-pay patient may still work in their favor. For example, members may be responsible for their own prescriptions and routine care. Many pharmacies offer $4 or $10 generic drug programs that can help members save on prescription costs. And there is a growing number of retail clinics staffed by nurse practitioners or physician assistants who can provide basic medical care at a fraction of the cost of going to see a doctor. These clinics may even be conveniently located in grocery stores or large retailers such as Walmart and Target.
Even though a HealthShare membership is designed to help with big bills, there may be some services that cost sharing communities will not share in. Remember, starting out as a self-pay patient gives members the best discount they can get on their medical services, so members are already one step ahead. If a member finds themself in a situation where they have a big bill that is not shareable, there are many programs available that are designed to help patients with their medical bills.
To find a program that’s a good fit, members can start by searching online or contacting their local hospital or doctor’s office. They can also check with their state’s department of health for more information. Once a member has located a few programs, they’ll need to call and ask about their eligibility requirements and how to apply for assistance. Some programs may require that members meet certain income guidelines, while others may only require that the patient has an outstanding medical bill.
Healthcare is expensive—there is no way around that. Sudden illnesses and accidents have bankrupted many families, even those with insurance coverage. However, there are options available to help lower costs, especially for self-pay HealthShare members.
Members should carefully weigh the benefits of self-pay against their own needs and circumstances to decide what is best for their family. With the right strategy patients can avoid overextending their finances when they need medical care.
