Nurse Katz,
With health care costs and my health insurance deductibles on the rise, how can I assure that I don't go broke just paying my deductible?
Amy
Chevy Chase, MD
Dear Amy,
Unfortunately, this is a common concern for many, which is why I call it the "curse of the rising deductible." Many people have been forgoing or delaying, necessary treatments, because their deductibles are so high, and god knows what other expenses my not be covered. This is what I call the curse of the rising deductible. One solution I have mentioned in my books to this problem is knowing when you may get a better deal by paying cash. Of course, there are exceptions, but in most cases, there are just a few steps you need to take in order to get the best healthcare for less:
1. Know the "market value" of the procedure you are getting: If you have a chance, price around. There are several apps and websites that can save you time from calling around and asking for procedure prices. In fact, some providers may be reluctant to give them to you. I have even listed a few of my favorite apps and websites in my latest book, Healthcare Made Easy, but there are plenty others that are out there. If you decide to do this the "old fashioned way" by calling around, here is a trick that can work if you get push back; let the "billing person" know that you are interested in paying cash upfront. You might be surprised at the response, especially if you let them know what their competition is charging! Also, be sure you do not call at a busy part of the day. Keep in mind that you might have to call back if the original person is in a bad mood....everyone is entitled to a bad day, and being pleasant always helps.
2. What is your budget? This is KEY when negotiating. Now that you know the going rate," be sure you are realistic about your budget. Don't throw out a number you cannot afford, and keep it as close to the "going rate" as possible.
3. Do you need to use your health insurance? Know how to maximize the benefits of your insurance plan. Do you have a high deductible that you may never meet? Do you have more procedures in the future that may/may not be covered by your health insurance? Does the facility and its "outside entities" even accept your insurance? Generally, as soon as a facility hears you have health insurance, the charge will be more; however, if you offer cash upfront, the facility is more likely to discount the rate because they know they are getting the money immediately without the hassle, which also means less paperwork and time taken from their staff. Here is an example of a "cash accepted rate" 
4. Get a receipt: Today, most medical offices are understaffed, very busy, and turnover is high. So if you worked out a deal, be sure you get a receipt and file it away. There is always that chance that your paperwork may end up in the "unpaid pile," especially since you may not be the "typical patient." Today, most patients have health insurance, which can be confusing to the billing staff when your paperwork is passed on. If you don't have the cash on hand, use a credit card. This way you have "double proof" that you paid upfront.
Keep in mind that some facilities refuse to discount their rates, even if you are paying cash, but you have the right to go somewhere else. Don't let your health insurance dictate where YOU want to go. If your desire is to go to a certain facility because you have a great relationship with the staff and you trust the care you will be getting, go for it and work out a deal! It is not worth sacrificing your health, when the stress of fighting a bill and poor care will cost you more than that high deductible in the end.