Nearly 28 million people in the United States do not have health insurance, leading to an increasing number of people opting to include HealthShare membership in their healthcare strategy. Consequently, more patients than ever are now choosing self-pay when they visit a medical provider. While transitioning from insurance to self-pay may seem risky, particularly for those accustomed to insurance coverage, there are several advantages to claiming self-pay as a HealthShare member.
Advantages of Self-Pay for HealthShare Members
1. Discounts
Patients who claim self-pay or cash-pay receive significant discounts, often 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.
In certain instances, patients who pay in advance or within 30 days may be eligible for additional discounts. 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 contributes to 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.
2. Flexibility
Another advantage of being a cash-pay patient as a HealthShare member is the increased flexibility in choosing healthcare providers. Currently, most HealthShares do not use a provider network, unlike traditional insurance plans, allowing members the freedom to shop around and see the providers of their choice. Even 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.
A 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. Tools like Healthcare Bluebook and Solv are highly rated. These resources empower members to make informed decisions and find cost-effective healthcare options.
3. Avoid billing disputes
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. An additional bonus is that the time saved in avoiding these disputes may result in faster service and shorter turnaround times for members.
Key considerations for cash-pay HealthShare members
1. Credit cards
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. Some patients may prefer 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 the bill in full, any cash discount may be entirely negated by interest charges. For the cash-pay discount to be truly strategic, a patient should ensure they have sufficient funds to pay the bill outright.
2. Insurance coverage
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.
3. Unshareable services
Certain medical services or treatments may not be shareable by a HealthShare. In these cases, being a cash-pay patient may still work in a member’s 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. Additionally, a growing number of retail clinics are emerging, staffed by nurse practitioners or physician assistants who can provide basic medical care at a fraction of the cost of seeing 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. 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.
Government assistance
To find a program that is 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.
Personal Circumstances
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 cash-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.
