Sunday, April 22, 2012

Savvy patient finds hidden discounts just by asking

The following anecdote was written by Suzanne Nesmith, a patient from Arkansas who was a finalist in the 2011 Costs of Care Essay Contest.

My husband and I have been self-employed for many years, and though our income is quite limited, we have always been careful with our finances,  have always managed to live within our means, and have always paid our bills without assistance.  We had private health insurance coverage and saw premium increases each year. Then to avoid further increases, coverage of office visits outside of deductible was dropped, and our deductible was raised to $4500.  Finally, about seven years ago, the cost became prohibitive for us; when yet one more increase was announced, our monthly premium payment would amount to approximately 30% of our monthly income.  We were in relatively good health and, in fact, in 10 years we had only one health insurance claim-- an emergency room visit when our  daughter fractured her arm in a roller skating accident. 

We did not do it lightly, but we made the decision to drop the health insurance coverage we could no longer afford. We started to research alternatives and found Samaritan Ministries International, a Christian need sharing group. It was through SMI we were first made aware of how prices for medical charges could vary, that discounts were often made to self-pay patients, and what a difference simply asking about prices could make. What valuable information—for anyone, but especially for the self-paying!

Recently, I required more than routine health care and my doctor ordered a CT scan.  I called three facilities to ask what the cost of the ordered CT scan would be, understanding that it would not include the physician’s reading fee only and that it would be only an estimate.  The first things that was obvious was that hospitals are unfamiliar (and it appears to me uncomfortable) with being asked this question.   I was often transferred from one department to another, usually ending up in billing or finance, and more than once, was told,  “I’ve never been asked  that before.”   When finally connected with the person who could give me that information, I also asked if any discount was available for self-pay patients, and for cash payment.  The results were so interesting  that I put them in the form of a chart to show to my doctor.  

estimated result
20% discount if contacted within 10 days of billing, and paid with first billing
20% discount for self-pay
20% discount if balance paid within 1 month
58% discount if  ½ paid in advance and balance paid in next billing cycle.

Not only did we have the benefit of cost savings by comparing prices, we had additional cost savings through discounts by  simply asking—these might have otherwise been missed.  My doctor has since ordered a colonoscopy.  So, I called different facilities and was quoted prices of anywhere from $1288 to $1500; and in each instance it was not until I simply asked about any discounts was I told that I could arrange for a 50% discount if I would simply ask to pay (even as little as 1/4th payment) at the time of service.  Simply asking about price and discounts will now be an essential part of my personal responsibility and proactive attitude concerning  my own health care.


  1. Your strategy is brilliant. Imagine if as few as 10% of people who needed non-emergent care asked for and negotiated discounts. It would tilt the current payment structure on its head as providers scrambled to accommodate this new model.

  2. One might also reference the Medicare Allowable in their area. In most States, Medical Allowable for a CT Scan is well under $300. This is public information on the website.

    Most providers will welcome a 100% Medicare rate paid 100% at time of service.



  3. Thank you.
    I too am a part of Samaritan Ministries (and self employed).

    My wife recently required a visit to the hospital. The service was terrible. They lost paperwork, samples, and more. It took us 2 extra hours to get out of there simply because they lost our paperwork. In the end, the work they performed was of such low quality that our Doctor asked us to get the service redone from a different 3rd party provider.

    When we got the bills, the hospital was 4 times as expensive as the 3rd party provider! And the hospital provided less than half the service. The hospital offered us a 10% discount for being "self-pay". (just FYI - 10% should not be considered a discount)

    My solution: file an official complaint with the hospital, never pay a bill unless it is itemized, & I refused to pay this bill in question since their service was so bad (below required medical standards as per numerous other doctors/medical professionals) I had to get the procedure redone elsewhere.

    Unfortunately People need to pay close attention to medical billing.

    Thanks for this informative article.

  4. I recently went through the same thing with my husband needing a colonoscopy. I too asked for pricing, was switched back a forth to serveral different people before finding the correct person. I paid the quoted price up front,in full, only to receive a bill later for $700.00 more than quoted. I called, and they told me that they could only give an estimate, something I wasn't told before hand. I was able to get the $700.00 cut in half. Always ask question and shop for services!!!

    1. Gina,

      I'm glad it worked out for you - but I wonder why you paid the bill. They quoted you a fee. I think you should have stuck to your guns and refused to pay the invoice on grounds that you were quoted a fee for the service. Legally speaking, the fact that you paid in advance shows that they DID quote you a fixed fee.

      The medical industry has become a bully. Yes, big government makes it hard on them... but then they turn around and unjustly punish us with poor service and a horrid billing system that often overcharges.

  5. Charles N RutledgeApril 23, 2012 at 1:04 PM

    Here is a service that I found. I have not used them yet so I don't know how good they are.$320_-_ct_scan_$220.htm

  6. So the point of this story is that one must have money to save money...

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  9. Very informative. It is odd to see the prices vary so much for the same thing. I recently went to a physical therapy appointment and it seemed as though he discounts depended on the billing software in physical therapy practices that they used.

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