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.
| Facility | Estimate | Discounts | Estimated result |
| XXX | $2921 | 20% discount if contacted within 10 days of billing, and paid with first billing | $2441 |
| XXX | $5459 |
20% discount for self-pay
20% discount if balance paid within 1 month
|
$3276 |
| XXX | $3849 | 58% discount if ½ paid in advance and balance paid in next billing cycle. | $1616 |
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 1/4thpayment) 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.
Suzanne Nesmith is a patient.
This story was part of the Costs of Care 2011 healthcare essay contest, with the goal of expanding the national discourse on the role of doctors, nurses, and other care providers in controlling healthcare costs. These stories from care providers and patients across the nation illustrate everyday opportunities to curb unnecessary and even harmful health care spending on a grassroots level.
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