Healthcare hack I couldn’t believe works!

Just ask the question. How much does it cost if I pay cash today? Nobody does this at the sign in desk when they go for medical care. But even if you have insurance, chances are you’re a cash payer until you hit your deductible for the year. So you’ve got to take control and ask some simple questions up front, especially when getting something really expensive like a CT scan.

I learned the hard way that with the ACA that the wrong question to ask is “Do you take my insurance?” I know it’s practically an automatic question when anyone makes an appointment. The answer “yes” doesn’t always mean I’m getting that care for free though. Far from it, my out of pocket this year is $5,000, and on top of my monthly cost, I’m paying $11,000 before my insurance even kicks in!

Recently I was ordered a couple of common, but really expensive diagnostic tests that many of us will have at some point: a chest x-ray, sonogram and CT scan. I’ve had testicular cancer in the past, and luckily 25 years ago my great surgeons and oncologists at JHU were able to treat and cure me of the disease! And sometimes I’ll get a feeling, a lump or other bump in the night that just rattles me and makes me afraid that it is back again since I only lost half my reproductive system to that menace called cancer. And luckily again I have two beautiful, healthy children through natural means thank God! (More about this cancer thing in my next article…)

I digress. So these tests were ordered by my urologist to detect possibly a hernia but also to rule out a recurrence of testicular cancer, or worse. I took my papers requesting a chest x-ray, sonogram and CT scan to the hospital in New York that my doctor works for, let’s just call it Big University Hospital or “BUH” for short to protect the innocent and the guilty alike.

Now when I get to the diagnostic center, it is in a beautiful wing of BUH staffed with friendly and hardworking people. It’s a welcoming environment, unlike many practices and procedure rooms in any big city. So I feel very good about what’s about to happen to me even though I could walk out knowing that I’ve got cancer again.

I’ve had a few CT Scans in my life. Enough to know they are damn expensive but really amazing diagnostic tools. I know I need this test. But I also know that my odds of needing it RIGHT NOW to give me an answer about that lump in my abdomen are pretty low. So I decide to do something I’ve never done before in healthcare…. Wait for it….

I ASK “HOW MUCH WILL EACH OF THESE TESTS COST?”

The most magical, taboo and IMPORTANT words I have ever uttered in a hospital or medical setting in my life.

Here’s why.

I was expecting a standard response. Something like “Your insurance carrier will tell you. Please give them a call.” Or, “We can’t disclose that information.” But I guess in this new age of the ACA/Obamacare, information is now a lot more accessible and for those who ask the question extremely empowering!

Why should you ask how much healthcare services cost? Many reasons. Most importantly is because it’s your money! You, like me, probably have a pretty high out of pocket minimum in your plan due to the changes in health insurance structure ushered in by the ACA/Obamacare. My plan is pretty good actually. I have “Nemo” insurance (again not the real company name) and with the “Simple Silver” I get good coverage, high tech features like apps to find doctors and a nice help desk and my medicines are completely covered with no co-pay. Great right? Wrong.

My out of pocket cost for the year is $5,200. That’s on top of the $5,000 per year I pay for coverage on a monthly basis. And that’s why I asked that magical question “how much will each of these tests cost” because even though my insurance plan would be billed, I will still pay the full amount of the test “out of pocket.” Which means in plain English that I am buying these tests with my own money. But unlike anything else in this world, I wouldn’t know what I’m paying until after I get the service and I get my bill from Nemo a few days later. It’s like going to a restaurant without prices on the menu. But in the case of healthcare, you usually don’t have that many options before you indulge in the “meal” and get treatment since your doctors direct the process and where you go for testing etc. Who is going to “shop around” for MRI’s, Cat Scans and other diagnostic tests? Well, we all should!

“How much will each of these tests cost?” I ask with a certain amount of hesitation.

“I don’t know, but I can look them up for you.” Says the very nice woman at registration, let’s call her Marge.

“Great!” I say, “My health insurance plan is Nemo Simple Silver.” I say with confidence since I really like this new type of insurance company that I have.

“Ok, let’s see.” as Marge flips through her notebook she lands on a plastic sleeved page that conveniently lists prices for each of my tests.

I can’t help but wondering what all the different numbers are so I ask “What do all those prices mean?”

“Oh, they are for different plans. One for Medicare, one for no insurance and one for your plan.” Says Marge.

But I causally notice something, doing my best to read upside down, since why not it is my money and this is my “menu” from where I’m ordering this expensive buffet of diagnostic delicacies at this healthcare restaurant.

“Your sonogram will be $820, your chest x-ray $152 and your CT Scan $2,300!”

Marge has my full attention now. Over $3,000 for all three. That still won’t even get me to my “out of pocket” minimum of $5,200 for the year. And realizing it is all my money that I’m shelling out, even though it will be through an elegant system of billing my insurance and then Nemo sending me a polite notice that I must pay in full that whopping $3,272 out of my bank account and into theirs within 30 days.

So I ask the second most important question in healthcare….

“WHAT IF I PAY CASH TODAY?”

I don’t know why I asked it. I think I read or heard from someone in the medical community that if you ask how much a cash price is then you could get some savings. But I never knew or dreamed how much it would be! Utterly shocking, amazing and really mind blowing is what I actually found.

“Well I don’t know, but let me ask my supervisor,” was Marge’s polite and actually curious response. You see nobody really asks that kind of question when they have insurance. It’s always the same thing. “Do you take my insurance,” asks the patient? “Yes” says the admin. “Great” says the patient! “Ok, please have a seat and the doctor will be with you shortly” says the admin and that’s about all that someone gets by way of pricing information for healthcare… Until you get hit with the bill.

Marge comes back to me about 15 minutes later and calls me over in a hushed voice. “Anthony, my supervisor told me that if you pay today with your credit card or debit card, the tests will cost $52 for the x-ray, $450 for the sonogram and $1,200 for the CT scan.”

OMG! I scream silently in my head. I just saved about 50% by just asking a couple questions and waiting 15 min for my exams to begin. OMG. Now I love a good deal. And even more so when I can uncover one that’s really hard to find like this one.

But I’m not done. “Ok that’s awesome Marge! Thank you!” I say now really trying to control my joy and glee. Which is totally ironic and somewhat nuts since I’m about to have tests to rule out cancer. But I’ve been there done that so many times that it’s just not so scary anymore I guess.

So I decide to double down on my quest for savings and control over my healthcare costs, “I’ll just do the x-ray and sonogram today Marge, thank you. The CT scan can probably wait anyway so I’ll come in another day for that one.”

“Ok Anthony. No problem. Please have a seat and the doctor will be with you shortly.” Says Marge kindly and in a great mood since she’s made someone so happy with the pricing her manager was kind enough to grant me.

So now feeling very curious about this CT Scan pricing since I got such a good deal on my sonogram and x-ray, I start googleing things like “cheap CT Scan” and “lowest cost CT scan in NYC”. There are plenty of sites offering pricing on these tests, but the lowest cost ones are in Pennsylvania and they are still about $800. It’s not worth my time and travel costs to go to Philadelphia versus BUH where Marge and her manager have given me my cash discounted rate of $1,200.

Since I’m a bit older and can remember the days when you only had to dial 5 digits to call someone, I decide to start calling around to medical imaging centers in NYC just to see how they compare to BUH and the deal offered on the websites but all the way down in PA.

I call another big city hospital, let’s call it “City Memorial.” “How much is a CT with and without contrast for lower abdomen” I ask confidently expecting to be treated respectfully, which I was.

“What’s your insurance?” says the woman on the other end. “Nemo Simple Silver”, I say.

“Ok your insurance negotiated rate is $3,200 for that test” says the woman.

Feeling like I have nothing to lose since BUH I know will do it for $1,200 and in PA I can get it for $800 I go into my negotiation mode.

“Can you ask your manager if I were to pay cash at the time of the test, would you give me a better cash price of say $800?” I say mater of fact.

“Let me check”

After a few minutes the nice woman comes back.

“My supervisor told me that your exam, the CT of abdomen with and without contrast, if you pay with your credit card and no insurance, will be $470.”

Another OMG moment! That doesn’t make any sense to me since I offered $800. “Just to confirm, so if I come in with this order for my CT scan and pay with my credit card, the total cost will be $470?”

“That’s right” says the nice lady, who’s now my best friend in the world since she’s basically given me enough savings to go on a trip to Miami.

“Ok, when can I come in?”

“Tomorrow at 7am. Don’t drink or eat for four hours before you come in for the exam.”

“Great! See you tomorrow.” I say practically hugging her through the phone.

I go in the next day expecting some excuse or glitch in the system to hit me with a higher price. But it doesn’t. The test goes well and the machines are close to new as far as I can tell. The people are very nice and the bill that I pay upfront before my exam is $470. I pay with my debit card just and the exam goes as expected without any complications.

When I get back to my office, I can hardly control my excitement with my team. I relay the story and in disbelief we discuss what just happened. Nobody can believe it. But it’s true. They all heard me negotiate the rate the day before. And at City Memorial the center was clean and the CT machine was new and the people were really great.

So how in the world did I get an 80% discount on a CT scan that would have cost me $3,200 if I just went with the standard insurance reimbursement and out of pocket billing system that everybody always just mechanically goes through? Honestly I have no idea. All I know is that asking the questions in the right way and being prepared to pay up front in “cash” is a magical thing in healthcare!

There’s more to the story. That day at BUH I noticed that the pricing of my sonogram was laid out very nicely on the page in Marge’s notebook. I glanced across the line and saw: Medicare $210 No Insurance $450 With Insurance $820. I would pay the “no insurance” rate which I deciphered means “cash pay.” Why is there such a wide difference in cost? I thought that the promise of ACA/Obamacare was “affordable healthcare” for everyone? Why do I pay 5 TIMES more than the government plan does for the same exact test through my insurance? That’s a topic for another article but it went through my mind more than a couple times during this journey.

The lesson, and one of the most cost saving lessons I learned from this experience is this. If you have the opportunity to ask how much your healthcare procedure costs then you should ask early and ask often! Especially if you have insurance with a high deductible/out of pocket limit.

When you have to go through diagnostic tests or treatments you should be armed with a few simple facts and be prepared to ask a few important questions.

1. Be prepared with knowledge of your exact plan, your co-pay and out of pocket maximum for the year.

2. Be prepared to pay with cash — which means with a credit or debit card (not actual $20 bills).

3. Know what exams you need and how to talk about them specifically. Ideally you have what’s called the CT codes but you don’t always need them. Just read the doctors’ orders before you go into the exam center.

4. Ask these questions:

a. How much will each of these tests/procedures cost individually?

b. How much will my insurance be billed?

c. What if I pay cash today without my insurance, what DISCOUNTED CASH PAY RATED CAN YOU OFFER ME?

5. If you don’t get a discount of at least 40% from what your insurance pays, then be prepared to ask the “supervisor” why and if she can do better.

6. Finally, if you’re tests or procedure isn’t life threatening or an emergency, then be prepared to walk out and shop around!

I learned so much from this experience and I saved roughly $2,200 by asking a few key questions and doing things a lot differently than I had ever before in the navigation of my healthcare options. When I was with big wall street firms, I had the now reviled, politically incorrect “Cadillac Plan” where everything was covered with just a miniscule $20 co-pay. So of course I got the best care I could find and didn’t care how much my insurance paid.

But now with a startup and my own healthcare costs coming out of my own pocket more and more, I want to know and I want to be in control.

Ironically, as an empowered and informed healthcare consumer who asked, negotiated and paid upfront for my care, I was able to save over 70% on my exams!

Even more shocking is that you don’t have to do much negotiation. It seems like hospitals and centers are prepared to offer “cash” prices and will do so readily when asked. But you have to ask! So even more ironically, the most important thing in saving money today really isn’t the ACA/Obamacare, it’s your own knowledge, preparation and action.

Now in healthcare, you have to ask the question you always ask before buying something expensive in every other part of your life. “What does it cost?” The answer may surprise you, empower you and certainly enrich you. Who knows maybe that trip to Miami can ease the pain of going through the whole ordeal as well!