Out of Pocket

Healthcare providers often struggle to decide how much a procedure will cost, especially for insured patients. Out-of-pocket patients will ask about a specific price only to be told, "we don't know the price until the end of your visit." This is obviously dysfunctional. Patients can't be expected to sign a

The Washington Post reports "denials of health-insurance claims are rising — and getting weirder". They go on: [health insurance] companies appear increasingly likely to employ computer algorithms or people with little relevant experience to issue rapid-fire denials of claims — sometimes bundles at a time — without even reviewing the patient’s medical

Medical debts of less than $500 are now being ignored by the credit reporting agencies, apparently at the behest of the Biden administration. People with debts like this have already seen their credit scores rise as a result. However, lower-income people will now find it harder to get medical care.

Many healthcare providers offer a discount to financially vulnerable patients. These go by various names: * Self-pay discount * Cash-pay discount * Prompt-pay discount These discounts have good intentions. Unfortunately, they create some fairly serious dangers for both providers and patients. There is probably only one viable way to address these dangers, which

Yes, most Americans pay entirely out of pocket for their healthcare in each given year. That might be surprising, considering that most Americans have health insurance. But most health insurance policies do not prevent you from paying out of pocket. Before we get into explaining why most patients pay for

No, private health insurance prices are not the best prices on medical care. In fact, private health insurance prices are generally normal market prices. If you want the best prices you must be part of a non-insurance network. You may have heard that insurance companies negotiate big discounts on healthcare

Unfortunately it's true, most health insurance is effectively non-insurance. That's because most people can't afford their deductible. Most people with health insurance have a high deductible plan. That means they are paying a relatively low premium in exchange for a relatively high deductible. Around half can't afford their deductible. That

If a healthcare provider fails to file an insurance claim on your behalf, files it incorrectly, or fails to pursue a denial, who is on the hook?  It turns out you are, dear unsuspecting patient. Patients worry that insurance claims aren't being filed properly It's fairly common for patients to

Many people have come to believe health insurance is a predatory scam.  While that might not be fair, it is totally fair to be frustrated because you aren't getting value for your money. People pay for health insurance in exchange for two main benefits: 1. Covered healthcare expenses 2. Discounted

Most people paying for healthcare are paying out of pocket.  Naturally, they want the best prices to minimize the cost.  While health insurers usually negotiate modest discounts, you can get much better prices by paying directly, without insurance being involved.  This is called paying "cash," although it might actually be

Reddit user PearlLo writes: Basically until you meet your [health insurance] deductible it's a medical discount plan. Is that true?  Basically, yes.  Until you have paid out of pocket up to your annual deductible amount, health insurance is simply a way to get discounts from list prices – but not necessarily

Is it possible to get healthcare anonymously, without revealing your name, address, or social security number?  Yes, it is.  We'll show you how to arrange an appointment, pay for your care, and even get the best possible price. What kind of patients want healthcare anonymously? People might want to receive

For many Americans, health insurance is a major recurring expense.  The price is often heavily influenced by whether they are married or not.  In some cases it is much cheaper for a couple to be married.  In other cases, it is much more expensive for a couple to be married.

An impactful new report on medical debt concludes: "Sick and struggling to pay, 100 million people in the U.S. live with medical debt".  This report is the product of a reporting partnership between KHN and NPR exploring the scale, impact, and causes of medical debt in America.  What they

Reddit user Soupcindy writes: I asked the [healthcare provider] about doing it cash pay, and they said they do not recommend getting a CT scan via cash pay, because if they find something, then my insurance can deny further claims to treat whatever they find because it was cash pay.

To quote Reddit user failed-at-culting: Yes, if your estimated monthly healthcare costs are less then your insurance premiums (90% of Americans) then you are better off with a high deductible plan and an HSA with some access to that money. In other words, they are saying the cheapest health insurance

When you pay for health insurance, you expect it to cover procedures your doctor recommends.  But in many cases it doesn't. For example, consider this story posted on Reddit: Just found out this morning that my insurance denied the authorization for oophorectomy surgery because it is not medically necessary. My

Americans say the biggest problem with healthcare is cost. In fact, Americans say their biggest problem generally – perhaps their only big problem – is the high cost of healthcare. But are innovators avoiding the problem? SXSW Interactive is one of the most prestigious annual events for entrepreneurs and other business innovators.

The healthcare industry is full of acronyms and unusual terminology.  Maybe your doctor's bill has an acronym you don't understand?  Or your insurance paperwork has a term you've never seen?  Use this alphabetical dictionary to help you decipher the heiroglyphics of healthcare. * Authorization (prior authorization): Confirmation from a health insurer

Yes, hospitals usually charge uninsured patients the highest prices. The Wall Street Journal reports: Cash payers are often charged more than insurance companies for the same service by the same hospital, according to a WSJ analysis of previously confidential data To people who follow the healthcare industry, this is no

Will Bruhn is the co-founder of Restoring Medicine, and he wants to fix American healthcare.  How does he hope to accomplish such a daunting objective?  With transparency. In a YouTube video he explains his perspective: * In a well-functioning market, prices are consistent and informative.  In the American healthcare market, prices