Beyond Insurance – Saving Money on Physician Visits This Little Known “Patient Right” Can Reduce Your Costs

March 21, 2016 7:23 pm Published by Leave your thoughts

A deductible to be paid before health benefits kick in is now the norm for most people. And, as those deductibles go up and up and up each year, fewer and fewer people realize any benefit of even having insurance.

Yes, it’s nice to have coverage there as a security blanket for a major illness, but having insurance may actually cause you to spend more than necessary before your deductible is reached. For most people, meeting their deductible without incurring a major health event is just not happening.

According to an analysis by of one large insurer’s 2012 claims, just under 11 percent of people with a $2,500 deductible met the deductible for that year. For those with a $5,000 deductible plan, the figure dropped to just under 4 percent. Only 3 percent of people with a $7,500 deductible had that much in claims, and at the $10,000 deductible level the figure was just over 2 percent.

Somehow, in some strange fashion, the insurance industry has shifted medical expenses to the patient.

Imagine that!

Let us say that you fall into the 89% (at the $2500 deductible level).
What makes the situation worse for you who are relatively healthy is that you still may need periodic medical care, and during that deductible period. If you don’t know this “patient right” you will likely be spending more than you need to at the doctor’s office.
When you arrive at the physician’s office, after the “hello” the next question is usually, “what is your insurance”. That disclosed, the cost of your visit will be the maximum that the insurance company allows the physician to reimbursed when they, the insurance company, is paying the bill. And that number is often higher than you need to pay. “Your insurance rate (example) for this visits is $130.00.”

But, it needs not be that high if you consider exercising a right that you have under amendments passed to HIPPA (the Health Insurance Portability and Accountability Act).
There is a provision in HIPPA that give you the right to request to make personal payment for medical services, then and there. And of course your payment will be cash, and now you can ask for the cash price, and most medical practice will discount their services in return for payment at time of service directly from the patient.

When a patient makes this request, which they have the right to do, and pay for the service personally, your medical record for those services are precluded from being reported or otherwise made available to that insurance carrier.

This regulation was created to protect the privacy of the young adults who were now covered under their parent’s policies but did not want their parents to know of such things as abortions, or birth control prescriptions.

Why you are invoking your right to request this HIPPA provided option is not subject to question, and needs to be made clear to the receptionist if needed. It is a right you have under the law, and you can use that right to request to pay cash and to pay at a discount for your care.

There is a downside

Now there is a downside – a risk. What if later in the year you have a major illness? What you have paid using this technique will NOT be counted towards your deductible; you will have to meet that required amount using current payment. This is the risk. If you are in the 11%, 3% or 2% noted above, and you use this technique, you will be paying in essence twice.

That said, if you are in the 89%, 97% or 98%, and you are able to turn this HIPPA right into a cash paying discount, you are ahead of the medical game.
A few finer points. Some offices may not be aware of this HIPAA right, although most are more than willing to offer a cash discount. So start with, “can you offer me a discount on that fee if I pay cash now?” You need only mention your HIPPA right if there is initial resistance.

Not so surprisingly, no insurance company will care to tell you or even your physician about this “HIPPA right.” But, HIPPA is Federal law, and it’s your money.

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This post was written by Robert Goff

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