A few data points from recent years:
1) A family practice we used to use in Western MA had 2 doctors but 9(?!) office staff, primarily for handling billing. They offered a 40% discount to “self-pay” patients if you paid on the spot instead of having their team deal with payments.
2) While self-pay, we had one bigish event in recent years: There were 10 separate bills from 2 different hospitals, 4 different doctors (ER docs, radiologists, anesthesiologists, orthopedic surgeons), etc. Discounts range from 0% to 60%.
3) While insured recently, we had one bigish event: There were 7 different bills. Same sort of story. It’s no less confusing when on a high-deductible plan than being un-insured because you still get a million bills. The only difference is you don’t need to ask the doctors/facilities to give you a break on the fees because the insurance company does that for you. Similar discounts. Roughly 0-60%.
4) It was cheaper to pay out of pocket while uninsured BUT it’s not exactly that simple because:
4.1) There are now state (and federal) fines for not being insured
4.2) Self-employeed people cannot deduct health care costs unless above 7.5% of income. But they can deduct premiums.
4.3) You can’t have a pre-tax HSA medical-bill savings account unless you have an insurance account.
4.4) Discounts are guaranteed and it’s a pain to deal with this.
5) Back in the olden days when on an HMO with no deductibles, this was alot simpler. Now of course, those plans cost a fortune. Equal to paying the premiums plus the full OOP (Out of pocket max) on most plans with deductibles. So it doesn’t make sense. Less paperwork though.
This is a mess.
Erik's Blog 