Informed Patient + Fair Pricing = Thumbs Up

An educated health care consumer combined with honest billing practices leads to an equitable outcome.

Two weeks ago my nephew Josh Stone sliced a deep gash into the tip of his thumb. 

What followed was truly astonishing. Josh navigated to the most appropriate medical provider - an urgent care, not the emergency room. He received excellent care and fair and transparent prices up front, at the time of service. In short, Josh didn’t get ripped off by the American health care system. How refreshing!

Josh’s story includes lessons for patients, health care providers and even elected officials. Let’s take a closer look. 

Josh does property management, maintenance and home remodeling. While installing a window, he sliced his left thumb with a razor blade. The gaping wound was a bloody mess, but not life threatening. Josh, a father of three who lives in Fort Collins, Colorado, is an informed health care consumer. He subscribes to this Allen Health Academy newsletter – and reads it! He remembered my recent column that explained how to protect yourself from price gouging at the emergency room. He texted me to confirm the language he should use to alter his financial agreement. “Going to get a couple stitches on a sliced finger,” he wrote.

I called him right away. “Whoa - you’re not going to the emergency room, are you?” I asked. 

Josh was already ahead of me. He’s read my book, “Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win.” That’s where he learned that the prices at an urgent care are much lower than they are in the emergency room. Obviously, some cases need lifesaving emergency care. But the thumb injury could be treated with a lower and less expensive level of medical attention.

Josh avoided the emergency room. He went to Associates in Family Medicine, an urgent care clinic near him. There, he made a couple of other smart money-saving moves. Josh does not have traditional health insurance. Instead, his family uses a health sharing plan through Christian Healthcare Ministries. That means he’s a self-pay patient when he goes to get medical care. 

So he followed another key tip I cover in my book: He asked for the cash price. I have a chapter in my book about how it’s often cheaper to pay cash instead of using your health insurance. Your insurance company may not be getting you a good discount. And if any health care provider says you can’t pay cash if you have insurance, that’s not true, as I wrote about in this column.

This is where I have to give a shout out to Associates in Family Medicine and the elected officials in Colorado. The desk clerk handed Josh a sheet of paper that listed dozens of medical services, from immunizations and lab tests to laceration repairs, EKGs, fracture repair and X-rays. Beside each service the sheet listed (gasp!) a price. Even better, it also listed a billing code for each procedure. Those billing codes allow a patient to check the prices of each procedure to make sure they are fair.

I reached out to Associates in Family Medicine to congratulate them and ask about their pricing, but they did not return my call. The price sheet appears to be in compliance with a 2017 Colorado price transparency law, which requires providing prices to self-pay patients. If you’re in Colorado, ask to see those price sheets whether you’re insured, or not.

Price transparency is also required nationally at hospitals under the federal Hospital Price Transparency Rule. Many hospitals have complied by publishing their cash rates and their negotiated prices with each insurance plan. Now we can see how some patients are unfairly required to pay much more than others just because of their insurance coverage. Unfortunately, many hospitals are still failing to post prices, in violation of the rule. That’s lame! Every patient has a right to know the price of the care they will receive - before the treatment is provided. So let’s applaud Colorado for requiring price transparency, at least for self-pay patients. Other state legislators should do the same - and expand it to all patients.

Josh ended up with a tetanus shot and a dozen stitches on his thumb. To price it, the physician assistant circled a tetanus shot for $61 and a “2.6 to 7.5 cm” laceration repair for $251.

I looked up the billing codes on FairHealthConsumer.org and that’s about the going rate in that area. So let’s give props to the urgent care again, for its fair prices.

When it was time to check out, Josh made another savvy move: He asked for a discount. This nephew makes me proud! You should also ask for a discount when you receive medical care - always. In general, health care billing departments are making up the sticker price and then applying discounts. They ought to give you a break.

Ask, and you shall receive. Josh got 25% off the $312 total for paying the full amount right then and there. His total came to $234.

Josh gets a gold star for avoiding the ER and asking for a discount. Colorado lawmakers get a gold star for passing a law requiring prices to be posted for self-pay patients. And the urgent care gets a gold star for posting its prices, up front, with the billing codes. And even better - the prices were fair.

It’s nice to see that not every medical encounter has to be a billing nightmare. But in this case it took a combination of a savvy and educated patient and a fair billing process at the urgent care clinic. Let’s turn this into a trend! 

Action steps:

• Be an informed consumer. Josh said he didn’t realize an urgent care is much cheaper than an emergency room until he read the chapter on protecting yourself from price gouging in my book, “Never Pay the First Bill.” You can get the book on Amazon for less than $16. It’s worth the investment!

• If possible, avoid the emergency room. Try an urgent care or doctor’s office.

• Get the cash price. Even if you’re insured, the cash price might be less than you’d pay with your insurance plan.

• Always ask for a discount. Don’t pay the sticker price. Ask nicely for a reduction in your bill. The discount should be even better if you pay in full on the spot.

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Coming soon: “The Never Pay Pathway” health literacy videos

The next phase of my campaign to help working Americans navigate our health care system will launch soon. “The Never Pay Pathway” is a series of 16 health literacy videos, 3-5 minutes each, that lay out the principles and tactics in my book, “Never Pay the First Bill,” in an engaging and easy-to-understand way.

I will be crediting by name each person who contributed to my crowdfunding campaign that funded the production of these videos. The executive producers will be named in the video curriculum itself. Other backers will be credited on my website. Please email me right away at marshall@marshallallen.com if you *DO NOT* want to be named as a funder. The videos are looking great and I want to be sure to recognize each person who helped make them a reality. I appreciate you!

My Allen Health Academy smartphone app will launch after the videos - it’s still in production. My other services will include an online group that I will moderate to coach patients, HR people, advisors and others who are dealing with medical billing and health insurance issues. It’s going to be fun to bring this financial health care literacy movement to scale.

Subscriber update

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This is a free newsletter, and I’m hoping you’ll share it with everybody you know, so they can by guided through the financial perils of our health care system. Seriously, if you’re an employer or a benefits advisor, please encourage the members on your health plan to subscribe.

I invite readers to become paid subscribers, and I’m donating those proceeds to hire professional patient advocates for cases that are especially complex. I’ve already used some of these funds to help one patient. I look forward to sharing that crowdfunded victory with you soon, once it becomes final. Your generosity is helping people!