When was the last time your doctor told you how much a test was going to cost upfront, before doing the test?
I just got done doing some data consulting relating to this...
There are literally 10's of thousands of procedure codes (called CPT codes) that doctors use when billing a patient or his insurance. You may see the doctor and he sticks a penicillin shot in your arm and you think he just did one thing, but according to your bill you will probably see half a dozen CPT codes.
Further more... when a doctor documents
1 of those CPT codes, it then gets cross-referenced to the appropriate fee schedule. BCBS, Humana, Cigna, Medicare... and probably a limited cash fee schedule.
Why limited?
Because there are literally 10's of thousands of procedure codes and the doctor would have to have his billing staff create a fee entry for each one of those CPT codes for the cash fee schedule.
And he would have to update it annually, just like his insurance ones.
But: He has fancy-pants smart people like me to just import the latest fee schedule from Humana or Medicare, and it takes me 10 minutes.
There's no "source" for an updated cash fee schedule. You can decide to increase everything by a fixed percent (no one wants to do this for some reason), or you can onesy-twosy your way through the codes and adjust prices as your whims dictate.
Result? The cash basis fee schedule simply doesn't exist at most practices. A penicillin shot is worth $35 if you're a Humana patient, $42 if you're a Cigna patient, $17 if you're a medicare patient and $X dollars if you're a cash patient.
If you're a SMART cash patient, you'll negotiate up front to pay cash on a percentage of a particular insurance fee schedule. I'd suggest Medicare, but the docs and office managers all are well aware that that contract pays the least out of all of them. But: paying cash, you can probably get away with 50% of the cost of a standard insurance contract since they don't have the agony of dealing with submitting a claim, waiting for approval, arguing during denials, negotiating a settlement and all the other crap involved.
Did you know that any given small medical office has a BILLING staff equal in size to the number of billable practitioners on site?
But... with cash patients, the receptionist runs your credit card or takes your cash at the end of the session. 3 minutes, instead of headaches and hours (and $15 an hour employees and IT infrastructure). Not unlike the dentist or veterinarian prior to the insurance industry getting their meathooks into those offices.
Cash is king at the doctor's office. You just have to declare so as you begin your relationship with a given office and get the cash fee schedule worked out. Because it probably doesn't exist for the particular CPT codes you're going to use in their computer system.
