How to Be Your Own Advocate as a Cash Pay Patient
Navigating the healthcare system can be challenging and confusing. This is especially true when trying to find affordable healthcare options in a system largely dominated by health insurance — a complicated and costly financial product.
Health insurance plans commonly restrict freedom and control over healthcare choices. Members of an insurance plan make healthcare decisions that are influenced by the cost of premiums, deductibles, out-of-pocket expenses, and dictated by network restrictions.
Medical Cost Sharing is not health insurance. It’s a free market, non-insurance solution to paying for medical care — as a cash pay patient. It does require learning how to be a savvy healthcare shopper, but the rewards of being in charge of your own healthcare decisions are huge.
Cash pay patients have freedom of choice and price transparency
Members of Sedera Medical Cost Sharing have freedom of choice when seeking providers and value-driven care, and price transparency is always front and center.
However, because medical cost sharing is not insurance, Members don’t walk into a provider's office, hand over their “number” and simply hope for the best. Instead, they are empowered and engaged participants in their healthcare decision-making and learn how to be their own advocates as cash pay patients.
Members find it exhilarating and deeply fulfilling when they realize how much they have saved on their medical costs. Being a cash pay patient can result in significant discounts for high-quality care. Plus, having the support of the Sedera Community for large, unexpected medical costs brings tremendous peace of mind.
It’s important to note that being a cash pay patient doesn’t mean that you have to compromise on the quality of care that you receive. In fact, by eliminating the middleman and having a direct relationship with your provider, you may actually receive better, more personalized care. And, “cash pay” or “self-pay” doesn’t mean you have to pay with actual “cash.” You can also pay by check, credit card, or debit card.
How to find cash-pay-friendly providers in your area
Sedera Members have access to multiple resources to help find cash-pay-friendly doctors and other providers including the Sedera Cash Pay Marketplace where Members can search for:
Surgery, procedures, and medical tourism opportunities
The RX marketplace for discounted prescriptions
In addition, Sedera’s Medical Concierge Service allows Members to request comparison cash pay pricing for doctors and other providers, procedures, and medications.
After Members submit a Medical Concierge request, a Member Advisor will conduct expert research and respond — generally within 2-4 business days.
Savvos — The nation’s largest cash pay marketplace
To give our Members even more opportunities to shop for care, Sedera partnered with Savvos. Savvos is the nation’s largest cash pay marketplace of affordable cash prices for shoppable medical care, including imaging, outpatient surgery, labs, and more.
Members can log in to their own Savvos portal and are empowered with a simple, comprehensive way to shop for cash pay medical care. Savvos is a game changer when it comes to finding providers, reasonable and transparent cash pay prices, scheduling procedures, and simplifying payment.
Sedera Members know how important it is to shop for the best value when choosing providers and medical care to avoid inflated medical costs. Per our Member Guidelines, paying inflated amounts for medical services reduces the effectiveness of the cash pay approach, results in higher costs for the Sedera Community, and results in less funds available for Community sharing.
As such, Sedera reserves the right to reduce sharing for charges that exceed industry price norms. To avoid this we strongly recommend using our convenient Member shopping resources and Savvos to search for the best cash pay price for non-emergency surgery. Plus, because Savvos is such an effective and powerful tool for finding great care at reasonable rates, Members who use Savvos may have their IUA reduced.
How to present yourself as a cash pay patient to your providers
When a doctor provides care to a cash pay patient, they don’t bill a 3rd party administrator such as health insurance. They bill the patient directly. This reduction in administrative overhead is one of the reasons they can provide lower fees for care. As a cash pay patient, you will pay your provider directly for the services you receive.
Being a cash pay patient may be a new experience but don’t worry — most providers are well aware that health insurance is not the only way to pay for medical care. In fact, many providers are free-market healthcare advocates themselves. Here are a few important steps to take after you’ve shopped for value-driven care:
Always let your provider know that you are a cash pay patient when scheduling your appointment.
Ask what cash pay discounts are available.
Ask for the cost of care (if it can be provided upfront). For example, the fee for an office visit or the minimum due at the time of a procedure.
Let them know that you will need an itemized bill that shows the charges for the care received.
Important: If the cost of your care is for an eligible medical expense for sharing, and it will exceed your IUA, it’s best to only pay up to your IUA to allow Sedera to negotiate inflated pricing if needed.
Despite taking the steps above, you might be asked again for your “insurance card” when you arrive for care. Don’t worry! Simply reiterate that you don’t have insurance and are a cash pay patient. There’s no need to mention your medical cost sharing membership.
Information to further empower you as a cash pay patient
As a part of the No Surprises Act, providers must supply all uninsured patients with a Good Faith Estimate (GFE) before providing any goods or services. A GFE includes all expected charges for the goods or services you’ll receive, thereby removing any surprise billing you might receive after your treatment. As a cash pay patient, it is your right to request this in writing (delivered electronically if that is your preference) when scheduling your appointment.
A Good Faith Estimate provides price transparency. If you receive a bill after your medical care that is $400 or more above the GFE, you can dispute the charge. It is then the provider’s responsibility to prove why their GFE was incorrect.
Don’t misplace your GFE once you’ve received medical care! It’s important that you keep it so that you can ensure the final bill doesn’t include any changes, including the removal of discounts and/or inflated pricing.
For more information about Good Faith Estimates and to see a sample one, check out this article on Understanding Costs in Advance.
When a provider asks for large upfront payments
Be aware that some providers may not provide the amount required upfront prior to a major procedure until 2-3 days beforehand unless this is requested in advance.
As soon as you have presented yourself as a cash pay patient to be billed directly, scheduled a procedure, and obtained the Good Faith Estimate, ask for the minimum amount required to pay before the procedure takes place.
Upfront sharing for a medical procedure
If the upfront amount requested exceeds $3,000 and the procedure is scheduled at least 2 weeks in advance, upfront sharing may be available. This is when Sedera shares funds with you ahead of time in order to pay the provider in advance. There are requirements that must be met for this to happen, so it’s critical to contact your assigned Needs Coordinator for guidance through this process.
If a provider is requesting an inflated upfront payment, you have the right to seek care elsewhere. Sedera Member Services is happy to assist you with finding a more cash-pay-friendly provider.
When a provider is unfamiliar with cash pay healthcare
The popularity of medical cost sharing and cash pay medical care continues to grow as people realize there is a better way to pay for healthcare. The popularity of Direct Primary Care has also grown rapidly as a cash pay healthcare option for people who want greater access to personalized primary care, the freedom to choose their provider, and a more engaged relationship with their primary care physician.
However, some providers lack familiarity with the cash pay model or are resistant to it. Red flags are if the provider is unwilling to provide an itemized receipt/bill or requires an inflated upfront payment.
A provider should not pressure you to provide the name of an insurance entity or give them a membership card in order to receive care. As a Member of the Sedera Community, it is important not to mention Sedera or Medical Cost Sharing to providers to prevent any confusion or difficulties with the billing process.
Simply tell them you are a cash pay patient to be billed directly. This is sufficient for them to accept you as a patient and provide all discounts that are available.
Reminder: When you use the Medical Concierge Service and the additional shopping resources included in your Sedera Membership, you gain confidence that the providers on the list are committed to providing reasonable rates and a great healthcare experience for cash pay patients.
Sedera Member Services is here to help every step of the way
Sedera is committed to empowering Members as cash pay patients to help them achieve high-quality, value-driven healthcare for the best health outcomes. And, by being savvy healthcare shoppers, Members can also help protect the Community to ensure there are more funds available for Member Needs.
Being a cash pay patient is just one part of being a Sedera Medical Cost Sharing Member. Here’s even more information on how to make the most of your Membership! Not yet a Sedera Member and want to know more about health sharing? Learn about the history of medical cost sharing as an affordable alternative to health insurance.
If you have any questions about how to navigate the cash pay process or other questions, feel free to give us a call at 1-855-973-3372 or send us an email at email@example.com. We are happy to help!
*SEDERA DOES NOT PROVIDE MEDICAL ADVICE. The information contained herein is for informational and/or educational purposes only and is not intended or implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.