It seemed unthinkable, but I decided to ponder about it anyway. Would it be possible to have a hospital birth without maternity coverage? I had time, and I had options, so I decided to figure it out. I have to start by being transparent. As the title implies, I am a physician, specifically an ob-gyn. Many people will think that affords me a significant advantage over the general population or hand-shake discounts, but this is not the case. My main advantage was knowledge of codes, which can be requested or even searched online. I also have an understanding of the existence of the self-pay discount, which is what I want to share with my readers.
The whole idea behind this article is to convince you of a few things:
1. You have options.
2. Health insurance is not the same thing as health care – your insurance carrier is not in charge of your health care; you are.
3. With enough patience, anyone can learn to navigate this system, which may help improve it for all patients in the long run.
The group health insurance plan available to my family would be ~$1,000/month and covered 80% after a $3,000 deductible. Without knowing the plan’s contracted rate with the hospital, I assumed I was already in for the full $3,000 deductible plus 20% of this not insignificant as of yet undetermined amount (this 20% is referred to as coinsurance). Then I factored in the additional cost of the monthly premium (something many forget to do as it cleverly sneaks out of their bi-monthly paycheck). If I chose to insure my family with this plan for the duration of the pregnancy and postpartum period, the yearly premium alone would be ~$12,000 (If I chose coverage for myself alone, ~$5,500).
My next move was to go to the hospital financial office to inquire about the self-pay charge for a maternity stay. They were slightly caught off guard by my inquiry, but I got an answer after one call and one in-person visit and was pleasantly surprised. For an uncomplicated maternity stay, they quoted between $3,100 and $3,300 (representing a 70% self-pay discount), with the latter charge being for a cesarean section. So again, with just a reasonable guess at the 20% coinsurance, I am spending roughly $10,000 on premiums. Patient responsibility ($5,500 in premiums + $3,000 deductible + a guesstimate of $1,500 coinsurance) for the maternity stay if I insure only myself, and roughly $16,000 (same math as above but with $12,000 in premiums) if I am insuring my family for the year. Even without factoring in the separate physician fees (which would also incur 20% patient responsibility coinsurance), it seemed like a no-brainer. So I decided to go the self-pay route.
I was even more surprised when my hospital offered me two options: an additional 5% discount for payment in full within 30 days or an extremely reasonable payment plan. When all was said and done, the payments I made to the hospital and the fees I negotiated with my physicians totaled around $6,000.
Most large health care organizations are like any other marketplace – they are willing to negotiate rates with anyone willing to pay. I believe that they have begun to appreciate the self-pay population for the liquidity that the arrangement offers (keep in mind that if you are using insurance, it violates the insurance contract for the hospital or physician to negotiate rates, though payment plans may still be an option). If you can plan for a medical event (elective surgery, maternity stay, etc.), and even in some cases that aren’t predictable, being self-pay allows you to take an active role in negotiating your fees.
Health insurance is not the same thing as health care. I feel like I want to say that again… Health insurance is not the same thing as health care, but the middle-men (that add little to no value) have spent a lot of marketing dollars (your insurance premiums) to convince us that these two things are equivalent or interchangeable. They have also somehow convinced us that we could not exercise any other option.
By convincing consumers that health care comes from being insured, rather than it being a skilled service provided by medical professionals, these middle-men are commoditizing the doctor-patient relationship, and they are profiting at the expense of your health care. Every dollar in the pockets of non-value-added intermediaries is a dollar less towards your health care. In essence, you are loaning them money, hoping that they will pay you back when you need it. Publicly traded health insurance companies have much more incentive to satisfy their shareholders than they do to maximize the dollars paid toward patient health care.
But, if, as patients, we recognize that we are consumers of the healthcare industry and we are in control of our healthcare, there is power in that. The slowly burgeoning “direct-to-consumer” health care movement seems to demonstrate this and has asked the middle-men to wait in the parking lot. We are patients, people, human beings. Our health care should not be a commodity to be bought, sold, and publicly traded.
Before beginning this journey, it is essential to note that the self-pay health care market still has a long way to go. Smaller facilities or physician practices may not have a self-pay fee schedule or any comfort level in managing self-pay debt, so it takes a lot of research and pavement-pounding to create your “network.” I am currently navigating this in my practice and with less boldness than I would like to admit, just like leaving the matrix as a patient was nerve-wracking, doing so as a physician is also scary. My hope in writing this is that more people feel empowered to take control of their health care and, in doing so, foster the creation of this patient-centered marketplace.
Dr. Barrett is an OB/GYN and amateur blogger in Savannah, GA. Please visit her site, notacommodity.com