Possible to join a discount provider network w/o insurance?

[gigi]

Hi, does anyone know if there is a way to join a discounted provider network such as a POS, PPO, etc. without having health insurance? I'd like to pay in order to be able to use providers within a network and receive the discounted rates for services that are negotiated within those networks. I would then pay the discounted rate out of pocket at the time of service, requiring no payments from or any further involvement from an insurance company, etc.

 

[broggyb]

@gigi That really isn't a thing, outside of dental discount plans.

Cash pay is generally considered a "discount" in that most clinics will offer insurance-adjacent rates to folks who are self-pay / uninsured. This means you can see any doctor you want, provided they're taking new patients, and pay as you go.

 

[gigi]

@broggyb Ok, I just noticed some things like once when I had labs drawn, the company accidentally charged me as a self-pay patient, and the bill was over $1,000. Once they applied my insurance, the discounted rate for the labs was $200-$300. I also read that the average price of a colonoscopy as a self-pay patient is around $1500, whereas the average rate paid to providers by insurance companies is $650. It seems like there are times when the self-pay rate is significantly more than the discounted rate within those provider networks.

 

[broggyb]

@gigi Yup. That's health care pricing in a nut shell. Pricing is all over the place, with virtually no set standards. Some self-pay clinics are trying to nudge that change with transparent pricing models, but it's barely a scratch on the surface of the beast that is our health system. Just yesterday, someone came to this subreddit with a copy of their EOB that showed their local hospital lab charged $1,300 for one of the most common comprehensive metabolic panels, to which their insurance's allowed amount was just north of $300. The lab's cash pay price is $350 or so. When I get that exact same comprehensive metabolic panel at my PCP's office, they're charging my insurance $29. That's it. A dollar short of 30 bucks. And my insurance pays it in full.

Some cash pay customers actually pay *less* than what some insurances reimburse for, so it's all extremely fact, location, and service-specific.

 

[bblessed76]

@gigi That is not always the case. Yes the norm is the network discount will help considerably. But many times the self-pay rate is actually less especially at imaging centers. You need to be diligent and price out both options before deciding which route to take on anything (unless your out of pocket max has been achieved then always use insurance).

To answer your question - no, you cannot just join a network for provider discounts for health insurance. With dental you can. They sell PPO discount plans for cheap. They pay nothing but you get discounts for all dental costs without a waiting period.

 

[sebastian154]

@gigi That is the power of an employer or other POS/PPO sponsor having thousands of patients that can be used to negotiate savings from healthcare organizations. As an individual you simply do not have the same dollars behind you and therefore don’t have the same negotiating power.