[Amadou]

A couple of months ago, Time magazine (of all places) did a really good story about the lack of price transparency in healthcare and how that may well be the single largest contributor to the burgeoning healthcare costs in the US. I think it is behind a paywall, here is a starter though:

http://www.time.com/time/magazine/article/0,9171,2136867,00....

In a stunning example of competence and efficiency, the US government responded to that article by publishing a ton of medicare pricing information on a hospital by hospital basis. Here's one article discussing the data:

http://www.boston.com/lifestyle/health/blogs/white-coat-note...

FWIW, as a person who has been using catastrophic insurance (e.g. super high deductible) for over a decade I find this move to more price transparency long over due. I've had the experience where some practitioners simply refused to take cash up front, it was insurance or nothing while others would give a significant discount, like over 50% for cash up front. We've still got a long, long way to go, but it's a start.

[EvanAnderson]

Fellow high deductible plan-holder here. Have you run into the circumstance yet where a provider is under an exclusive contract w/ your insurer and, once the provider finds out who your insurer is, is obligated to refuse to allow you to pay cash? I've had this happen 3 times in the last year and it's driving me mad. The providers were unwilling to talk to me unless I divulged my insurer, and when I did they were then unable to give me cash pricing. Maddening.

[jen_h]

Or worse, some providers won't even provide care if you are a high deductible insured person paying cash.

On more than one occasion after having an appointment scheduled, and mentioning to the provider that we have a high deductible, doctors' office staff have changed their stories and claim that they didn't accept our insurance or that they weren't accepting new patients (after already putting family members "into the book" for an appointment, even; one provider used one excuse after another, despite prominently advertising in the local paper that they are looking for new patients and "accept all insurance"). Another office actually claimed that the doctor had gone to lunch and wouldn't be back for 3 hours...immediately after I told her our deductible amount--her mouth dropped open and she ran back into the back and came back with the lunch story. I don't understand it, because I offered to pay up front and the care was always for simple issues that never would have hit the deductible nor broken the bank anyway (a flu in one case, a basic checkup and blood tests in another). I assume it's illegal, too, otherwise the universal response wouldn't be a stammered excuse.

This kind of behavior does help to weed out bad doctors/doctor's offices (net good, I guess?), but in a situation where your issue isn't bad/acute enough for the emergency room and not forestallable enough to wait a month to get an appointment for a good doctor, it's really frustrating.

Luckily, there's a nice urgent care locally with prices on the walls, accepts real money and even gives a cash discount, and handles the basics...but for traditional/specialist doctor's visits, I no longer offer up any information about the fact that the deductible is high and we're paying for services ourselves before the appointment.

[Amadou]

I have not had that happen, but it is rare for me to see a new doctor. I would be super pissed though. I'd be writing to my state attorney general if it happened to me.

[jrmg]

Why do you want to pay cash? Wouldn't it be better to pay via your insurance company to 'use up' some of the deductible?

[LogicX]

That only works if you anticipate regular medical needs that will 'save' you money by tapping into insurance.

Otherwise if you never anticipate hitting your deductible for the year, it makes more sense to pay a discounted cash rate out of pocket, and maintain the insurance only for a catastrophe situation where you far exceed your annual deductible: preventing yourself being stuck with a $100k hospital bill.

[drakeandrews]

As far as I am aware, most deductibles are per-incident. If you have a $5k (figure pulled from arse) deductible and paid $1200 last month, $2300 last week and have a bill for $2000 today on three visits for three separate things (with three separate bills), you still owe $2000 because that bill is under the deductible.