Informed patient + fair pricing = thumbs up, Marshall Allen

*Editor’s note: This information was published in the August 2022 issue of Heartfelt Magazine, CHM’s monthly magazine that provides CHM membership-related tips and tricks, medical advice from doctors, testimonies from CHM members, and more. Please refer to the CHM Guidelines and applicable web pages for the most up-to-date information regarding CHM membership, sharing eligibility, and ministry news.*

Two weeks ago, my nephew Josh Stone sliced a deep gash into the tip of his thumb. 

Josh navigated to the most appropriate medical provider—an urgent care center, not the emergency room. He received excellent care and fair and transparent prices up front, at the time of service. How refreshing!

His story includes several lessons on navigating the healthcare system. Let’s take a closer look. 

Josh does property management, maintenance, and home remodeling. While installing a window, he sliced his left thumb with a razor blade. The gaping wound was a bloody mess, but not life-threatening.

Josh, a father of three who lives in Fort Collins, Colo., is an informed healthcare consumer. He knew that prices at an urgent care are much lower than they are in the emergency room. Obviously, some cases need life-saving emergency care. But his thumb injury could be treated with a lower and less expensive level of medical attention.

Josh avoided the emergency room. He went to an urgent care clinic near him. There, he made a couple of other smart money-saving moves. As a CHM member, he’s a self-pay patient when he goes to get medical care. So he followed another key tip: He asked for the cash price.

The desk clerk handed Josh a sheet of paper that listed dozens of medical services, from immunizations and lab tests to laceration repairs, EKGs, fracture repair and X-rays. Beside each service, the sheet listed (gasp!) a price. Even better, it also listed a billing code for each procedure. Those billing codes allow patients to check the prices of each procedure to make sure they’re fair.

The price sheet complies with a 2017 Colorado price transparency law, which requires providing prices to self-pay patients. If you’re in Colorado, ask to see those price sheets. Price transparency is also required nationally at hospitals under the federal Hospital Price Transparency Rule.

Josh ended up with a tetanus shot and a dozen stitches on his thumb. To price it, the physician assistant circled a tetanus shot for $61 and a “2.6 to 7.5 cm” laceration repair for $251.

When it was time to check out, Josh made another savvy move: He asked for a discount. This nephew makes me proud! You should also ask for a discount when you receive medical care—always. Josh got 25% off the $312 total for paying the full amount right then and there. His total came to $234. (Editor's note: This total is below the qualifying amount per incident, and is thus the member's responsibility.)

In this situation, a combination of a savvy and educated patient and a fair billing process at the urgent care clinic turned this medical event into a win-win for everyone. Let’s turn this into a trend! 

Action steps:

• Be an informed consumer. Josh said he didn’t realize an urgent care is much cheaper than an emergency room until he read the chapter on protecting yourself from price gouging in my book, “Never Pay the First Bill.” 
• If possible, avoid the emergency room. Try an urgent care or doctor’s office.
• Get the cash price. Even if you’re insured, the cash price might be less than you’d pay with your insurance plan. (Editor’s note: As a ministry, CHM is always considered secondary to other sources of funding, including insurance plans.)
• Always ask for a discount. Don’t pay the sticker price. Ask nicely for a reduction in your bill. The discount should be even better if you pay in full on the spot. Editor’s note: Please don’t pay in full for any bill over $1,000 since this can hinder CHM’s ability to negotiate additional discounts for you.

About the author

Marshall Allen is the author of “Never Pay the First Bill: And Other Ways to Fight the Healthcare System and Win.” He’s a two-time Pulitzer Prize finalist and recipient of the Harvard Kennedy School’s Goldsmith Prize for Investigative Reporting. A version of this column originally appeared in his free health literacy newsletter. You can subscribe by clicking here.