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Do the High-Deductible Shuffle

Why paying out of pocket at the doctor's office can save you money.


This is part of "Live Large, Spend Less," a comprehensive guide to surviving (and even flourishing) in America's most expensive city. See all of the stories here.

So you’re one of the 17.4 million suckers with a high-deductible health plan, you’re paying for everything out of pocket, and you’re not even sure how much until the bill arrives.

You’re doing it wrong. As it turns out, doctors love getting paid in cash up front, so much so that they’ll usually give you a discount, according to Lisa Maki, chief executive officer of PokitDok, a San mateo–based health-care comparison-shopping app. “High-deductible plans are potentially one of the best things to happen to American healthcare,” she says. With these plans, doctors are processing paperwork only to find that the bill should have gone directly to the patient. According to Maki, that means that they lose around 30 to 50 cents for every billable dollar—and it takes them longer to get paid.

So if you offer cash up front, they have an incentive to give you a discount. Concierge practice one medical charges $100 per visit if you pay in person. “We want to care for our patients in the most affordable way possible,” says chief executive officer Tom Lee.

Insurance companies will sometimes put those payments toward your deductible. Discount double whammy.


Originally published in the November issue of San Francisco

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