- We would call the provider and make an appointment. When we make the appointment, we would indicate we are self-pay. At that point in time they would provide us with an estimate of the cost. It was acknowledged that routine procedures like the check-up we were using as an example have a very accurate cost but surgical procedures would likely not be 100% accurate. In a surgical procedure, there’s more going on that could create variation. I get this. (P.S. Why does it take being a self-pay customer to get a cost estimate prior to receiving healthcare?).
- Once we went to the appointment we would be expected to pay for the estimated cost of the healthcare (check-up in this example). Based on my conversation with the healthcare provider you wouldn’t’ always need to pay the entire cost up front but at least a portion of the cost. Even for a check-up I imagine you could pay a portion up front then be billed. The required “pre-pay” amount likely varies based on services provided and the caregivers policies.
- We would receive a 35% discount on the list price of the procedure as a self-pay customer. This made sense to me. If we cut out the insurer, and the provider gets paid significantly faster, there should be a discount. I would argue it should be greater than 35% but perhaps we’ll find that’s negotiable. As you likely know, insurers negotiate discounts with healthcare providers within their network. With a traditional insurer, even if you have not reached your deductible, you will receive a discount on the provider's list price as long as it is in network. I compared the 35% discount to the discount our current insurer offers. The discount our insurer receives is greater than 35% but it wasn’t drastically more. So, yes, you’ll likely receive a greater discount from a traditional insurer but you pay for it through your monthly premium.
- In this scenario the healthcare provider would get in touch with Liberty (or more likely vice versa) and arrangement for payment would need to be made. The Cleveland Clinic (the healthcare provider I called) would not move forward unless there was assurances of payment. This is where Liberty would likely try to pre-negotiate the cost of the procedures with the healthcare provider (if they could).
However, I couldn’t just rest with one explanation. I found the name of a member of the Finance organization who deals specifically with healthshare ministries and other faith-based groups. He was very knowledgeable and informed me that, while the Cleveland Clinic had negotiated rates with another healthshare ministry: Christian Healthcare Ministries. They were not able to come to negotiated rates with Liberty and thus viewed Liberty members as self-pay. The difference, it seemed was that with Christian Healthcare Ministries they had agreed upon a 50% discount on medical procedures over a certain dollar threshold. That agreement was not reached with Liberty so Liberty members would just receive the same 35% discount that a self-payer receives. Frankly, they indicated they would not negotiate with Liberty in the situation a major procedure was performed. Thus the following questions came to my mind for follow-up with Liberty: