How To Pay For Surgery Without Health Insurance

Three months ago we had a baby and paid for it without health insurance or government aid.

Last week my wife had a surgery and we’ll have it paid for as soon as we get the final invoice, again without any health insurance or government aid.

You should note that I have NOTHING against private health insurance (well, I think it’s grossly overpriced and doesn’t offer what it should) nor am I against getting government aid when appropriate (more on that tomorrow). This isn’t a political post, or a bashing post… I just wanted to share a couple of ideas that might help you save money (or, be able to afford the health care you need).

When asked what our insurance is we simply respond that we are “self-pay.”  This means it doesn’t go through insurance, rather that we pay for it ourselves.  As self-pay you can finance the service(s) through the service provider (hospital, doctor., etc.).  Or you can pay in full.  Why would you pay in full? Read on.

When we had our baby we told them we were self-pay and asked them if they offered a discount.  Guess what the discount was?

OVER 50%!  Instead of paying more than $8,000, our total hospital bill was around $3,400.  That is a huge, significant savings.  I like getting things on sale, and I like saving almost $4,000.

Note: We had to pay this in full before my wife got out of the hospital.

Fast forward three month (yeah, surgery three months later sucks).  My wife goes in for a surgery, fairly standard, and the doctor said he would do surgery wherever we wanted, so we could shop around.  We didn’t know you could or should shop around, asking hospitals what the cost would be.  We found there were pretty significant differences and chose to stay with this same hospital, which offered 50% off of this procedure. (we also learned that if you are insured and pay the copay up front you save 25%)

The doctor also offered 50% off – we took advantage of this for both the birth and the surgery.

Did you know you could save so much?  We had no idea.  But for us it’s a necessity.

We also learned we could get a prescription for any oral medicine the doctor would prescribe that was to be administered in the hospital and get that filled at our local pharmacy and then just bring that in for another significant savings.  I have no idea how much we saved but it was cool to know we could do that.

My point with this post is that health insurance isn’t the only way to get stuff paid for… if you don’t have it simply ask your doctor or the staff (the medicine thing was a suggestion from his front desk staff), and the hospital finance people… there are plenty of people who are self-pay and it isn’t as bad, scary or undoable as we thought it would be.

The scary part of this is that it exposes how expensive health insurance is.  If a doctor and a hospital are willing to discount 50% of their invoice just to (a) get paid in full upfront, and (b) not go through the insurance system, can you imagine what healthcare would be without health insurance in our system?

Do you have any other suggestions on finding affordable healthcare.

12 thoughts on “How To Pay For Surgery Without Health Insurance”

  1. Jason,

    We have certainly had our share of converstations about health insurance.

    I have been in your position in the past – we had two of our sons sans insurance and found the same as you did, discounts and payment plans.

    The tipping point for me was in 1995, when one son needed a test that was necessary to rule something out. It was $100 and that was a lot of money to our family at the time (as it is now). I agonized over the test and spending what was equal to our food budget for the month.

    I never ever ever wanted to be in that situation again and the very next day signed up for health insurance for $265 a month. It was a stretch to pay it every month. We sacrificed many things that year and in the following years.

    The peace of mind was well forth the money.

    Fast forward to 2007. My family is getting older and our bodies are showing signs of the wear and tear of being in our 40’s and 50’s.

    The doctor said that knee would never really get any better! The only option – knee replacement surgery. How much we asked $30000 should cover it they answered. And we thought the knee pain was bad.

    My premiums in ’07 were just under $13000 for the year. For five of us at the time. That’s a couple of nice vacations to Mexico or Disney. Can’t this year kids, we have to have health insurance.

    The surgery was performed and the recovery was quick – and at the 3 month check up it was determined that the replacement knee needed to be replaced. Great – what kind of warranty did the last surgery have. None! 30K down the tubes. This one will be more – hospital this time not surgical center. Ouch – much harder to swallow the second time.

    Had I been self-pay, I would have had to refinance the house and sell the cars. How does one come up with that kind of money. It would have been tough to do though it would have been done. In today’s market, no way.

    Throughout the whole ordeal, I slept very well. I wasn’t the least bit worried about the mounting doctor and hospital bills.

    I have health insurance and though I now pay over $1250 a month for it, I know that I cannot live without it. I can live without a new car, a boat or a trip to an exotic island.

    My total extra out of pocket for two Knee Replacement surgeries – $2000.00

    Jason – thanks for sharing and letting me rant.

  2. A combination of self-pay and insurance is the ideal solution for almost everyone.

    Insurance is meant to cover expenses that would devastate you financially. All insurance serves this purpose including home, car, life, health, business, etc.

    Take advantage of self-pay discounts by increasing the deductible on insurance to the highest amount you can self-insure for a year, say $10,000 or whatever works for your income/savings. Then use insurance to cover everything above this amount. Increasing the max payout on all your insurance policies is also recommended, as once again, the purpose is to avoid catastrophe.

    When you calculate the savings through discounts listed above, lower monthly premiums and what you would spend in co-pays you will always come out ahead in the long run by self-insuring. You also have to calculate in all the exclusions on your policy, things the insurance doesn’t cover.

    Insurance companies are in business to make money. They take in more money than they pay out or they won’t stay in business. Become your own profitable insurance company by self-insuring yourself and only pay for the minimum amount of insurance that would devastate you financially.

  3. Thanks for sharing, Jason. Both the baby delivery and your wife’s surgery had some “lead time” — i.e. you’ll have time to comparison-shopping. However, in the case of ER, the patient and family would not be able to compare-shop. For example, one of my little ones was rushed to hospital by ambulance and stayed in ER for a few hours. In the end, he was okay. But, the total stay cost about $30K. Fortunately, I have the whole family covered under my health insurance.

    So, I’m curious: why you don’t have health insurance to cover your family?

  4. While you may be able to negotiate with hospitals and pre-pay to get such deals, you might not have the same luck paying for doctor bills outside a hospital.

    My GP charges me $90 per visit!

    But I have found 2 significant discounts: buying my meds through Walmart (Walgreens can’t compare, even with their discount card), AND getting blood tests done through a firm that contracts with labs across the nation. So, for what Quest or Tower Diagnostics would charge me for a two blood tests ($300, once!!) I can have done by Private MD Labs for maybe $100 or less.

  5. We had a 6 month period when we moved from California back to the east coast where we had no health insurance and I know I did not sleep well. If my son climbed a tree, I would tell him to get down, if my daughter ran, I would tell her to walk. I think I was a basket case and just like with car and home sleep better knowing that I can always get the help we need.

    We have insurance now through my husband’s employer, but notice that things have slowly crept up even in the last year. Between copays and allergy medicine we spent over $500 last month – so I know that even with insurance costs are rising.

    They now have wellness clinics in the CVS in PA where we live and my husband went there a few weeks ago, because he felt an eye infection coming on. The doctor on duty was thorough and called him on Monday to check up on him. That was$65. I agree that insurance should be more about catastrophic illnesses…kinda like car insurance. I should be able to pay for well check or simple visit just as I would an oil change (more money of course).

    Something must be done, but my fear is that I hear nothing about an incremental approach which is my preference.

    Keep mom and baby well!


  6. Wow! As a Canadian, I tend to be quite blase about medical expenses. However, I salute you for talking about this. I will give odds that most people would never think that they had the option of looking and price checking or….. even asking for a discount. Thanks for opening my eyes.

  7. I guess times have changed in more than one way. I had my third child in 1991 without health insurance. No discounts were available and we had to pay cash up front or they would not see us. The prenatal care, delivery, and only 18 hours in the hospital for mother & child cost 20% of our gross income that year. We paid cash as demanded but many other expenses went on credit cards, beginning the debt that oppressed us until the final part of it was paid off only a few months ago, when our daughter was 17 & 1/2 and 7 & 1/2 years after we divorced….

    Jason, I really hope your luck holds, but I don’t know anyone whose luck did hold. In my experience it gives out around the age of 45, if not earlier.

  8. This is the type of reform needed. Self pay makes prices go down as health care providers compete for your money.

    Obviously, some form of catastrophic insurance would be needed in case of large medical bills, but for just about everything else you can pay it yourself. Just take what you’re currently spending on premiums and put it in a savings account to be used when little Tommy goes to the doctor.

    I have a Health Savings Account, which works similarly. Unfortunately, I still have to pay fairly high premiums, but they are slightly lower than a conventional plan’s premium. I pocket the savings and put money into an interest bearing savings account with pre-tax dollars. We just had a baby and it worked really well.

  9. No, I disagree, that peace of mind isn’t worth the premium we’re paying for!!! So many peoples stuck in bad jobs just to keep to have health insurance coverage for themselves & most importantly their families, how pathetic is that!??

    Thanks, Jason, for reminding, not only shopping around for better prices but also ask for various payment terms! I checked myself into the General hospital ER (didn’t have health insurance), I asked for installment payments as I was unemployed without insurance. Knock-on-wood, I still have no insurance but I don’t lose sleep over it! It makes me vomit just thinking of how expensive these costs have become! I say, REFORM is the way to go, the system needs desperately AN OVERHAUL!

  10. Great article! My perspective is NO health care insurance at all! What we never hear is what the cost of health care would be if competition was between the providers. Let’s see the physicians, hospitals, labs, dentists etc compete and watch prices of health care come plumeting down. If the costs are too high, make payments. Afterall, what do we think premiums are? At least payments would only be until the bill was paid off. Premiums are paid all of our lives even when we are not needing care. No one
    between you and your doctor, no discrimination for pre-existing conditions or age or sickness or too heavy for your weight. Also, what would be eliminated, fraud. Even prevention would be possible. Join a gym, it’s cheaper than health care bills. What you never hear is, why do we have health care insurance? It was created so the providers would get paid! It wasn’t for us. So why are we supporting a billion dollar industry? If some are very poor, give them Medicaid.

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