What happens if I manually submit a "cash pay" claim to my health insurance provider?

There is another option – that $0 would count toward your deductible.

I think that you should use your insurance and just bill it.

@Cupcake

I know that is the obvious option and what I plan to do.

@marinelife

If I bill it to the insurance directly it will cost me $348, more than the cash price of $175

It all depends on how much health care you may need this year. If you end up fulfilling your deductible, you’ll wish you’d spent the $348, since you would have saved that much, and more, depending on how much over your deductible you spent.

On the other hand, if you don’t anticipate meeting your deductible, then spend $175 out of pocket, and deduct nothing from your deductible.

A proxy measure for potential health care utilization is age. If you are under 35, spend the $175. Above, spend the $348 and count it towards your deductible.

If this MRI is for something that will potentially require a lot of care, and if you feel like you probably have a condition requiring care, then spend the $348. Otherwise, if you think this is probably a wild goose chase, go for the $175.

This also depends on cash flow. If you have cash flow problems, you may have to do $175, even if you are very sick, simply because you don’t have the cash now for $348. Although, if you are sick, then you will soon be spending $1000 (or whatever your deductible is), which you also don’t have, so I guess it doesn’t matter. Tell them to bill you the $348 and you’ll pay it when you can.

Of course, this is why we need single payer. This kind of calculation is nuts, and how can you know how sick you are? This is why you go to the doctor in the first place. This is a form of moral hazard (as they say in the insurance industry). Perverse incentives encourage you to purchase insurance only if you need it. Supposedly, when everyone has insurance, this kind of thing won’t be necessary. But for now…. well… just how sick are you?

@inshelp22 Rught, that is their negotiated price with the insurance company.

I would pay the cash price of $175. and then submit. I don’t believe they will charge you for the difference between that and $348. I think they will likely take $175 off of your deductible but that is just my opinion. Nobody but the company knows exactly what they will do.

I would be surprised if they took $175 off your deductible. If you report it to insurance, then the hospital probably is legally required to charge you the rate they have negotiated with the insurer. I would guess that you can only get the $175 rate, if the hospital doesn’t know you have insurance—and they never find out. Which means that if you ever try to use insurance at some future time, they will check to see that you are newly covered, and if they find out coverage has been in place for a while, during the time they provided other services to you, they may back bill you for what you didn’t pay in the past. They may have to do this, or else break their contract with the insurer. But this is just speculation. I hope you could get away with what is best for you.