Health Savings Accounts and being a savvy self-pay patient — Healthshare

Health Savings Accounts and being a savvy self-pay patient

Team of DoctorsGuest post by Sean Parnell of The Self-Pay Patient

Having a health savings account (HSA) to pay for medical expenses is a great tool for what I call self-pay patients, who pay directly for some or all of their health care needs. Instead of having to find money in the household budget to pay for an unexpected visit to the doctor or an MRI, HSA owners who have put aside money for these expenses know that a trip to the doctor doesn’t have to mean cancelling plans to take the family to dinner that week or having to miss a credit card payment.

But there is a problem with HSA’s, one that not everyone knows about. Simply put, while people with HSA’s have funds to pay directly for their needed care, they don’t usually have the ability to easily shop for the best care at the best price.

Prices at most doctors’ offices and other health care providers are hard to come by, and when you can get a price it is often only part of the cost – a bill might have a dozen or more line items on top of the doctor’s office visit, none of which you were told about in advance.

Doctors are usually totally ignorant about the costs of any given treatment or procedure. My wife recently had an imaging procedure prescribed by her doctor, when she called and found out it would cost $2,000. Not wanting to pay this unless it was necessary she talked with the doctor, who was astonished it cost so much, and then said the test wasn’t really necessary anyways!

This ignorance about what things cost, and the trouble in getting a real price, is a real problem for HSA holders. And because using an HSA doesn’t usually eliminate the bureaucratic expenses associated with paying for routine medical costs through the third-party payment system, it can sometimes be hard to see much benefit to HSA’s aside from the tax benefits.

Fortunately, there are a growing number of doctors and other providers that cater to self-pay patients including people with HSA’s. Not only are they able to easily provide real prices up-front, they are often much less expensive than going through the insurance system. Here are a few of the best options for self-pay patients.

  • Cash-only doctors. These are doctors that do not accept any insurance at all, only direct payment from their patients. Some of these doctors operate on a ‘fee for service’ basis where you pay for the service provided according to their price schedule, while others operate direct primary care practices where for a relatively modest monthly fee patients have nearly unlimited access to care.
  • Telemedicine. There are several companies that allow patients to call a doctor (who has access to their medical records) and get a diagnosis, treatment recommendation, and a prescription, all over the phone (some offer video connections as well). Some of these operated on a per-call fee structure while others have monthly fees, and in almost all cases they are much less expensive (and more convenient) than a visit to the doctor’s office.
  • Online bidding. One site, Medibid, allows patients to submit the medical treatment they need into an online portal (with their privacy protected, of course) and have doctors around the country bid on providing that service. One man in Chicago who had been told he’d have to pay $3,500 for a colonoscopy, when he went to Medibid he found a doctor in Oregon who would do it for $800. Even after the cost of plane fare and a hotel room he still saved a lot of money!
  • Package pricing. For more complicated care, like surgery, finding real prices is usually even harder than finding them for routine care. A hospital stay or surgery bill can include hundreds of lines of billing charges, most of them incomprehensible to the average person, and most hospitals can’t give a flat price for a procedure. Some can however, including the Surgery Center of Oklahoma and Regency Health Care in New York City. Having a procedure done at these or similar facilities can help to prevent surprises when the bill comes.
  • Medical tourism. There are options around the world for relatively low-cost, high-quality care. For HSA owners who are facing large out-of-pocket costs for a procedure, either because the procedure isn’t covered or the only in-network option isn’t satisfactory, going abroad to receive treatment can be a way to save a lot of money.

These are just a few of the many options that self-pay patients, including HSA owners, have for receiving medical care at affordable rates. Here’s the catch (there had to be one, didn’t there?): if you have not only an HSA but also a high-deductible policy, then going to any of these types of providers may not count towards your deductible. Fortunately most people will never reach their deductible in any given year, but it is something to think about especially if you know you’re likely to hit the deductible amount in a particular year.

Aside from this one catch, however, relying on doctors and other providers that cater to self-pay patients can be a great way to save money while still getting access to high-quality affordable health care. You can learn more about these and other options at my blog, The Self-Pay Patient, and if you have any questions please e-mail me at

Sean Parnell writes at The Self-Pay Patient blog, a source of news, commentary, and information for people who pay directly for some or all of their own health care, primarily the uninsured and those with high-deductible health plans.


4 thoughts on “Health Savings Accounts and being a savvy self-pay patient”

  1. Are diagnoses required on invoices I give my therapy clients who are turning them into their HSAs?

    1. Wiley Long says:

      Hi Barbara,

      It is not necessary to submit a diagnosis to get reimbursed from an HSA, but the patient should be aware that if they are audited, they may have to provide proof in the form of a diagnosis at that point that the treatment was for a necessary “medical condition.” Of course it sounds like this would not be an issue.

      1. Audited by the IRS or the HSA program?

        1. Wiley Long says:


          Either – if they request it during an audit to verify eligibility for HSA funds.

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