Health Tech

Healthcare’s dirty secret: cash pay can be more economical than paying with insurance

Solv Health launched ClearPrice that compiles data from more than 5,000 providers so consumers can evaluate the cost of various services before they are rendered and decide if they want to pay cash or use insurance.

Hospital and urgent care clinic cash rates for the uninsured can be cheaper than paying high deductibles. Many don’t know if this is the case for them and end up paying higher rates by not asking for cash rates. Enter ClearPrice, a service launched by Solv Health that allows patients to see the cash prices for common services like covid tests, lab tests, x-rays, and in-office visits at urgent care clinics before they book an appointment.

Oakland, California-based Solv Health worked with more than 5000 urgent care facilities to publish their cash-pay prices and is comparing cash pay to hospital prices, both at the national and local level. Heather Fernandez, CEO of Solv, answered questions about how patients can leverage ClearPrice to potentially save money.

MedCity News: What was the gap in care prior to Solv launching ClearPrice?

Heather Fernandez: Imagine going to your local coffee shop to buy a cup of coffee. Instead of charging you at the counter like usual, they tell you to expect your bill in the mail. Two months later you receive a bill for $175. This would be outrageous, right? In healthcare, this is the way billing has been handled for decades.

MedCity News: Why address it now?

Fernandez: We are seeing a recent trend with new and proposed legislation–such as the No Surprises Act for hospital bills and statewide laws enforcing prescription drug price transparency. All these are attempting to address consumer concerns around price transparency.

MedCity News: How does ClearPrice work?

Fernandez: What many people don’t realize, is even if you’re insured with a high deductible health plan, paying out of pocket may cost less than using your insurance – and the cost could be dramatically different between the hospital, your doctor’s office, or your local urgent care.

For example, imagine you’re at your son’s football game and he sprains his ankle. And like many Americans, you’re on a high deductible health plan, so you’re insured but you are concerned about affordability. You immediately come to Solv looking for care near you, type in X-ray, and say you need it ASAP.

Instead of going into the ER and finding out what your insurance will cover later, you are able to see where you can get an X-ray at an urgent care location near you, and you can see self-pay prices, alongside the hours they’re open, the address, and the phone number. You can also use the ClearPrice calculator to compare local costs and find the best care in your city and surrounding areas.

You select your location and book your appointment for the same day.

Knowing how much you’ll pay before you book any other type of service is standard but when it comes to healthcare, it’s radical. We want to be the ones enabling this type of radical departure from the norm in American healthcare.

MedCity News: How do patients access ClearPrice, and what does it cost them?

Fernandez: Consumers can access ClearPrice for free on Solv. Anyone can go on our website and app and discover prices for themselves.

MedCity News: Why is self-pay more affordable?

Fernandez: The current pricing scheme in healthcare is really about a negotiation between payers and providers, not at all about the consumer who ultimately pays in the end. Most people blindly believe that if they have insurance, they will get the best price for their care. And why shouldn’t they think that, when they pay a monthly premium for those services? Unfortunately, that’s not the case in many situations. Will the cash pay price always be better than insurance rates? Not always. But with information readily available, consumers have the ability  – for the first time – to make informed decisions.

MedCity News: Do you have examples where cash pay is cheaper than insurance?  

Fernandez: Here are a few third party sources that show cash pay prices can be more affordable than insurance rates:

MedCity News: Could you explain some of the more surprising/significant findings of the data collected by ClearPrice? 

Fernandez: Here is a snapshot of some of our key findings:

Prices of some of the most common services:

    • Stitches:
      • National average urgent care price: $255
      • Average national hospital price: $334
      • Manhattan average price: $252
      • San Francisco average price: $214
    • In-office visit:
      • National average urgent care price: $142
      • Average national hospital price: $303
      • Manhattan average price $172
      • San Francisco avg price: $228
  • Top 5 most affordable cities for an in-office visit: Baton Rouge, Knoxville, Detroit, Albuquerque, and Columbus.
  • Top 5 most expensive cities for an in-office visit: Denver, San Francisco, Dayton, Cleveland and Spokane

Photo: Solv Health