What is Cash Pay Packaged Pricing

 In Insurance & Social Security

What is Cash Pay Packaged Pricing (and why should you be interested)


he Affordable Care Act is now in full effect. The previously un-insured are now faced with purchasing health insurance on the marketplace or paying growing penalties. Even though the ACA (also known as “Obamacare”) does not allow insurance companies to exclude people with pre-existing conditions, many people are finding many plans to have high premiums that they are unable or unwilling to afford, therefore choosing “catastrophic” plans with a higher deductible. These plans are required by law to cover most diagnostic screenings, but may not cover facility, laboratory, anesthesia, and diagnostic imaging fees until the deductible has been met. This is the advantage of Cash Pay Packaged Pricing!

Ambulatory Surgery Centers (ASCs) like Pend Oreille Surgery Center, are beginning to offer Cash Pay Packaged Pricing (CPPP) to circumvent the costs and hurdles required to bill insurance. By lowering these costs, ASCs are able to pass those savings to patients.

Continued below…

CPPP has several more benefits:

  • Transparent pricing: you know the cost before you schedule the procedure,
  • One payment typically covers the facility, surgeon, and anesthesia fees, but may not include pre & post-op doctor visits, or pre-op tests (confirm with the ASC),
  • Ease of scheduling: since we are not billing an insurance company, we do not need to wait for a pre-approval,
  • Since the ASC is not operating under a contract with an insurance company, ASCs are usually able to bill at a lower price for any hardware or implants necessary for the procedure (e.g. plates and screws for orthopedic procedures).

What kind of procedures qualify for CPPP?

  • Carpal tunnel release
  • Knee Arthroscopy
  • ACL Repair
  • Rotator cuff repair
  • Bunion repair
  • Hernia repair
  • Gall bladder surgery
  • Endoscopy/Colonoscopy, etc.

These procedures are typically same-day and elective. Patients arrive at the ASC, have the procedure, and leave the same day.

What is an Ambulatory Surgery Center (ASC), and are they safe?

  • An ASC is usually a physician-owned center that is certified to perform ambulatory or “same day”
  • ASCs can be single-specialty, such as endoscopy, or can be multi-specialty, such as orthopedic, podiatric, general, etc.
  • ASCs cannot keep patients more than 24 hours. ASCs also do not have Emergency Rooms, Intensive Care Units, or Delivery Rooms. Therefore, they do not have the 24-7 staffing requirements of a hospital, and can pass those savings on to their patients.
  • ASCs do not treat patients with acute illnesses or infectious diseases.
  • ASCs are required to have the same trained and credentialed providers as a hospital, such as Registered Nurses, Medical Doctors/Surgeons, and Anesthetists. This ensures the patient will receive the same high quality care expected from a hospital.

Can I have my procedure done at an ASC?  In most cases, yes, but you must meet certain criteria:

  • Are you otherwise healthy? Remember, ASCs do not treat patients with acute illnesses or infectious diseases, e.g., if you have a cold or flu, you would need to re-schedule.
  • You must be a good candidate for surgery at an ASC (un-controlled diabetes, congestive heart failure, or un-controlled high blood pressure may preclude you from ASC services). However, you may be able to have some procedures, such as a diagnostic colonoscopy. Other procedures that require a longer recovery, necessitating a hospital stay (longer than 24 hours), are not offered.
  • What kind of surgery do you need? A carpal tunnel or knee arthroscopy usually requires only a few hours before you can return home, whereas, open-heart surgery can require 24-7 monitoring for several days in an ICU and are not ASC appropriate in nature.

Can ASCs treat Canadians?

  • Of course! With increasing wait times for some elective surgeries, many Canadians are looking into “medical tourism” (traveling to a hospital or ASC in another country) to have their surgery, returning home for recovery. By avoiding the long wait times (and potentially longer recovery time), they may be able to return to activity much sooner.

Who do I need to talk to about scheduling an appointment and getting a quote for a surgical procedure?

  • If you are local, talk to your regular doctor to confirm your need for surgery. Your doctor can refer you to a specialist for a consultation. Ensure that specialist has surgical privileges at an ASC.
  • If you are out of town, call us directly and we can provide a list of credentialed surgeons certified to perform procedures in our facility.

Scheduling your procedure at an ASC is fast and easy.

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