Hospitals have two kinds of prices: the ones they negotiate with insurers, and the one they will take from someone who pays directly. The second is called the discounted cash price, self-pay price or prompt-pay price, and since 2021 every hospital has had to publish it. It is often far below the list price and sometimes below what insurers pay. Getting it is mostly a matter of asking the right person the right way.
Before you call
Look up the hospital's published cash price for the procedure code on this site or in the hospital's own file. Write down the code (for example CPT 45378 for a diagnostic colonoscopy) and the number. Look at the same code at two or three other hospitals nearby, so you know whether the price you are being offered is high or low for your area. Hospitals know their competitors' prices; it helps if you do too.
Who to ask
Not the scheduling desk and not the doctor. Ask for patient financial services, the billing office, or a financial counselor. Larger hospitals have a self-pay or price-estimate line. Say you are scheduling a specific procedure, that you will be paying yourself, and that you want the self-pay price for the procedure code.
What to say
"I would like your self-pay price for CPT 45378, in writing. I see your published cash price is $1,480. Does that include the physician, anesthesia and pathology? If not, who bills those, and what are their self-pay rates?"
Three things are doing the work in that sentence. You named the code, so there is no ambiguity about what you are pricing. You named their published number, so they know you have read the file. And you asked what is not included, which is where most cash-price surprises come from.
Ask for more than the published price
The published cash price is a floor for what you can ask, not a ceiling. Hospitals routinely offer:
- Prompt-pay discounts of 10 to 30 percent for paying in full before or at the time of service.
- Financial assistance based on income. Nonprofit hospitals are required by federal tax law to have a written policy, and many extend free or discounted care to households well above the poverty line. Ask for the policy by name and apply even if you are not sure you qualify.
- Bundled or package prices for common procedures, especially maternity, joint replacement and imaging, that include the physician and anesthesia.
- Payment plans without interest, which are almost always available if you ask before the bill goes to collections.
When cash beats insurance
If you have a high-deductible plan and have not met the deductible, you will pay the full negotiated rate yourself until you do. At many hospitals the cash price is lower than the negotiated rate for common outpatient procedures and imaging. You are allowed to pay cash and not use your insurance. The trade-off is that the amount does not count toward your deductible, so it makes sense for one-off services early in the year, not for a year with a lot of care coming.
Ask the hospital for both numbers: the self-pay price and the negotiated rate for your plan. Whichever is lower, ask for it in writing.
Get it in writing
If you are uninsured or self-pay, federal law (the No Surprises Act) entitles you to a good faith estimate before a scheduled service. It must be in writing, list the expected charges by code, and include the other providers involved. If the final bill is more than $400 above the estimate, you can dispute it through a federal process. Ask for the estimate by name and keep it.
If you are insured, ask for the estimate anyway; most hospitals will give one, and it is the document you will need if the bill comes in higher.
After the service
Ask for an itemized bill, check every code against your estimate and against the hospital's published prices, and question anything that does not match. Billing errors are common, and the published file is the standard you can hold the hospital to.