In this conversational interview, the host (Speaker A) asks a clinician (Speaker B) how to address doctors’ concerns that patients can’t afford care without insurance. Speaker B explains that patients already face high insurance premiums and deductibles—often $5,000‑$10,000 annually—so many are accustomed to paying large out‑of‑pocket amounts. When patients learn that many procedures cost far less when billed directly, they are surprised but receptive. The discussion cites dentistry and veterinary medicine as familiar cash‑pay models where patients routinely pay out‑of‑pocket for services like veneers or pet care. A concrete example is shared: an open‑MRI provider was paid $300 by insurers while the patient paid $1,300 out‑of‑pocket; the provider switched to a cash‑pay price of $750, a better deal for patients. The conversation underscores that patients are already paying high deductibles for routine preventive care, and that transparent, lower cash‑pay pricing can alleviate frustration for both patients and physicians.
Chapters
What would you say to someone that is really struggling with the concept that their patients won't be able to afford it, or their patients only will come see them if they have insurance? Because that's a pretty common question that we get in this industry. Yeah. What do you say to doctors when they ask that?
Yeah, so it's really interesting. I didn't know how that was gonna go. But, you know, obviously I did it anyways. But, and so I didn't know how that was gonna go. And what I found is, number one, patients are on the short end of the stick from the insurance company. They are paying high premiums and high deductibles. So no matter what the heck they do, they're already on the hook for, you know, $5,000 deductible, $7,500 deductible, $10,000 deductible. With insurance. And so they're a little bit more used to paying money than we think they are, first of all. And then second, when they find out how little it actually costs to do medicine outside the insurance company's grasps, it's not expensive. And so I think people are always shocked when I tell them my surgery prices. They're like, That's it? I was like, yeah, that's it. Like, you should raise your prices. I'm like, I probably should. Thank you for that input. Um, but yeah, that's it. And so I think people are, are surprised, pleasantly surprised, but they're always nervous. They're like, well, how much is this gonna cost? And that's been something that I've gotten used to, but it was really disconcerting and hard at the beginning to like just spit out my prices. I was like, that's gonna be $1,500. And they're like, oh, okay. But I think some of the industries that have kind of paved the way that people have experience with all the time is the dental industry, where insurance, it doesn't really get you anything. And we're used to paying out of pocket anyways. And there's some higher ticket items that we choose, like veneers or those things, And people are used to paying that. The other one is the vet industry, right? Everyone has very expensive pets. And I have 3 of them.
They're very expensive.
You go to the vet, you're like, oh, I need this. And you pay the money and you're like, okay, well, that was the thing. This is what we do is we pay the money for the services. And so I think when I talk to people about that and I'm like, oh, I take CareCredit, you're familiar with for your dentist or your vet. Oh yeah, we do that all the time. Like no problem. Same same thing. We do that too. It's not an issue. I just want to help you and for whatever makes sense. But I think that that it's it's scary in theory. But I think you until you talk to your patients about money, you won't realize that people are already expecting to pay like ten thousand dollars. That's when they come in. They're And so if it's anything less than $10,000, they're like, okay, interesting.
Well, that's what, that's what the average family— so if a family has— 60% of Americans have what the government considers is a quality plan. You know, I don't know what the heck that means, but, but whatever that is. Right. So they have a, they have a corporate company-backed plan or something like that. The average family in America, their deductible out-of-pocket expenses for the year is $10,000. Yeah, 10 grand.
Absolutely.
And, and I will tell you, so I will tell you, my wife has a very great plan. I tell this to my doctors all the time. And about 3 years ago, I had to have a prostate biopsy, right? So did the MRI, did the, you know, and then had to do the biopsy. So I get the MRI done. And so I'm talking to one of my doctors and he has an open MRI machine. I said, how much do you make on an MRI? He said, I get paid $300 from the insurance companies on I said, really? I said, do you wanna know what my out-of-pocket expense was for my open MRI on my prostate? And he goes, what's that? I go, $1,300. He's like, what? And I said, I have great coverage. I had— my out-of-pocket expense was $1,300 and you got paid $300. He— his face got so red. We're actually transitioning that business. He has an open MRI machine. He's no longer taking insurance for it, and he's gonna charge $750.
Wow.
Because that's a better deal for the patient. Yeah. Right. We did the research, like, and so my point is, is like, I've had, um, you know, I've had some heart, like, scans and all, you know what I mean? Just typical stuff that you go, my out-of-pocket, I mean, I'm, I'm dropping $3,000, $4,000 a year out-of-pocket, bare minimum for just base, you know, for preventative care medical stuff.
Yeah.
So your patient will pay this. They're, they're paying it already, folks. Yep. Like, absolutely. And as frustrated as you are as a doctor, the patients are even more frustrated and ticked off.
Yep.
Like times 10.
They so are. And so they're feeling shortchanged and they're getting shortchanged. They really are. When I talk to my patients, because I talk to my patients, I have the luxury of time to talk to my patients and I tell them and I educate them and they're like, when do you think insurance is going to cover orthobiologics? I said, gosh, I hope never, because then they're going to dictate who can and cannot have these services. And it's going to be a race to the bottom and our reimbursement for services are going to go down, down, down, just like they have. And the cost of it is going to go up, up, up. And when they have to pay out of pocket and it's more expensive to pay out of pocket with the insurance than it is for cash pay, that is a problem. I had that same experience. I had an MRI And my out-of-pocket expense was more expensive than a cash pay product. And so I should have paid cash, but I thought I had good coverage. And I was surprised by this bill, which was my out-of-pocket expense, that was more expensive. I was like, what in the world? And so I called them and I said, well, you know, this seems really expensive. They're like, well, this is market value. And I live in a very rural environment. And I said, well, what market is that? And because we're, we're the only one. So we were— we're setting our own prices and we're gouging the patient. I mean, by we, insurance companies and the hospital are setting their own prices and gouging the patient and making more money. Um, and the insurance company is taking a huge cut of that as well. And so the patient is suffering. So I actually, um, recommend Cash pay for a majority of what people need because it's actually cheaper. It's less expensive for them to just pay cash than to actually go through insurance. Yeah.
