How to Ask a Hospital for Its Self-Pay Price

What a self-pay price is and why you can ask for it

A self-pay price, often called a discounted cash price, is what a hospital may charge a patient who is uninsured or who chooses not to use insurance. It differs from the gross charge, the list price on the hospital's chargemaster. Insurers pay negotiated rates, and many hospitals also offer a discounted cash price. Our guide to the cash price versus the insured rate compares the two.

Since January 1, 2021, hospitals in the United States have been subject to the CMS Hospital Price Transparency rule (45 CFR Part 180). Each hospital must post a machine-readable file of its standard charges, which include the gross charge, the discounted cash price, payer-specific negotiated charges, and the de-identified minimum and maximum negotiated charges. That file is one place a number may already be posted.

Check the hospital's posted information first

Before calling, it can help to see what the hospital has already published. The same rule requires a consumer-friendly display of 300 shoppable services, or an online price estimator tool instead. CMS describes a shoppable service as one that a patient can schedule in advance, so a planned scan or procedure often falls into this group. Our guide to shoppable services explains the idea further.

• Look for a pricing or billing page on the hospital's website and check whether it offers a price estimator.
• Open the machine-readable file if you are comfortable with it. Our guide to using hospital price transparency files walks through the layout.
• Browse Texas or Florida hospital pages on this site, or start from the procedures list, to see posted gross charges, cash prices and insurer rates by hospital.

A posted number is a starting point. A written quote from the hospital for your exact service is a separate step.

Who to call at the hospital

Hospitals organize this differently, so more than one call may be needed. Some people begin with the scheduling or registration desk for the department where the service will happen, such as radiology or endoscopy. Others go straight to the patient financial services office, the billing office, or the department that handles price estimates. A patient advocate or financial counselor, if the hospital has one, may be able to route the request.

A simple opening can work: "I am scheduling a service and plan to pay myself without using insurance. Can you give me the self-pay price?" Mentioning self-pay status early may change which staff member handles the question.

Codes and details to have ready

The more specific the request, the more useful the answer tends to be. If a clinician's office has supplied a code, share it. Our guide to CPT codes explains what they are.

• CPT code: a five-character code maintained by the American Medical Association that identifies a procedure or service.
• HCPCS Level II code: maintained by CMS, these cover items such as supplies, drugs and some services.
• MS-DRG: inpatient hospital stays are often paid by MS-DRG, so it may be worth asking about if the service is a planned admission.
• Revenue codes: hospital bills often list these for the department or type of service, so they may come up in the answer.
• Service details: the exact test or procedure, whether it is with or without contrast if that applies, the department, the planned date, and the name of the ordering clinician.
• Payment status: that the patient is uninsured or choosing not to use insurance.

For an example of how details change a price, see why MRI prices vary.

Questions that make the price clearer

A single number can leave gaps. These questions can show what it includes:

1. Does this price cover only the hospital's facility charge, or other fees too?
2. Will the radiologist, surgeon, anesthesiologist or other physician bill separately? The facility fee and professional fee are usually separate, and the prices shown on Clear Hospital Costs are hospital facility charges taken from the hospitals' own files, not total costs.
3. Are supplies, drugs, imaging contrast or pathology billed on top of the quoted price?
4. Is the price tied to a payment-in-full or prompt-pay arrangement, and what are the terms?
5. How long is the quote valid?
6. Is there a financial assistance application, and how is it requested? Nonprofit hospitals must have a written financial assistance policy, though each hospital sets its own eligibility rules, and many other hospitals offer assistance on varying terms.

What to ask for in writing

A spoken figure is hard to rely on later. A patient can ask the hospital to put the quote in writing or in a patient portal message, listing the name, the service, the codes, the date of service, the total, and what is included and excluded. Noting the date of the call and the name of the person who answered also helps.

A separate written document may be available too. The No Surprises Act gives uninsured people, and those who decide not to use their insurance, a way to request a good faith estimate of the expected charges for scheduled items and services. A provider is generally required to supply one if the service is booked at least 3 business days in advance, and also whenever the patient requests it. Should the final bill from a provider or facility come in at least $400 above its good faith estimate, the patient may be able to turn to the patient-provider dispute resolution process, which in general has to be started within 120 calendar days of the bill date. CMS runs a No Surprises help desk. Our guide to the good faith estimate has more.

After the quote arrives

Keeping the written estimate with other records makes it easy to check against the bill when it arrives, line by line. Our guide to reading an itemized hospital bill can help with that. If the numbers differ, some people call the billing office and ask for an explanation, and our guide to negotiating a hospital bill describes options.

For anyone weighing more than one facility, our guide to comparing hospitals by price shows how to set quotes side by side. For common scheduled services, local pages such as MRI cost in Houston show what hospitals have posted. Care that cannot wait is a different situation: in an emergency, dial 911 or head to the closest emergency room.