Dr. Jerry Rogan has been consulting about Medicare and medical care delivery for a variety of companies beginning 2003, having served over 100 clients, some for a short term need and some over several years.
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Becoming a Self-Pay Patient
How to Navigate Healthcare Without Insurance
Becoming a Self-Pay Patient
How to Navigate Healthcare Without Insurance
With looming changes in federal and California state healthcare budgets, millions of residents could soon find themselves without medical coverage. If you're among them—or simply trying to save on healthcare costs—you may face the daunting reality of paying out of pocket for your medical care.
As a former family and urgent care physician, I’ve helped many patients manage their care without insurance. Here are some practical strategies to help you navigate the system as a self-pay patient.
Avoid the Emergency Room—If You Can
Avoid the Emergency Room—If You Can
Unless you're facing a true emergency—like chest pain that could be a heart attack—stay out of the ER. Emergency departments are the most expensive way to receive care, and they typically add hefty facility fees to the physician’s charge. For non-life-threatening issues, opt for a local urgent care clinic or visit your primary care doctor, if you have one.
Call Ahead and Ask About Prices
Call Ahead and Ask About Prices
Before you go, call the clinic and ask for the cash-pay fee schedule. Many doctors accept Medicare rates as full payment for self-pay patients—even though these rates are lower than standard fees. In Sacramento, for example, Medicare reimburses about $75 for a 15–29-minute new patient visit, and around \$116 for a 30–44-minute visit. Follow-up visits for established patients typically cost less, ranging from $60 to $95.
Be Prepared and Help Your Doctor Help You
Be Prepared and Help Your Doctor Help You
Arrive with a written list of your symptoms and all medications you're taking, including over-the-counter remedies. This helps your doctor get straight to the point—saving time, and potentially money.
Don’t Automatically Agree to Every Test
Don’t Automatically Agree to Every Test
Some urgent care centers push for tests before you even see a doctor. But many common issues—like a sprained ankle—can often be diagnosed and treated based on a physical exam alone. In cases like this, a doctor might suggest you return in a few days if symptoms persist, at which point an X-ray may be warranted. Ask whether tests are truly necessary up front.
Know Your Rights in a Medical Emergency
Know Your Rights in a Medical Emergency
Federal law requires hospital emergency rooms to assess any patient who comes in with a potential emergency, regardless of their ability to pay. However, once you're determined to be stable or not facing a life-threatening issue, the hospital is not obligated to continue treatment—and you’ll still be responsible for the bill.
Ask About Financial Aid
Ask About Financial Aid
California law requires hospitals to disclose their fees if you ask, including facility fees. Many hospitals also maintain charitable funds to help patients who can’t afford care. Don’t hesitate to ask if you qualify.
Request Affordable Prescriptions
Request Affordable Prescriptions
If your doctor prescribes medication, ask about the least expensive effective option. Many older, generic drugs are just as effective as the newer (and pricier) alternatives. Your pharmacist can often suggest ways to save, including discount programs or therapeutic substitutes.
Bottom Line:
Bottom Line:
Being uninsured or paying out of pocket for care is challenging, but it’s not impossible. With a little preparation, informed questions, and smart choices, you can still receive quality care without breaking the bank.
~ Gerald N. Rogan, MD
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