Navigating Healthcare

Sharing info, experiences, and building tools to help mere mortals smartly navigate healthcare & insurance

[Navigating Healthcare @NavigatingHC]

@Kamikarainmo @stats_feed It's certainly worth trying but getting the full amount applied to your deductible is not automatic and depends on several factors.

Of course, because medical billing is never straightforward. 😡

[Navigating Healthcare @NavigatingHC]

I find these cash price numbers genuinely ASTOUNDING.

Same knee MRI: $415 in New Jersey, $4,650 in Utah.

Your zip code matters more than your diagnosis.

[World of Statistics @stats_feed]

🩻 Cash price of a knee MRI at US hospitals, by state (median)

1. New Jersey: $415
2. Maryland: $583
3. Puerto Rico: $725
4. Louisiana: $808
5. Arkansas: $900
6. Tennessee: $974
7. New York: $1,006
8. Indiana: $1,017
9. Mississippi: $1,118
10. Kansas: $1,271
11. West Virginia: $1,302
12. Oklahoma: $1,345
13. Maine: $1,367
14. Arizona: $1,446
15. New Mexico: $1,472
16. Hawaii: $1,504
17. Georgia: $1,516
18. Michigan: $1,527
19. Kentucky: $1,609
20. Connecticut: $1,619
21. Missouri: $1,664
22. Montana: $1,678
23. Idaho: $1,746
24. Ohio: $1,752
25. Pennsylvania: $1,756
26. Oregon: $1,776
27. Alabama: $1,786
28. Massachusetts: $1,842
29. Washington: $1,846
30. Wyoming: $1,910
31. Minnesota: $1,932
32. Virginia: $1,932
33. North Dakota: $1,933
34. Colorado: $2,012
35. New Hampshire: $2,059
36. North Carolina: $2,061
37. Rhode Island: $2,100
38. Wisconsin: $2,110
39. Texas: $2,159
40. Iowa: $2,232
41. Nevada: $2,297
42. South Carolina: $2,447
43. Delaware: $2,452
44. Nebraska: $2,524
45. Illinois: $2,860
46. Vermont: $3,078
47. South Dakota: $3,170
48. California: $3,196
49. Alaska: $3,222
50. Florida: $3,535
51. Utah: $4,650

Source: Hospital price transparency data via SelfPayRates (October 2026)

[Navigating Healthcare @NavigatingHC]

60% of insurer-negotiated rates are HIGHER than the hospital's own cash price.

Read that again — then ask for the cash price before you hand over your insurance card.

[Wall Street Apes @WallStreetApes]

The American health insurance system is a scam

RFK JR says “The whole system is corrupt.” They found

- Hip replacement in Boston costs $17,900 at one hospital, and at a nearby hospital, it costs $74,000 for the exact same surgery
- Researchers have found MRI prices varying as much as 9x within a single city
- One analysis found that 60% of insurer-negotiated hospital rates were higher than the hospital's own cash price

“Think about that. The insurance company, who is supposed to be negotiating for all of its members and beating down the price, has actually negotiated a price that is higher than if you just walked into that hospital off the street and asked for that procedure”

“The whole system was corrupt. It was crooked. And there was no marketplace, and that was deliberate. That was by design. There was no marketplace and those are not signals of a functioning market. Markets cannot discipline prices that they cannot see”

I looked into this exact study, over 2,300 hospitals were looked at and what they found was

- Cash price is better nearly 60% of the time
- Cash discounts averaged about 64% of normal price, this is often cheaper than insurance rates

Insurance is a scam

[Navigating Healthcare @NavigatingHC]

@mhp_guy Please define "makes"

[Navigating Healthcare @NavigatingHC]

Have you ever paid direct / cash pay for routine bloodwork?

Did it save you any money?

If so, lets talk !

[Navigating Healthcare @NavigatingHC]

I myself have never observed direct price is better than negoriated insurance price specifically - ar least when it comes to lab blood work.

https://t.co/JPjpOHYOGL

[Navigating Healthcare @NavigatingHC]

Do you know the medical billing codes for routine (and not so routine) bloodwork?

You should.

(Unless you are fine flying blind and/ getting ripped off)

[Navigating Healthcare @NavigatingHC]

It's a scam until you actually need it.

Then it's the difference between an inconvenient bill and medical bankruptcy.

[Carnivore Aurelius ©🥩 ☀️🦙 @AlpacaAurelius]

Is it me or is health insurance a total scam?

You pay $500-$2k a month, then when something happens to you, they don’t even cover it.

Meanwhile, if you pay cash you can negotiate the ridiculous bills hospitals charge you down.

[Navigating Healthcare @NavigatingHC]

@AlpacaAurelius It's a scam until you need it. Then it's the difference between an inconvenient bill and medical bankruptcy.a

[Navigating Healthcare @NavigatingHC]

I consider myself upper middle class - mid 50s. A have a decent IRA, an emergency fund, and no mortgage.

Having said that a MAJOR illness/accident to any family member would likely destroy us financially.

90+ percent of us are ONE STEP away from medical bankruptcy.

Thoughts?

[Navigating Healthcare @NavigatingHC]

Great lesson here.

In the current environment, EVERY medical bill is a negotiation.

Treat it like one.

[Logan Robison ⚡️ @LoganARobison]

Hospital bills are just made up numbers, right? When we had our 3rd baby, the bill was $12,674 (after insurance)

I tried for weeks to negotiate (22 emails) but they wouldn’t budge. I figured I’d have more leverage if I waited until the end of the year to negotiate. So on 12/30 I sent an email offering to pay $10k if they would clear the balance.

My hope was that they would be focused on closing out accounts and might be more willing to make a deal.

On 12/31 the finance office called and took me up on it. Saved +20%.

[Navigating Healthcare @NavigatingHC]

@pgipe @rshawnm Interesting

[Navigating Healthcare @NavigatingHC]

If you could speak freely and at length with your patients, what's the FIRST piece of advice you'd give about maximizing health care dollars?

[Navigating Healthcare @NavigatingHC]

@StevePhillipsMD Our medical history - ALL OF IT - should be owned by the patient.

Not siloed off into 10 different specialist databases that can't/won't share info.

[Navigating Healthcare @NavigatingHC]

@docshanep @rshawnm @dpcalliance See my reply to original post.

[Navigating Healthcare @NavigatingHC]

@DennisByron99 @rshawnm Yes

[Navigating Healthcare @NavigatingHC]

The second data point you have to search for on the Medicare/CMS website using your Billing Code and your location.

This will return a messy table of data representing "the amount Medicare has officially decided it will pay a provider for that specific service or procedure"

[Navigating Healthcare @NavigatingHC]

In order to be an effective health care consumer these days, you MUST arm yourself with 2 CRITICAL pieces of information for every visit/procedure/service you receive.

[Navigating Healthcare @NavigatingHC]

First is the Billing Code.

In no other industry but medicine they seem to be intent on HIDING this from you.

You will either have to ask for an itemized bill, or find it on your patient portal.

The key bit is a FIVE DIGIT code, look for something lie this:

[Navigating Healthcare @NavigatingHC]

In order to be an effective health care consumer these days, you MUST arm yourself with 2 CRITICAL pieces of information for every visit/procedure/service you receive.

[Navigating Healthcare @NavigatingHC]

In order to be an effective health care consumer these days, you MUST arm yourself with 2 CRITICAL pieces of information for every visit/procedure/service you receive.