Self-pay and prompt-pay discounts on a medical bill: how to ask

Paying for care without insurance can mean a bill at full list price. Many providers will take less if you ask. A self-pay discount lowers the price for people who pay on their own. A prompt-pay discount takes money off for paying quickly. This guide explains both, and how to ask. It's part of our guide on how to lower medical bills.

Before you ask for a discount, make sure the bill is right. Our guide on how to get an itemized bill shows you how to see every charge. Then check whether you qualify for hospital charity care, which can lower the bill even more.

What are self-pay and prompt-pay discounts?

They're 2 different discounts, and you can often ask for both.

A hospital's list price is called its gross charge. It's the price on the hospital's chargemaster, its master list of prices, before any discounts. A bill sent to someone without insurance often starts there.

The discounted cash price is the price that applies to someone who pays cash or the equivalent. Since January 1, 2021, hospitals have had to post it online, along with other prices. If a hospital doesn't offer a cash price for a service, its consumer-friendly price list shows the gross charge instead.

Who can ask?

Anyone can ask. These are the people most likely to get a self-pay rate:

• People without insurance. This is who the cash price is for.
• People whose plan doesn't cover the service. If your plan won't pay, you're paying on your own anyway.
• People who choose not to use their insurance. Sometimes the cash price is lower than your plan's price, and you won't meet your deductible this year. Ask your plan first whether what you pay counts toward your deductible.
• People with a balance after insurance. A self-pay rate usually applies to the whole service, not your share. But a prompt-pay discount on your share is worth asking about.

Why is the cash price so different from the bill?

A few things explain the gap:

• The first bill starts at the list price. The gross charge is the price before any discount. Insurers rarely pay it.
• Insurers negotiate their own rates. Your plan's price for the same service may be lower or higher than the cash price.
• Providers save money when you pay quickly. Billing, waiting, and collections cost them money, so some take less for fast payment.
• No one applied the discount. Some bills go out before anyone sets up the self-pay rate. Asking can be all it takes.

How discounts fit with charity care and estimates

Discounts aren't your only tool. Here's how they work with your other rights.

Charity care comes first. Nonprofit hospitals must have a written financial assistance policy. If you qualify, they can't charge more for emergency or other medically necessary care than they generally bill people with insurance. For other covered care, they must charge less than the gross charge. That limit can be lower than the cash price, so apply first. Our charity care screener shows where your income falls.

Your good faith estimate should include the discount. If you're paying without insurance, providers must give you a good faith estimate (GFE) before scheduled care. Federal rules say its expected charges should be the cash pay rate, reflecting any self-pay discounts. If a provider's bill is at least $400 more than its estimate, you can start a dispute. You have 120 days from the first bill. See our guide to good faith estimates and the $400 dispute rule.

The posted price gives you a starting point. You can look up a hospital's cash price before or after care. Our guide on how to look up what a hospital charges shows where to find it.

If you have Medicare

The rules are different for the share Medicare says you owe. The U.S. Department of Health and Human Services Office of Inspector General (OIG) enforces federal laws on Medicare billing and kickbacks. It has said that routinely waiving Medicare deductibles and coinsurance can break those laws.

There's an exception for financial hardship. A provider can waive or reduce your Medicare share if it doesn't advertise the waiver or do it routinely. It must also decide in good faith that you're in financial need, or waive it only after reasonable efforts to collect have failed. The OIG says financial need isn't limited to very low incomes.

So if you have Medicare and can't afford your share, ask about financial assistance. Don't expect the cash discounts that people without insurance may get. This is general information, not legal advice.

What to do

1. Check the bill. Ask for an itemized bill and look for errors. Fix those first.
2. Ask about financial assistance. Get the hospital's policy and apply if you might qualify.
3. Look up the posted cash price. Find the hospital's discounted cash price for your service.
4. Call the billing office. Ask them to bill you at the self-pay rate and to hold your account while they do.
5. Ask about a prompt-pay discount. Ask how much it is, how long you have, and whether it stacks with the self-pay rate.
6. Get it in writing. Before you pay, get the new amount and any deadline in a letter, email, or portal message.
7. Pay only what you can. Don't borrow at high interest to get a prompt-pay discount. Ask for a payment plan with no interest instead.

Here's what you can say:

Hi, I'm calling about account number [number]. I'm paying for this care myself. Can you bill me at your self-pay rate? Your posted cash price for this service is $[amount].

If I pay the full balance within [number] days, is there a prompt-pay discount? How much would I owe, and can you send that to me in writing?

For more lines, see our guide on how to negotiate a hospital bill.

Say Andre doesn't have insurance. He has a small outpatient procedure at a hospital to remove a cyst. His first bill shows the gross charges. His income is above the limit in this hospital's financial assistance policy.

He looks up the hospital's posted discounted cash prices and calls the billing office.

Line	Gross charge	Posted cash price
Procedure	$2,400	$900
Facility fee	$1,100	$450
Lab test	$300	$90
Total	$3,800	$1,440

The hospital agrees to bill him $1,440. It also offers 10% off if he pays in full within 30 days. That's $144 off, so he'd owe $1,296.

Andre has $1,300 saved, so he pays $1,296 within 30 days. That's $2,504 less than the $3,800 he was first billed.

Results vary. Another hospital might offer a different discount, or none.

When to get help

You can often get a self-pay rate with 1 call. It's worth getting help when:

• The provider won't tell you its self-pay rate or cash price.
• The bill is large, or it comes from several providers.
• The bill is already in collections.
• You're handling bills for someone else and you're short on time.

A hospital financial counselor can explain the financial assistance policy and the self-pay rate. Dollar For, a nonprofit, helps people apply for hospital charity care for free. A medical bill advocate can make the calls for you. If the bill came in far above your estimate, the No Surprises Help Desk can explain your dispute rights at 1-800-985-3059.

If you still can't afford what's left, see interest-free medical payment plans and what to do if you can't afford medical bills.