Cash Pay Rates

- Uninsured Patients
  - Options for uninsured patients that cannot pay Cash Pay Rate upfront
    - Payment plan based on gross charges, not discounted Cash Pay Rate
    - Uninsured Compact pricing (only applies to emergent care patients)
- Non-Covered Services Patients
  - Patient exhausted the benefits on their Health Insurance Policy
  - Pre-existing condition exclusion
  - Service was denied in the Health Insurance Policy pre-authorization process
  - Patient wants to pay out of pocket and is opting out of Health Insurance Policy
- Federal Health Care Program Beneficiaries
  - Available only for services that are excluded from coverage (e.g., cosmetic surgery)
- Patients on a High Deductible Health Plan
  - Must also meet the definition of uninsured to get cash pay rates
  - Also agree to pay upfront and waives right to billing insurance payer
- Patients that are Foreign Nationals
  - Eligible if they meet Cash Pay Rate Policy criteria
  - Those with insurance coverage would not qualify for the Cash Pay Rate

- Elective Services Eligible for Cash Pay Rates
  - Imaging services
  - Obstetrical services
  - Plastic surgery
  - Bariatric surgery
- Cash Pay Rate Availability at Facilities
  - Services and payment amounts are subject to facility’s determination
  - Single rate schedule for common elective procedures/tests for hospital’s departments
  - Separate licensed centers may have their own Cash Pay Rate Schedules established

- Proposed Cash Pay Rates
  - Rate must be more than Medicare rate
  - Rate is not lower than Medicaid rate
  - Reasonable margin over fixed and variable costs exists
  - Any external market consideration for service
  - Exceptions require approval by Counsel and VP Operations Finance
- Cash Pay Rates and Services Approvals
  - Request is submitted to VP, Operations Finance
  - Request must be approved before offered to patients
  - All cash pay rates must be reviewed at least annually

- Advertising Cash Pay Rates
  - Patients and physicians can be told that Cash Pay Rates are available 
  - Marketing or advertising any Cash Pay Rates should not be done unless approved
  - Advertisements plans must be submitted for review and approval in MARS
- Agreement and Payment of Cash Pay Rates
  - Patients sign an agreement that service is going to be paid via cash pay rate
  - Cash Pay Rates must be paid in full upfront and no portion can be paid over time
  - Does not apply to deductibles, co-payments or any other co-insurance amounts when insurance is being billed for the service
  - Patient cannot use Cash Pay Rates if they are using another payment policy
  - Tenet legal counsel should be consulted for patients who used Cash Pay Rates and want to retroactively apply and qualify for charity or discount programs (financial assistance).