You may have noticed that prices for medical services can vary greatly. With the lack of transparency that is common in the healthcare industry, it can be difficult to know if you are getting the best price for your healthcare services. This may feel especially important if you have expenses that do not meet your IUA or that are not a part of a medical need.
At Zion HealthShare, our goal is to keep our member contributions as low as possible. We do this with the help of our members, who take responsibility for their own healthcare every day by searching for the best prices on the services they need. But how can you do this when healthcare prices can differ by thousands of dollars for the same procedure? Let’s explore why medical costs work the way they do and what you can do to save money when you need a medical service.
Why Do Healthcare Prices Vary So Much?
1. Insured patients’ costs are determined more by their insurance plan than actual service prices
When a patient has traditional insurance, the amount they pay is generally based on either a copay or their deductible and coinsurance amounts. This means most average healthcare consumers probably aren’t too interested in how much their insurance company is going to be charged for their healthcare.
It is up to insurance companies to negotiate rates for the overall costs of healthcare services. For a long time, these rates were kept secret. Recent laws forced hospitals to publicly reveal the rates they negotiated with insurers, a move the American Hospital Association pushed back against without success.
2. There is a lack of competition
Healthcare consumers are often limited in where they can receive care—either because their insurance limits them to in-network providers or because they simply do not have options in their area. Additionally, more hospital mergers mean fewer choices.
3. Health services are often unexpected but necessary
Many healthcare services are the result of an accident or emergency, meaning consumers don’t have the option to shop around or get the lowest prices on services. If a patient is being rushed to the hospital for a stroke or a broken leg, they likely aren’t asking to be taken to the facility with the lowest prices. Many facilities can charge more than they might if the patient was able to shop around and compare prices beforehand.
How to Save on Medical Bills?
1. Ask for negotiation / get a self-pay discount
Most people don’t know that you can negotiate your medical bills. Hospitals and providers usually charge insurance companies more than uninsured patients. If you ask for self-pay at the time of service, most providers will give you a discount. Sometimes, this can be as simple as asking for a discount when you receive your service.
With the extreme variation in healthcare pricing, negotiating is not always so simple. Zion HealthShare’s Medical Advocacy service is available if you have any questions about finding reasonably priced providers. Learn more about Medical Advocacy.
2. Do your research
Negotiation is often about doing your research to find out what a fair price would be on your medical bills. You can look at the Medicare rate for services to get a good idea of what a reasonable charge would be. Generally, “fair pricing” is considered a rate that is somewhere around 150% of the Medicare rate. For services that don’t have an available Medicare rate, finding reference-based pricing for your area can also be helpful.
New laws are making hospitals more transparent about prices for specific services. You may be able to find prices on the facility’s website or call their billing department and ask for information.
3. Ask for costs in advance
We suggest finding prices as soon as possible, especially if it allows you to compare facilities. Shopping around for healthcare isn’t something most people are used to, but it is a good way to save on healthcare costs for non-emergency services.
4. Get itemized bills
Sometimes, hospitals overcharge due to errors. They bill for extra services or make other mistakes. Zion HealthShare requires itemized bills for sharing anyway, but it’s often a good idea to look over your bills even if expenses don’t amount to your IUA. Just reading over your bills and looking for errors can sometimes save you a significant amount on a medical bill.
5. Try direct primary care
Direct primary care is a great way to get routine healthcare services at a low price. If you haven’t already heard about DPC, you can learn more here. Using a DPC practice for your preventive needs may be a great solution that will help you save a lot of money on your routine care and prevent larger medical expenses from ever occurring. It’s basically a win-win.
6. Take advantage of your Zion HealthShare’s community!
If the thought of navigating the world of healthcare prices and negotiating bills seems overwhelming, remember that Zion HealthShare is always there to offer advice and help you find the lowest price for any healthcare need. Feel free to contact our Member Support team whenever you’re thinking about a medical service, and we will do our best to help.
How to Present as a Self-Pay Patient
Zion HealthShare is not insurance; if you do not have another health insurance provider, you should present as a self-pay patient when seeking services from your provider. This will allow for the appropriate application of self-pay discounts, as most providers tend to offer these discounts automatically upon being informed. These discounts allow us to keep membership contributions low.
If your membership began before 2022, you may have received a membership card.
This card was originally designed as a quick reference guide. However, we discovered that it sometimes caused confusion—some members believed they needed to present the card to their healthcare providers. This led providers to mistakenly assume Zion HealthShare is an insurance company and attempt to bill us directly. We cannot accept claims from providers as we are not insurance. You should obtain itemized bills and receipts to request payment or reimbursement from the Zion HealthShare community. In some cases, prepayment may be an option.
If you are also covered by any relevant insurers, third-party administrators, or government assistance plans, please do not present as self-pay. These plans will be the primary payor, and Zion HealthShare will be secondary.
Before Your Appointment: Look for providers who accept self-pay patients. Some clinics or providers may offer discounts or have special rates for self-pay patients.
During Scheduling: When scheduling your appointment, clearly state that you are a self-pay patient. This will help ensure a smoother process for sharing. Additionally, ask about any available self-pay discounts they may offer. Being transparent about your payment status can also open the door to discussing the cost of services and exploring affordable options. For some services, request an estimate of the costs for the services you expect to receive in advance.
At the Appointment: When you arrive, remind the front desk staff or billing department that you are a self-pay patient. Please be sure to request itemized receipts for all services provided.
After the Appointment: Once you receive your bill, please carefully review it to ensure there are no errors. While billing errors are rare, they do happen. If you notice an error on your bill, call your provider to request the error be corrected before submitting any bills to Zion HealthShare.
Once you have an accurate bill, submit all documents to your member portal under your open sharing request. If you have not opened a sharing request for this medical need, please do so as soon as possible.
No Surprises Act
The No Surprises Act, enacted on January 1, 2022, is a significant piece of legislation aimed at protecting patients from unexpected medical bills also known as “surprise billing”. These unexpected charges can create a significant financial burden for patients. While the Act applies to most types of health insurances, it also extends protections to self-pay patients, such as Zion HealthShare members.
It is important to know your rights and protections as you seek care. Zion HealthShare members are encouraged to understand and utilize the protections of the No Surprises Act, especially the requirement for good faith estimates.
Your Right to a Good Faith Estimate
As part of the No Surprises Act, healthcare providers and facilities are generally required to provide a “good faith estimate” to self-pay or non-insured patients prior to a scheduled appointment. This estimate is a written document that outlines the expected charges for the service. Providers must give these estimates upon request or at least three business days before the service. A typical good faith estimate includes:
A list of expected charges for items or services by the provider or facility.
Details about each item or service, including healthcare service codes.
For example, if you are scheduled for surgery, the estimate might include the cost of the surgery itself, anesthesia, and any necessary lab tests. However, it may not cover items or services scheduled separately, like pre-surgery appointments or post- surgery physical therapy. Separate estimates will be provided for these additional services if you schedule an appointment or request an estimate.
If you receive a bill that is $400 or more above the good faith estimate, you may be able to dispute the bill. Please note, good faith estimates will not be provided during emergency care.
Limitations and Dispute Resolution
While the No Surprises Act provides significant protections, it is important to note it does not regulate or set the cost of healthcare services. The Act addresses unexpected charges and provides transparency but does not control or cap prices.
Good faith estimates are based on anticipated costs and may not cover all potential charges that arise during treatment. However, if you receive a final bill that exceeds the good faith estimate by $400 or more, you have the right to dispute these discrepancies.
Steps for Disputing Charges
1. Negotiate with the Provider: Start by contacting the provider’s billing department to discuss the discrepancy. Reference the good faith estimates and try to resolve the issue directly.
2. Formal Dispute Resolution: If negotiation does not resolve the issue, you can submit a formal dispute. This must be done within 120 days of the billing date. During this process, the provider or facility cannot:
- Move your bill to collections or threaten to do so.
- Collect existing late fees on the unpaid bill.
- Take any negative action against you for disputing the bill.
If your bill is already in collection, collection efforts must be halted until the dispute is resolved.
For additional support and resources on how to dispute a bill, visit the Centers for Medicare & Medicaid Services: Dispute a Bill
Zion HealthShare & the No Surprises Act
As members of Zion HealthShare, it is important to understand how the No Surprises Act impacts your healthcare experience:
1. Always Request a Good Faith Estimate: When scheduling medical services, ask for a detailed cost estimate to avoid unexpected charges. Use this estimate to compare prices and make informed decisions about your healthcare options.
2. Inquire About Discounted Rates: Based on the provider or facility, self-pay or non-insured patients may be eligible for discounted rates. These rates may be offered under different categories as designated by the provider. Common named discounts include: self-pay, cash-pay, prompt pay, or pay in full. Ask your provider or facility to apply all available discounts.
3. Understand Your Rights: Familiarize yourself with the protections offered by the No Surprises Act to ensure you are not overcharged.
4. Use the Dispute Resolution Process: If you receive a bill that seems excessively high compared to the estimate, use the dispute resolution process to challenge the charges.
5. Communicate with Providers: Clearly communicate your self-pay status with providers and ensure they understand your billing preferences to avoid confusion.
Additional Resources
For assistance or more detailed information about the No Surprises Act please refer to these resources or reach out to Zion HealthShare at 888-920-9466:
Centers for Medicare & Medicaid Services: The No Suprises Act
Know Your Rights When You Aren’t Using Health Insurance
No Surprises Act
When Your Provider or Insurer Might Not Be Following the Rules
Why Choosing a Surgical Center Can Save You Money
If you’re facing a medical procedure, you may have more choices than you realize. One of those options is a surgical center also known as ambulatory surgical centers. Surgical centers are medical facilities that perform outpatient procedures, which means you can go home the same day. They focus on routine or specialized surgeries and are often a more affordable alternative. When it comes to medical procedures, choosing a surgical center instead of a hospital can lead to significant cost savings without sacrificing quality care. Here’s why:
-Lower Overhead Costs: Surgical centers have lower operating costs compared to hospitals. They are smaller facilities with fewer administrative expenses, which translates to lower prices for patients
-No Overnight Stays: Unlike hospitals, surgical centers focus on outpatient care, so you won’t need to stay overnight. This eliminates the costs associated with inpatient care, making procedures at surgical centers significantly less expensive.
-Efficiency and Specialization: Surgical centers are designed to handle specific types of procedures efficiently. This specialization allows them to streamline operations and reduce costs, while still providing high-quality care.
-Reduced Risk of Infections: Studies have shown that surgical centers have lower rates of surgical site infections compared to hospitals. This not only improves patient outcomes but also reduces the potential costs associated with post-operative complications.
The Importance of Saving Money in a Healthshare Community
As Zion HealthShare members, choosing cost-effective care like surgical centers helps us manage our collective expenses. Here’s why that matters:
-Shared Responsibility: In our Zion HealthShare community, we all pitch in to share each other’s medical costs. By choosing cost-effective options like surgical centers, you directly help reduce expenses, which keeps monthly contributions low for everyone.
-Sustainable Healthcare: Lowering costs ensures that the Healthshare model remains sustainable and accessible to all members. This is especially important for those with limited financial resources.
-Better Allocation of Funds: Saving money on medical procedures allows the community to allocate funds to other essential health services and support members in need.
Finding Surgical Centers Near You
-Online Search: Use search engines to find surgical centers in your area. Websites like Yelp or Healthgrades can provide reviews and ratings to help you choose a reputable center.
-Local Hospitals: Many hospitals have affiliated surgical centers. Contacting them directly can provide you with options.
-Referrals: Ask friends, family, or colleagues for recommendations based on their experiences.
Asking Your Doctor for a Referral
-Schedule an Appointment: Make an appointment with your primary care physician or the doctor managing your condition.
-Be Direct: Clearly explain why you prefer a surgical center over a hospital. You might say, “I’ve read that surgical centers can be more affordable and efficient. Could you refer me to one for my procedure?”
Make a Difference with Better Healthcare Choices
In a healthcare system that’s often unaffordable and unsustainable, choosing a surgical center is a powerful way to save money while maintaining quality care. By opting for cost-effective options, you help keep contributions low for the entire community, strengthening our shared commitment to better care.
Ambulatory Surgery Center Association locator tool
Your Upcoming Procedure: 5 Smart Steps for Zion HealthShare Members
Have an upcoming procedure or appointment? Here is what to do as a Zion HealthShare member.
If you’re a self-pay patient and part of Zion HealthShare, you’re in a unique position. You don’t have traditional insurance, but you do have a community ready to help share your eligible medical expenses. Still, preparing for a procedure or appointment can feel overwhelming, especially when you see big numbers on estimates. The key? Start early and stay organized.
Starting early helps avoid delays and confusion. It also allows the Zion HealthShare team to review your sharing request and provide guidance before your appointment or procedure takes place.
Step 1: Open a Sharing Request Immediately
As soon as you know about an upcoming procedure or appointment, log in to your Zion HealthShare account and open a sharing request. This notifies the team and begins the review process. Opening a request after care has already occurred can slow things down and may delay sharing.
*If you are experiencing an emergency, seek care immediately. You are not required to contact Zion HealthShare before receiving emergency care. You can open a sharing request as soon as you are able afterward.
Step 2: Ask About Self-Pay Discounts
Because you’re a self-pay patient, providers often offer discounts, sometimes significant ones! Here’s what to say:
“I’m a self-pay patient. Do you offer any discounts for paying out-of-pocket or for setting up a payment plan?”
You can also ask whether prompt-pay discounts are available if payment is made quickly
Step 3: Gather Your Documents
Having the right documents ready helps the sharing process move efficiently. Be sure to collect:
- Your procedure estimate or Good Faith Estimate and appointment details
- Any written discount agreements from the provider
- Medical records if necessary
Step 4: Pay Your IUA (Initial Unshareable Amount)
Before expenses become eligible for sharing, you are responsible for paying your Initial Unshareable Amount for each medical event. Make sure you know your IUA amount and plan for it in advance. Paying your IUA promptly helps prevent delays. Your IUA can be paid directly to Zion HealthShare or to your provider.
Step 5: Understand Your Payment Options
Even after discounts and sharing, your provider may ask you to pay a portion of the cost upfront. If notified with enough time before your procedure, Zion HealthShare may be able to make pre-payments on eligible medical needs once a determination is made. If timing is tight, ask your provider about payment plans that work within your budget.
Zion HealthShare also offers flexibility in how eligible medical needs are paid. Depending on your situation, this may include reimbursement after you pay the provider, direct billing with the provider once your IUA is satisfied, or payment through a prepaid card when available.
As a Zion HealthShare member, you’re not alone. Acting early, opening a sharing request, asking for discounts, and gathering documents, helps you get the most out of your membership and reduces stress. You’ve got a community behind you, and these steps make the process smooth and affordable.
Understanding “Final” or “Urgent” Notices on Your Bill
If you’re paying for your care yourself, seeing phrases like “Final Notice” or “Urgent” can feel stressful, but here’s what it really means:
- These notices are often standard language generated by billing systems to keep accounts moving. They are not typically a sign that immediate action or negative consequences are about to happen.
- You still have options. Most providers are open to conversations about your bill, including setting up payment plans or reviewing charges. A quick call can often bring clarity and relief.
- The amount shown reflects the full self-pay cost because there’s no insurance involved. That does not mean you are expected to pay everything at once.
- You’re not alone in this. Many self-pay patients have the same questions, and billing offices are accustomed to helping patients talk through next steps and make arrangements.
How to Ask for a Self-Pay Discount
Many providers offer discounts for patients who pay out of pocket. It is okay to ask. Here is a simple way to start the conversation:
1. When calling the billing office, you can say: “I’m a self-pay patient. Do you offer any discounts for paying out of pocket or for setting up a payment plan?”
2. Be polite and straightforward. Billing teams handle these requests every day and often have policies in place.
3. You can also ask about prompt-pay discounts for paying quickly or hardship programs if the amount feels overwhelming.
4. Once you reach an agreement, ask for the details in writing so you have a clear understanding of the final amount.
What to do next
If a bill feels confusing or stressful, reach out to the provider’s billing office as soon as you can. They can explain the charges, confirm timelines, and often help set up a payment plan that works for you.
These notices are reminders, not threats. Asking questions and starting a conversation is an important step in navigating your healthcare costs with confidence.
Zion HealthShare is not an insurance company. Neither this publication nor membership in Zion HealthShare are offered by an insurance company. Visit zionhealthshare.org to view your state-specific notice.
Current as of: July 23, 2026