A patient walks into the exam room knowing exactly how much their visit will cost. A $50 lab bill is paid without ever going through insurance. As deductibles rise and new transparency rules are implemented, the reality of a cash-pay system is steadily gaining popularity.
According to the American Medical Association, healthcare costs equal around $5.27 trillion in the United States. A third of adults say they’ve skipped health care due to cost. Kaiser reports that the rate of inflation is outpacing medical costs. The response, for some physicians, is the movement to high-transparency cash-pay options, sometimes instead of insurance processing options, and sometimes in addition to it.
Dr. Brecken Moore, owner and provider at Desert Diabetes Thyroid & Hormone in St. George, Utah, offers both.
“Most of the people who come to us have been managing something complicated for a long time, often bouncing between providers who each saw one piece of it,” he says. “I wanted to build a practice where that doesn’t happen, where visits are long enough to actually get into someone’s history, where patients can reach us between appointments, and where they see the same person every time. Continuity matters enormously in this kind of care.”
Similarly, the Surgery Center of Oklahoma, for example, has a page directly explaining their transparent pricing: “At Surgery Center of Oklahoma, we believe transparent pricing is the only way to be compassionate and honest caregivers. Your health should be in your hands, and you should know your price,” they write, before listing a variety of surgery types with specific prices.
Here’s how the cash-pay takeover is easing some health care woes from unexpectedly high bills to access.
What’s Driving Patients Toward Cash-Pay
Even with good health insurance, patients can still get sticker shock. The bill often arrives six weeks later and deductibles and co-insurance still have to be paid. In fact, according to J.P. Morgan’s Trends in Healthcare report, 55 percent of consumers had received a medical bill of at least $400 in 2025, and the Center for Economic and Policy Research reports that in 2024, the average family paid almost $4000 on healthcare, including out-of-pocket and premium costs.
As inflation increases, for many routine procedures, the cash price is at or below the negotiated insurance rate. According to Insurance Enterprise USA, sometimes self-pay costs are cheaper than “chargemaster” rates, which they define as “inflated, unrealistic sticker prices that hospitals list but rarely collect in full.” After that, insurance negotiates a better rate, the “negotiated insurance rate,” which still might be higher than the discounts provided to patients through self-pay.
They give an example involving an MRI that might cost $5,000 at the “chargemaster” rate, be negotiated down to $2,000 with insurance, but offered to patients at a self-pay discount of $500-$800.
Some might simply find it easier to bypass the hassles of insurance.
“Insurance rules don’t always line up with good medicine. Prior authorizations, step therapy requirements, restrictions on which labs I can order, those are decisions being made by someone who has never met the patient,” Moore says. “When someone pays directly, we can order the panel that actually answers the question and start the treatment that actually fits, without waiting weeks for a company to approve it.”
Why Providers Are Publishing Prices
Margins are shrinking amidst inflation, and changes in reimbursement rates are having an impact on providers and healthcare systems, according to Kaiser’s research.
“Upfront pricing changes the whole tone of a visit. Patients aren’t sitting there bracing for a bill to show up six weeks later, and they’re not afraid to ask about a test because they don’t know what it’ll cost them. They can make real decisions with real numbers in front of them,” Moore says. “It also builds trust faster than almost anything else I do, being straightforward about money tells a patient you’ll be straightforward about everything else.”
Federal rules now require hospitals to post discounted cash prices publicly: The No Surprises Act protects consumers from unexpected medical bills, specifically for emergencies, certain in-network expenses, and air ambulance services. Yet, Insurance Enterprise USA claims actual transparency has been “poor,” blaming hospitals for hiding pricing information in difficult-to-read formats or ignoring the rule entirely, allowing hospitals and insurers to continue opaque pricing.
Filling the gap are alternative self-pay methods grabbing frustrated patients’ attention as a better option. According to Healthinsurance.org, there’s an increase in the number and interest in Direct Primary Care practices, which are like memberships for primary care visits and significantly less expensive (around $50-$100 per month) for a range of primary care services. In addition, “concierge” style care often involves the expectation of more attention and time, but self-pay processes.
“We do accept insurance, but a lot of the people who need this kind of care don’t always have it,” Moore says. “Offering a cash-pay option means nobody has to be turned away at the front desk.”
ABOUT THE AUTHOR
Alexandra Frost
Member of the Zion HealthShare Editorial Team
Alexandra Frost is a Cincinnati-based journalist and content strategist with 15 years of experience. She has written for national publications like the New York Times, Washington Post, Atlantic, Forbes, and others. She has also contributed to multiple healthcare associations and hospital systems’ publications. She is a parent to five young kids and a cancer survivor passionate about strong healthcare content.
Read more of her work at www.alexandra-frost.com.