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My dad is coming to visit me from a country with a very poor medical system. The kind of system where senior citizens don't get much attention from doctors at all and pretty much left to die from diseases that could be treated or at least managed here in the US.

He is 74 years old, relatively healthy and active. Yet, I'd like for him to undergo tests and screenings that are appropriate for his age to get an accurate picture of his health. Since he is just visiting, he is not eligible for Medicare.

The question is:

1) What would be the best way to do this diagnostics for him? (logistically)

2) What is the best way to pay for it? Paying out of pocket and buying a private insurance are on the table.

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    Question #1 "What would be the best way to do this diagnostics for him? (logistically)" is definite of-topic. As for #2, you two will have to determine which tests and screenings you want to perform, how much they cost, etc. Note also that non-Medicare health insurance for old people is likely to be expensive, and I doubt you could even get it for someone here on a travel visa. – RonJohn Jan 5 at 17:32
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Get liquid funds ready in advance, be prepared to put down sizeable cash deposits for services you can't or don't want to purchase outright, and try to negotiate discounts for paying bills immediately and in cash.

I spent quite a few years working in the financial services office of a large hospital, and have personal experience dealing with this sort of situation from the health care provider's point of view. That's the view that matters, because if you can't satisfy a provider's concerns they can easily refuse to provide the services you're describing.

There is an upside and a downside to the situation you describe, and they are complements of one another. The basic elements are:

  • You want your father to receive a known set of specific medical procedures while in the U.S.
  • Your father is in a relatively high-risk age category regarding medical expenditures
  • Your father does not currently have any sort of insurance to cover medical expenses
  • Your father resides, and presumably most or all of his assets are located in, a country other than the U.S.

First I'll list the downsides of that setup:

  • This situation isn't how insurance is really supposed to work. You 100% intend for your father to incur the medical expenses for the tests you have in mind while he's here. In insurance terms, the cost risk is 1-- there is no benefit of any kind to an insurer offering coverage for those services, since the expenses will happen, unless the insurer charges you more than those services would cost without the coverage. In which case you may as well skip the insurance altogether.
  • Any insurance your father might be able to access will almost certainly include coverage for far more than routine tests, and so will be priced according to a more complete array of health risks your father experiences. That means it will likely be expensive, addressing the possible need for services well beyond screenings.
  • As someone who will only be in the U.S. for a fairly brief time, and will then return to another country, efforts to collect outstanding bills will become more time consuming and expensive. Health care providers may be more reluctant to offer any sort of financing, and the terms that they offer may not be very generous.
  • There is no way to guarantee, or even plausibly suggest, that the medical expenses your father incurs will be limited to these tests alone. For example, if a test reveals an urgent need for medical services (such as surgery) it might not be realistic to claim that you and your father would not demand those services. In some cases the health care provider may be legally obligated to provide those services immediately.
  • There are few, if any, options a health care provider has to deal with an outstanding balance. Programs like Medicaid may be available, to some degree, depending on the state you live in (and I wouldn't count on it-- those sorts of special permissions are rare and their criteria narrow). It is likely that, in the event of non-payment, the provider would have to write off the balances as a loss or use part of an uncompensated care fund. In either of those cases the provider will have a limited amount of resources to defray those sorts of bills, and may be unwilling or unable to absorb such a loss. In this scenario that would play out as reluctance or refusal to extend any sort of financing at all.

The sum of all of that is that you're not really in the market for insurance (you're not trying to hedge against uncertain risks) and health care providers have little incentive to carry financial risk on your father's behalf.


The upsides:

  • Since insurance isn't quite on target for what you're looking for, and would likely be a poor fit for your situation even if you were looking for it, you can avoid one of the more complicated and frustrating elements of seeking medical care in the U.S. You don't have to worry about comparison shopping health insurance plans, dealing with provider networks, or anything like that. It's not a money saver for you, but it does remove a lot of complexity.
  • Since you are looking at a set of relatively limited, discrete medical services, you can have a more straightforward conversation with health care providers about what you want and how you want to pay for it. There isn't much confusion about ICD-10 coding for a panel of blood tests or generic lab work.
  • Since you are open to paying out-of-pocket for what are typically low-cost medical services, you have a good shot at obtaining those services by paying for them in cash, in advance, or putting down a sizeable deposit against the expected total bill.
  • If you are willing and able to pay the bills in full and in cash for specific services, you can inquire about discounts off of the total charges. Many health care providers are willing to offer discounts on services in exchange for removing all uncertainty and administrative effort around collecting payments.

You have a good chance of getting your father in to see a doctor or physician's assistant, given the details outlined above, if you are willing to immediately pay or personally guarantee the bills. You have virtually no chance of getting another party to shoulder any of the bills, aside from a potential discount for paying upfront and in full.

dwizum made a great point in a comment about negotiating a discount: you don't have to work primarily from the charge master price (the "sticker price" that the provider charges by default). It's worth asking what a typical insurance plan would pay and then negotiating towards that number, rather than simply trying to get away from the charge master price. As always, the worst that will happen is they will decline to offer the discount you'd like, and with routine services that don't involve much uncertainty the provider may be more flexible than for other services.

So my advice is to schedule the appointments as far in advance of the visit as possible (to help with scheduling difficulties on the providers' ends), state your intention to pay the bills in cash at the time of service (or ask about a suitable cash deposit) while you are scheduling the appointments, and inquire about any discounts the provider may offer for a full cash payment at the time of service.

Be aware that these same conditions will hold should the tests suggest some additional care that might benefit your father, and that you will be in the position to pay these bills out of pocket too (you will be bearing that risk) or that you will not be able to pursue those services (without pursuing more convoluted ways of getting money, such as taking out a large personal loan yourself).

Different providers will have different procedures for this sort of thing, but be prepared to offer documentation of your finances overall to convince them that you are willing and able to pay the charges. You may also be asked to sign papers legally establishing you as the guarantor for your father's medical services in the U.S. with that provider.

In all cases, make an effort to record the name, title, and department of anyone you speak with that gives you information on these matters (it's really helpful to remember who said what and when, and bureaucracy tends to make that harder with hospitals and clinics), and where possible get relevant policies and assurances in writing. I wouldn't make a huge deal out of that unless you really feel you have to, but uncertainty about the arrangements does not and will not favor you here.

  • How much of a cash discount can one expect? (I just got a 44% discount through my insurance company.) – RonJohn Jan 6 at 19:57
  • @RonJohn It's impossible to estimate well in the general case. It's largely a function of the charge master price (which you'll never see), the cost of interacting with insurers for payment, typical costs of collection efforts, "fluff" on the charge master price, the provider's overall financial situation, executive fiat, and other hard-to-assess factors. I can't reveal numbers from experience in my former job, but anecdotally for office visits I've heard of discounts ranging from 0% to ~70%. There is no downside to asking, but I would be prepared for the worst case of no discount at all. – Upper_Case Jan 6 at 20:03
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    This is a great answer. I would just add, don't negotiate just on the "cash price." Providers are tuned to getting paid by insurance companies, which usually contract to pay flat rates for services based on a percentage of CMS or other publicly-available fee schedules. You can always ask, what would a typical insurer pay for this? or, what would medicare pay for this? and then bargain to that number. A basic new patient office visit (99201) usually pays around $50 but some providers will bill it at $200 or more. – dwizum Jan 6 at 20:28
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    @dwizum That's a great point, especially for routine services. I've edited that suggestion into my answer. – Upper_Case Jan 7 at 16:32

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