Urgent Care Clinic (serving Pearland, TXMissouri City, TX and Sugar Land, TX )

Hours: Monday – Friday: 8:00 AM – 8:00 PM; Saturday – Sunday: 9:00 AM – 5:00 PM

(713) 340-3111

What is Self-Pay in Healthcare and How Does it Work?

Self-Pay In Healthcare

Healthcare costs in the U.S. continue to increase. According to KFF (Kaiser Family Foundation), an American family of four spends approximately 12% of its total income annually on medical services.[1] Having a company-backed health insurance plan is still the preferred choice for a majority of employed Americans, yet many people are now evaluating alternatives to paying for their healthcare expenses. One emerging trend in healthcare is the self-pay option.

“Self-pay” simply means a person pays for their medical services directly to the provider of the medical services without involving a health insurance company. The cost of medical services is determined by the provider and is generally at a reduced rate than what is billed to an insurance company. Medical providers deal with patients directly on payments due for medical services rendered and payments are often collected in advance or at the time of service.

For self-pay patients, it’s important to understand that payment policies and service rates vary from provider to provider so getting financial details in advance of receiving medical services is recommended.

Current Trends in Self-Pay

Even though coverage by health insurance plans have their benefits, many people are now switching to cash-pay options for several reasons:

  • No referrals or authorizations needed – Patients have the freedom to choose providers and are not stuck with only “in-network” providers or dealing with in-network restrictions when trying to access care.
  • Restricted treatment options – Certain medical procedures and therapies may not be covered under insurance. Self-pay options allow patients to fund these treatments – often at much lower rates than what insurance companies are charged.
  • Limited number of sessions – Some insurance providers may put restrictions on the number of medical sessions insured by them, affecting the patient’s quality of medical care. Self-pay options allow patients to fund these additional treatments on their own.
  • Limited appointment options – Appointment options like telemedicine may not be covered under some insurance policies. Self-pay options allow patients to choose the type and location of their appointment options.
  • Complicated billing processes with minimal cost transparency – Patient dissatisfaction with health insurance providers continues to grow as complications often arise in the billing for medical services. Multiple provider bills for the same treatment, surprise bills, denials of coverage after procedures, and lack of coordination between healthcare providers and insurance companies are all examples of billing complications which are greatly reduced with self-pay patients.
  • Self-reliance – With easy access to the internet, people have become proactive in looking for standardized health care at reasonable self-pay rates, eliminating the reliance on cumbersome insurance policies.

Benefits of Self-Pay for Non-Insured Patients

Self-pay healthcare options provide non-insured patients access to the same high-level medical care as people who have healthcare insurance plans. Self-pay healthcare also provides additional benefits that include:

  • No Gatekeeper – Self-pay eliminates gatekeepers (any person, department, or company who can make decision on a patient’s healthcare) and provides patients freedom of choice on their healthcare decisions
  • No hidden costs – Self-pay medical invoices provide transparent, up-front pricing and greatly reduces the chances of unexpected/unexplained expenses.
  • Time-saving – Self-pay patients don’t have to wait for lengthy approvals from insurance providers before they receive medical care/treatment. They can choose the provider and timeframe for treatment that works best for them.
  • No restrictions on benefits – Self-pay patients do not have to deal with any restrictions, requirements, or “in-network” designations when choosing their healthcare providers.

Benefits of Self-Pay for Insured Patients

If you currently have a health insurance, there are still ways to use self-pay to your advantage. Here are several potential benefits that insured patients can receive when using self-pay for healthcare services:

  • Avoid a high-deductible healthcare plan (HDHP) – When you cannot afford to pay the deductible of your insurance claim, self-pay provides an option that won’t delay treatment/healthcare.
  • Evaluate different costs for services – Certain treatments and procedures might not be covered by insurance or might be too expensive due to deductibles. Self-pay allows patients to research and evaluate healthcare costs in advance and then choose the options that works best for their budget.
  • Get quality care – Some diagnostic services like imaging (X Rays, MRIs), diagnostic assessments (blood tests, lab panels), and basic outpatient procedures have competitively priced self-pay rates that ensures availability of quality, timely medical care for self-pay patients.

Prime Urgent Care’s Competitive Self-Pay Rates

At Prime Urgent Care, a leading urgent care provider in Houston, TX, we offer competitive health care rates for urgent care services and diagnostic options at our walk-in medical centers in Pearland, Missouri City and Sugar Land.

Here are several common diagnostic/testing options we provide at affordable self-pay rates:

COVID-19 TESTING

The self-pay rate for the RAPID PCR Test is $165 and the self-pay rate for the RAPID ANTIGEN Test is $135. This charge includes the provider visit fee and is not added as a separate charge. Same day test results are offered on both tests.

Urgent Medical Care Services

For up-to-date self-pay rates on x-rays, flu tests, cough/cold/flu, strains/sprains/fractures treatment, and telemedicine visits, please call our office at 713.340.3111 to speak with one of our billing specialists.

If you live in the Pearland, Missouri City or Sugar Land area in Texas and need urgent medical care, Prime Urgent Care is here to serve you and your family’s healthcare needs. Our clinics are open 7 days a week (Weekdays – 8 AM to 8 PM; Weekends – 9 AM to 5 PM). We offer online check-in and you can schedule telemedicine visits by calling 713-340-3111

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Pearland, TX

2510 Smith Ranch Rd #102, Pearland, TX 77584
t: (713) 340-3111
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Missouri City, TX

8035 Highway 6 #170, Missouri City, TX 77459
t: (713) 340-3111
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Sugar Land, TX

20022 Southwest Fwy, Sugar Land, TX 77479
t: (713) 340-3111
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