His $11,339 Colonoscopy Bill Dropped to $799 — Here's How
What if your employee could walk away from a medical procedure and actually make money? That's not a fantasy. It happened to Tony, and it's happening more often as small businesses switch to smarter health benefit strategies.
The $11,339 Bill That Became $799
Tony needed a colonoscopy. The surgical center sent him a bill for $11,339.
Before paying, Tony asked one simple question: "What's your cash pay price?"
The answer? $799.
That's a 93% reduction — just for asking. No haggling. No lawyer. No insurance company fighting on his behalf. Just one question.
This kind of price drop isn't rare. Medical providers often have two prices: the inflated "chargemaster" rate they bill to insurance, and a much lower cash price they'll offer if you ask. The gap between those two numbers can be enormous.
Why Traditional Insurance Hides This From You
Big insurance companies — think Blue Cross, United, Cigna, Aetna, and Humana — advertise their "network discounts" as a major selling point. But here's the problem: those discounts are off an artificially inflated price to begin with.
It's like a store marking a shirt up to $200, then offering you 50% off. You pay $100 and feel like you got a deal — but the shirt was never worth $200 in the first place.
This is how insurers justify sky-high premiums. Employees never see the real price of care, so they have no reason to shop around. And when no one shops, prices never come down.
How Tony Actually Made $1,200 on His Colonoscopy
Tony had an indemnity health plan — a type of coverage that pays a flat benefit for specific medical procedures, with no deductibles and no copays.
His plan paid $2,000 for a colonoscopy.
He paid $799 out of pocket, submitted the receipt, and received a $2,000 check.
Tony netted $1,200.
That's the power of indemnity plans. When the benefit exceeds what the employee actually pays, they keep the difference. That creates a real financial incentive to find lower-cost care — and employees who shop smart get rewarded for it.
What This Means for Small Business Owners
If you're a small business owner offering health benefits, this model changes everything. Here's how it works in practice:
You set a defined contribution amount for each employee through an ICHRA (Individual Coverage Health Reimbursement Arrangement).
Employees who opt out of the ICHRA can choose your employer-sponsored indemnity plan instead.
Your defined contribution carries over to the indemnity option — if the indemnity premium is less than your contribution, the employee pays nothing out of pocket.
When employees use their indemnity benefits wisely, they can come out ahead — just like Tony did.
ICHRA gives you flexibility with no contribution cap. You decide what you can afford. Employees get real coverage and a real reason to be smart healthcare consumers. Everyone wins.
One Question Can Change Everything
Tony's story isn't a fluke. It's a preview of what healthcare can look like when employees are empowered to shop, negotiate, and keep the savings.
The right benefit structure makes this possible. And it starts with offering the right plan.
Ready to give your employees a health benefit that actually works for them? Visit benefitx.com to learn how The Benefit X-Change can set up an ICHRA or indemnity plan for your small business today.