In Oklahoma City alone there are roughly three dozen centers that are all or partly cash based, specializing in everything from radiology to oncology. While no organization keeps track of how many cash-based medical centers have cropped up nationwide in recent years, Smith and Lantier say theyвЂ™ve witnessed an explosion. If they go to a cash-based provider that meets the fundвЂ™s criteria, including the Surgery Center of Oklahoma, they pay nothing at all. In 2015 it announced a new rule: If patients go to a traditional hospital, they pay their deductible and co-payment. The Oklahoma state public employeesвЂ™ insurance fund, which covers 183,000 people, recently did similar math. Villa, for example, says his decision to go to the Surgery Center saved his company money, since his $19,000 bill is less than it would have been charged, even with a negotiated discount, by a traditional hospital. Because such companies pay their employeesвЂ™ medical bills out of their operating budget, itвЂ™s in their interest to steer everybody to the cheapest option. Self-insured companies, like the trucking and storage firm where Villa is the chief administrative officer, are also fueling the trend. Cash payments donвЂ™t count toward a patientвЂ™s deductible, but for some itвЂ™s worth the gamble. For a patient with an $11,000 family deductible, for example, it might make more sense to seek out a cash-based center like the Premier Medical Imaging facility in Minneapolis, which offers a basic MRI for $499, than to cough up the several thousand dollars that the same procedure generally costs at a traditional hospital. But nowadays many of the people seeking cash-based care are middle-class Americans with high-deductible insurance plans. Sometimes called direct pay, and closely related to concierge care, this sort of business model was once seen as the perquisite of rich folks and medical tourists from foreign lands.

If unforeseen complications arose during or after the procedure, the Surgery Center would cover those costs. And that price would include everything from airfare to the organizationвЂ™s only facility, in Oklahoma City, to medications and physical therapy. The Surgery Center would charge $19,000 for his whole-knee replacement, a discount of nearly 50% on what Villa expected to be charged at his local hospital. To Villa, the model seemed refreshingly subversive.

Loms cash only