Is Insurance the Reason Healthcare Is So Expensive?

I've spent hours putting together a 1,000-piece puzzle before. Only to come right to the end and realize my sibling took a few pieces and hid them from me, which led straight to that classic ‘are you kidding me?’ moment.

That’s exactly how I feel when I’m reading a medical bill. Like someone scrambled the puzzle box, took key pieces, and then charged me to solve it.

Line items, adjustments, “discounts,” and cryptic codes that somehow turn a $300 MRI into a $3,000 charge? Most people give up and just pay whatever shows up (me included).

So, what makes healthcare so dang expensive?

Sure, inflation, physician salaries, and new medications like GLP-1s are part of the story. But they don’t come close to explaining why the U.S. spends over $4.9 trillion annually on healthcare (more than any other country by a wide margin).

So, what does explain it?

Middlemen.

There are massive layers of administrative complexity between the patient and the provider. It’s your carriers, profit-driven hospitals, varying prices, pharmacy benefit managers (PBMs), and a system built to profit from keeping you sick.

That’s why more people are asking a simple, maybe radical, question:

What happens if I just pay cash?

What Does It Mean to Pay Cash for Healthcare?

Paying cash, aka “self-pay”, means you skip using your insurance card and pay your provider directly. Thanks to federal price transparency laws, hospitals are now posting their cash prices and (shocker) they’re surprisingly low.

For example, a CT scan that costs $3,000 through insurance might only be $550 if you just pay up front. High-cost imaging and surgical procedures can all be cheaper when you take insurance out of the equation.

I grew up thinking insurance was what made healthcare affordable. Now I know it’s the reason why we overpay.

When Paying Cash for Healthcare Saves You Money

Choosing to pay cash isn’t limited to people without insurance. Anyone can ask for a self-pay rate.

Can I actually skip insurance and pay out of pocket? (Yes.)

Can I still use my plan when it makes sense? (Also, yes.)

You have the legal right to be “self-pay”, with or without insurance. You can decide which route makes sense each time you get care. That’s the part no one tells you.

Cash wins when:

• You want to control costs and have transparency in healthcare

• You have access to multiple providers

Analyses from RAND and the U.S. GAO show that private insurers often pay hospitals more than twice what Medicare would pay for the same service. Because many hospitals set their self‑pay rates close to Medicare’s pricing, paying cash can result in significantly lower costs, often less than half what insurers pay.

For most care, cash usually comes out ahead. Still, going all-in without insurance can feel risky.

Navigating cash pay and the healthcare system shouldn’t be a DIY project. It’s important to have an expert on your side who knows which providers to trust, how much things should cost, and how to negotiate claims.

That’s where programs like Apta Cash and Apta Guardianship enter the picture. It's a new kind of healthcare benefit that lets members present themselves as “self-pay” patients. But behind the scenes, there is an entire team doing the following:

• Helping you find the right provider for your care

• Negotiating discounted, cash rates directly with those providers

• Paying the bill in full, quickly and transparently

Everyone is getting the benefit of cash pay and the protection of insurance without the usual cost chaos.

Real Numbers: How Cash Pay Compares to Insurance

*Pulled directly from real Apta Cash negotiations.

Why Paying Cash for Healthcare Matters More Than Ever.

From 2018-2023 premiums have increased by more than 22%. The rise in healthcare costs isn’t just a headline anymore. It’s real, and it’s hitting harder in 2026.

For millions of Americans, this isn't just frustrating. It's financially destabilizing. According to the Commonwealth Fund’s most recent national survey, 46% of U.S. adults said they had skipped or delayed healthcare in the past year because of cost.

It’s a sobering thought to have insurance but simultaneously not be able to afford your out-of-pocket costs.

Now is the time to learn how cash pay works – to understand what actually drives costs behind the scenes, and to prepare for your next renewal with eyes wide open.

These aren’t normal times. So why keep pretending the old system still works?

Here’s the point of this entire blog: You’re not overpaying because care is expensive. You’re overpaying because hospitals, facilities, and middlemen are overcharging. This is why you need a guide with you.

The System’s Broken. Here’s How You Take Control.

Paying cash for healthcare can absolutely be cheaper than using insurance. But only if you know when and how to do it. Now, with models like Apta Cash and Apta Guardianship, you don’t have to choose between savings and coverage.

You can get the best of both.

If you're tired of navigating a system built on confusion, it might be time to explore a simpler, more transparent way to handle healthcare.

Need help making sense of your options? Let’s talk. Contact us at info@apta-health.com for more information.

FAQ's

Can I pay cash even if I have insurance? 

Yes. Any patient can request self-pay pricing, whether they have insurance coverage or not. 

How is Apta Cash different from a traditional plan? 

Apta Cash negotiates cash rates directly with providers, cutting out administrative layers that drive up the price. It’s a new way of thinking about coverage. 

Are all providers okay with self-pay? 

Many are, especially when they get paid quickly. But it’s always best to ask ahead of time and confirm pricing. 

What is the difference between Apta Cash and Apta Guardianship? 

Apta Cash is a single point solution that helps members save money on medical procedures by negotiating lower cash prices directly with providers.  

Apta Guardianship is a cohesive benefit plan that helps members stay healthy and avoid the hospital by managing their care through virtual providers called guardians, using the Apta Cash team only when care outside the virtual guardian is needed.