We pay hundreds, sometimes thousands of dollars a year for health insurance, expecting it to save us money when we need care. But what if using that insurance doesn't always get you the better price?

For one South Tampa mom, routine brings comfortin routine a clean kitchen, her kids' calendar, knowing what tomorrow will bring. But when it comes to health care, Laura Kissak believes comfort doesn't mean necessary. And she did something years ago many families would consider unthinkable: She dropped health insurance altogether.

"Our family's been self-paying for about 7 years since my youngest was born," Kissak said.

She said the cost was what drove the decision.

"It was just the biggest expense, more than the mortgage," Kissak said.

But adds it was a scary decision to make.

"You're just going to die, you know, you're going to be bankrupt, the world's gonna end, and I totally believe that, like how, you know, how dare you go without coverage, you know, um, but you know you kind of ease into it and it gets better," Kissak said.

She has since created the Facebook page Self Pay Tampa Bay, where she's finding there are more people like her.

"We took the leap and left traditional health insurance," her post read. "As a business owner family, premiums were 2K a month with a 10K deductible."

She now pays about $200 for a monthly membership at a doctor who offers cash options for her entire family.

"We were having the experience where the self-pay price was cheaper than even after insurance," Kissak said. "I always remember like still getting a bill for $400 from Quest even after insurance, like just for a simple blood draw, and the primary care we use now does a blood draw in the office, and it's about $20 just for a simple blood work."

But understands there is risk. Kissak and her family the money they would be paying for health insurance premiums into an account each month and increased the bodily injury and liability coverage on her car insurance.

"I mean, maybe for catastrophic things, but even then we've been putting the money aside now and what we would have spent on premiums, we should be able to still even self fund some of that," Kissak said.

We wanted to see what this actually looks like in dollars and cents. So we went into hospital price estimators and searched some of the most common health care needs: blood work, an office visit, a colonoscopy and a mammogram. For most, the estimates were pretty similar, or insurance came out a little cheaper.

But then we tested the prices for a bilateral mammogram. Using Tampa General Hospital's estimator, our mammogram estimate with insurance was $529. The self-pay estimate? $185. Same search. Same medicine. The money is different $344 in this case.

In fact, researchers at Johns Hopkins studied prices for 70 common, shoppable health care services at 2,379 hospitals across the country. They found 47% of those hospitals had cash prices that were lower than or the same as the price negotiated by the insurance company.

Dr. Jay Wolfson is a professor at USF's Morsani College of Medicine. He said growing demand for self-pay options is a reflection of broader changes.

"It's a reflection of the changes in the health care system that have been brought about in, in fair part by the failures of the Affordable Care Act to do what it was intended to do," Wolfson said.

"The market's a wonderful thing. It's a wonderful thing. You don't have to be a big insurance company necessarily to play it," Wolfson said. "And if they can afford to do it and if they're in good health, maybe it makes sense for some people to say, I'm gonna stash the money away. Not everybody can afford to do that."

A lower cash price doesn't necessarily mean insurance isn't worth having, he said.

"Now if your employer offers it, take it. And if the price for a policy is reasonable, take it," Wolfson said.

While you can shop around for routine care, he said an unexpected illness or emergency can change the math quickly.

"But don't, don't bargain with your own health. It's not a roulette wheel," Wolfson said.

So his advice during open enrollment: Do your homework. Compare your options, know what your plan covers and what it costs, and don't assume the insurance price is always the lowest price. And whether you're using insurance or paying cash, he said it pays to ask.

"It never hurts to negotiate," Wolfson said.

Kissak said the right choice is a personal one.

"It's just, what it's, once again it's whatever works for your family. Every family is going to be on this. It's whatever you're comfortable with, your risk tolerance," Kissak said.

Each hospital group has a price estimator tool for you to test out cash prices versus insurance prices yourself. Take a look:

HCA Florida Healthcare

Tampa General Hospital

BayCare

AdventHealth

As patients grow frustrated with the traditional health insurance model, some doctors say it has burned them out, too.

Physicians in the Tampa Bay area are turning to what many call membership medicine, including direct primary care models that charge patients a monthly or annual fee for access to primary care services. Doctors who have made the switch say the model allows them to spend more time treating patients and less time dealing with insurance companies.

Watch more from Michael Paluska

At Xcelsior Health in South Tampa, founder Dr. Ryan Adami operates out of an unassuming home rather than a traditional medical office.

We're an example of a membership model, and we are different from concierge and more the price, and then the fact that we're cutting out third parties to go direct with patients or their employers, Adami said.

Adami said eliminating third parties can reduce costs and give patients more control over how they pay for care.

It makes zero sense that you're almost penalized for having insurance and going through it, and paying more out of pocket than if you were to just pay cash ahead of time, Adami said.

He said the model has also changed the way he practices medicine.

And then how we take care of them. To me, that is the biggest thing that I really didnt understand until doing it. How I take care of you as a patient is not dictated by the insurance, Adami said.

Adami said Xcelsior Health memberships start at $55 a month.

This year, some direct primary care patients have a new way to pay. Under the One Big Beautiful Bill Act, some direct primary care memberships can be paid for using tax-free health savings account dollars.

Adami said he does not want to return to the traditional insurance model.

How happy are you switching? Paluska asked.

Im much happier, much happier. I don't know if I would have stayed with it honestly, and I think a lot of doctors, you probably would have lost a lot of doctors to practicing medicine at all if there wasn't that membership model or direct primary care, Adami said.

Katherine Drabiak, a professor at the University of South Florida College of Public Health, said the administrative side of medicine can frustrate physicians.

I think part of this has to do with a lot of what goes into being a physician is the business of medicine, or the paperwork behind it, or dealing with insurance companies, or dealing with government-funded programs, Drabiak said.

Drabiaks courses include discussions about the realities students may face when they become doctors, including the business decisions involved in practicing medicine.

Do you tell your students you're going to come up against a lot of red tape with insurance? Paluska asked.

I think they know it think they know it. Yeah, Drabiak said with a laugh.

What do they say? Paluska asked.

They know it. So part of what I talk with with my students is navigating some of the risk of these business decisions and what they're able to do and what they're not able to do, Drabiak said.

Drabiak said patient frustration over medical bills is one reason models outside traditional insurance have emerged.

I think that's been one of the big frustrations among consumers and patients is feeling like why am I being billed for this amount? Where did this amount come from? Why is this so expensive? And so I think this is probably one of the areas why this model emerged. But as for what would the greatest model look like, I don't have the answer to that, so we'll have to we'll have to wait and see in the future, Drabiak said.

Membership medicine also comes with trade-offs. Membership fees do not go toward a patient's insurance deductible, and not everyone can afford an additional monthly expense.

The pro is they're able to get more access to that primary care physician and get those monthly visits to manage potentially some of those chronic health conditions that they might have, but it's an extra expense, Drabiak said.

Dr. Marai Roque of Our Personal MD has also moved away from practicing under the traditional insurance model.

I spent some time practicing with insurance medicine. Yeah, insurance medicine, Roque said.

How was that? Paluska asked.

It was exhausting. I mean, if we want to talk about burnout, it's not just not the kind of practice, the kind of medicine that I signed up for, Roque said.

Roque said dealing with insurance companies took time away from other aspects of practicing medicine.

"What is it that you have to jump through with insurance that causes burnout? Paluska said.

When you work with insurances, you spend a lot of time on administrative burden. You spend time meeting their criterias, fighting their denials, or asking them for authorization. Because of that, you need to hire more staff, Roque said.

She believes more doctors will consider making a similar shift.

I think every year we're seeing more doctors shift into this type of medicine because we feel like we're actually able to care for patients, and patients feel the difference. So I do think that this is going to become more and more of the standard, and hopefully the healthcare system adjusts to that kind of care, Roque said.

Adami stressed that membership-based primary care does not eliminate the need for

insurance to cover potentially expensive medical emergencies and illnesses.

So we're trying to change the system, where at least primary care has the time to spend with their patients, and it's affordable, and then use health insurance or wraparound policies that will cover things like emergency room, a cancer diagnosis, hospitalization. Those are huge, hugely expensive items that you really need that insurance to cover, Adami said.

Freestanding emergency departments have become increasingly difficult to miss across Tampa Bay.

These facilities promise convenient access to emergency care without requiring patients to travel to a traditional hospital campus.

But several patients told the Tampa Bay 28 I-Team that they did not fully understand the potential cost when they walked through the doors.

One patient said his insurer was billed more than $8,000 after a doctor treated his dislocated finger.

Another said a freestanding emergency room billed $35,000 following a visit for rabies vaccinations.

A third patient received more than $17,000 in charges after suffering a head injury.

I think theres something really broken here, Abram Jacobson said. And I know Im not the only one, and this was a really trivial instance.

Florida has 166 hospital-based, off-campus emergency departments, accounting for nearly 2 million visits, according to information reviewed by the I-Team.

Unlike an urgent care clinic, a freestanding emergency department operates as a hospital emergency room and charges emergency department rates.

A Florida House analysis from 2021 found that treatment at an urgent care center averaged approximately $193, compared with more than $2,000 at a freestanding emergency department.

A separate academic study found that each additional freestanding emergency center entering a market was associated with an average 3.6 percentage-point increase in emergency department spending.

The number one cost driver of every health plan in the United States is the emergency room, said Bill Hennessey, a physician and patient billing advocate.

For less serious conditions in which a patient does not expect to be admitted to a hospital, Hennessey said urgent care treatment typically costs approximately $200 to $300.

Theres a money-making opportunity, he said. Just follow the money.

Mark Currier dislocated a finger while playing basketball at a recreation center.

It was bent back about a 90-degree angle, he said.

Concerned that the finger might be broken, Currier searched online for nearby medical care and went to the closest freestanding emergency department that appeared on his phone.

They ended up taking my finger and pulling it straight, which hurt, and put it in a splint and said, OK, thank you very much, he recalled.

Then the bill arrived.

The overall fee that they billed my insurance company was over $8,000 to pull my finger, Currier said.

Currier said he believed an urgent care center could have treated the injury.

Absolutely, he said. It wasnt complicated at all.

He also acknowledged that he did not understand the difference between an urgent care clinic and a standalone emergency center when he sought treatment.

I didnt, Currier said. I just Googled it and went to the closest place that came up on my phone.

Abram Jacobsons experience began when his dogs cornered a bat in his yard.

Jacobson said he found the bat and touched its chest with one finger to check whether its heart was beating.

As a precaution, he took his dogs to a veterinarian for rabies booster shots, which he said cost $180 for both animals.

The veterinarian reported the incident to health officials, who directed Jacobson to seek medical treatment. He went to a freestanding emergency department.

I got in and out really quickly, and for me, a routine vaccination, he said.

But the bill was far from routine.

When I saw that they had billed $35,000 for the event, I was, What? What universe am I living in? Jacobson said.

Jacobson said the freestanding emergency department did not administer all the shots he needed.

He had to visit the health department for subsequent boosters.

Linene Kates was attending a boat show in Tampa when she tripped over a concrete wheel stop in a parking garage.

I went headfirst into a concrete piling, she said.

Kates went to a freestanding emergency department expecting that she would receive treatment faster.

Instead, she said she spent approximately nine hours there.

Nobody ever came to check on me, and my son kept going up there asking for more ice packs because they would melt, she said.

Kates underwent an MRI, was placed in a head wrap and was cleared to return home.

The total charges were $17,437, according to a bill she reviewed with the I-Team.

Kates said she also received a separate bill from the physician who treated her.

Florida lawmakers have acknowledged that patients may confuse freestanding emergency departments with urgent care centers.

State law requires freestanding emergency departments to post signs informing patients:

The facilities must also post their average facility fees.

Those fees can exceed $5,000 in some cases.

The Florida Hospital Association declined the I-Teams request for an interview but disputed criticism of freestanding emergency departments.

In a statement, the association wrote:

Hennessey said patients experiencing a possible stroke, heart attack, broken bone or another serious condition should seek emergency care rather than visiting an urgent care clinic.

He also advised patients who believe they need emergency care to consider going to an emergency room attached to a hospital.

I want someone who really thinks he or she needs emergency care to go to an emergency room thats attached to a hospital, so that in the event that you need further care by a physician specialist inside the hospital, youre already there, Hennessey said.

For patients whose conditions are less serious, understanding the difference between urgent care and emergency care before arriving could help prevent an unexpected bill.

Here's a guide Hennessey provided to the I-Team:

Urgent Care Symptoms/Condition  

ER Symptoms/Condition  

When Jen Mattingly opened a letter in the mail, she initially feared it was yet another medical bill.

Instead, the letter told her she no longer owed $2,953.06 in medical debt.

I opened the letter and I cried, Mattingly told Tampa Bay 28 I-Team Reporter Kylie McGivern.

The letter came from nonprofit Undue Medical Debt, which uses donations to purchase medical debt at a discount and relieve it for people experiencing financial hardship. The organization says every $1 donated relieves an average of $100 in medical debt.

Watch report from Kylie McGivern

"It says, 'Dear Jen, we're writing to share the good news. You no longer owe the medical debts listed on the right of this letter. Using a donation provided by national partners, Undue Medical Debt, a national 501(c)(3) nonprofit, bought and canceled this debt. It's a no-strings-attached gift. You no longer have any obligation to pay this debt to anyone at any future time, and no income taxes are owed.' It's a great letter."

Mattingly said her medical bills began piling up after she experienced serious health problems.

My life was still kind of shaken by the pandemic. I went through a health decline during that time, and it was a rough time, Mattingly said. I had thousands of bills from every doctor I went to, and I couldn't tell you why they were denying my claims.

She said repeated hospital visits ultimately led doctors to discover blood clots in her lungs and a blood-clotting disease.

It was tens of thousands of dollars that I was seeing in bills, she said. Really, I was just overwhelmed.

Medical debt is the No. 1 cause of bankruptcy in America. Mattingly says she considered it.

"I work in social services that don't have the means to pay people that type of money," she said.

Mattingly said Undue Medical Debt eliminated about $3,000 she owed, which she estimated represented at least two emergency room visits.

It does feel like a miracle, she said.

Her experience comes as medical debt continues to affect Americans, even when they have health insurance.

A September report from the Commonwealth Fund found one in three working-age adults with private health insurance is paying off medical debt over time.

Undue Medical Debt President and CEO Allison Sesso told Tampa Bay 28 the nonprofit seeks not only to eliminate debt, but also to draw attention to broader problems within the health care system.

This is not a problem that's your fault, Sesso said. This is a systems problem.

The nonprofit says its model uses donations to purchase large bundles of medical debt at steep discounts.

For Mattingly, the relief meant one fewer financial burden as she dealt with her health.

I feel great today. I feel happy, like I can talk about it, she said. I'm not ashamed to talk about it because it's something that most people, I think, are experiencing in the economy, and I'm just an average person. And if my story can help another person, then I want them to hear it.

Undue Medical Debt does not take individual requests for debt relief. Its website does, however, provide medical-debt resources and tips for people seeking help.

HEALTH INSURANCE DENIALS AND THE POWER OF THE PRESS

Since 2025, weve been investigating the cases of Florida patients denied insurance coverage for doctor-recommended procedures, including cancer treatments, medications and life-saving surgeries.

In case after case, those denials were reversed only after we started asking questions, with no explanation from insurers.

Watch report from Katie Lagrone

Madeline Rogers of Zephyrhills was denied coverage for colon surgery three times. Mary Barnes, a breast cancer patient in St. Pete, was forced to halt her chemotherapy treatments and Broxley Bunt of West Palm Beach was diagnosed with a brain tumor when he was denied coverage for surgery to get it removed.

These are just a few of the stories weve shared as part of our ongoing, award-winning Patient No More series.

DENIALS GET REVERSED WITH LITTLE TO NO EXPLANATION

But in each case, the denial was reversed only after our reporting began and even then, the insurance company offered no explanation for the sudden change.

"I was shocked. I was floored to hear from them so quickly," Rogers said after learning the $150,000 colon surgery would be covered after Investigative Reporter Kylie McGiven contacted Oscar Health about the denial.

"It's a relief, but why the hell do you have to go through this to get them to do what they're supposed to do to begin with?" Mary Barnes questioned after Investigative Reporter Katie LaGrone told her United Healthcare would, in fact, cover her breast cancer chemotherapy treatments after they originally denied it.

United originally claimed her doctor-recommended treatments, which included immunotherapy treatments, do not meet national cancer guidelines but then changed the designation to medically necessary.

REASONS FOR A DENIAL AND A SUBSEQUENT APPROVAL

Dr. Bill Hennessey is a physician turned patient advocate who helps people appeal insurance denials and negotiate medical bills.

He says most denials fall into three categories:

When asked under what conditions most insurance companies reverse their denials, Hennessey was direct.

"It'll happen if, number one, you're right and number two, you complain," Hennessey said.

As for why several denial cases we investigated ended up being reversed with no explanation, Hennessey summed it up like this: "Well, it's one of two things. You're either a miracle worker like Jesus, or you are correct. It is the power of the press. They don't want the negative public relations," Hennessey said.

Federal data recently analyzed by KFF, the leading health policy organization in the U.S., found most health insurance claims are ultimately approved but the data doesnt show how many claims are denied first, since insurers only report the final outcome.

That's significant because most patients who are denied never appeal.

Broxley Bunt was initially denied coverage for surgery to remove a meningioma brain tumor because his surgeon was out of network. His insurer, Florida Blue, reversed the denial after Reporter LaGrone started interviewing him from his hospital room where he underwent the surgery anyway.

"I don't think I could have done it on my own," Bunt said in response to the sudden reversal.

Mark Armstrong recently got his blood cancer medication covered after his insurer, Oscar Health, wanted him to pay thousands of dollars up front as part of a co-pay accumulator policy.

I HONESTLY BELIEVE ITS BECAUSE YOU REACHED OUT TO THEM

But, according to a federal court ruling, Armstrong should have been exempt from this policy since the medication did not have a generic equivalent. Reporter LaGrone questioned Oscar about the exemption, and only then did the insurer make his medication available at no cost.

His wife, Michele, believes the media scrutiny made all the difference.

"I honestly believe it's because you reached out to them. I think they're scared," she said.

Patient Mary Barnes echoed that sentiment after her denial for chemotherapy treatment was reversed following our phone calls to her insurer.

"I really believe that if you wouldn't be doing what you're doing, they would still be denying me," Barnes said.

HEALTH INSURANCE INDUSTRY RESPONDS (SORT OF?)

In response to questions about how the health insurance industry responds to public scrutiny, a spokesperson for AHIP, the nation's largest health insurance trade group, responded with the following statement:

Hennessey said patients must continue to fight and speak up.

"We just got to fight and fight and fight and publicize and publicize and talk to people like you. This is what I call a twisted sister moment. We're not going to take it anymore," Hennessey said.

WHAT TO DO IF YOURE DENIED

If you are denied a treatment your doctor recommends, don't assume the answer is final. Appeal the decision, ask questions and don't be afraid to take your story public by contacting the media or taking your story to social media.

Dr. Bill Hennessay shares advice on how to challenge a health insurance denial:

CONTACT ME!

If you are dealing with an insurance denial for medically necessary treatment that is recommended by your doctor, reach out to Katie below through the contact form: