Personally, I've never seen that work. And it doesn't even sound like a reasonable approach, unless you're trying like hell to stay under some annual or lifeti

Personally, I've never seen that work. And it doesn't even sound like a reasonable approach, unless you're trying like hell to stay under some annual or lifetime coverage cap. [1] Before I had insurance I was getting ~$1200 quotes for procedures. Paying up-front would get that knocked down to ~$1000. Paying cash would get it knocked down to ~$800. After I had insurance, the claims statements showed the insurance company's negotiated rate at ~$400 for the same exact procedure. If I let the up-front bills go to collections, the due amounts would drop massively from that $800. But that's not a sustainably advantageous strategy. And even then it's not going to be appreciably better than even paying cash at the insurance company's negotiated rate. [1] In which case, you really aren't a person who should have a capped medical plan. It's always going to cost you more to carry such a 'cheap' plan. Even if out-of-pocket payments are cheaper than going through your insurance plan and paying the difference. You'd be better off paying more up-front and getting proper coverage, if at all possible.