Self-Pay Prices and Financial Assistance Programs for Urology Appointments

Importance: For uninsured or out-of-network patients, uncertainty regarding the expected prices for urology appointments presents a meaningful barrier to timely evaluation. Although price variation for hospital-based services is well documented, self-pay price information in the ambulatory urology setting remains uncharacterized. Objective: To quantify self-pay appointment prices and characterize the availability and structure of financial assistance programs (discounts and payment plans) in urology clinics nationwide. Design, Setting, and Participants: This national, cross-sectional, audit study was conducted from July 1 through August 31, 2025, at outpatient urology clinics across all 50 US states. A random sample of up to 30 urology clinics per state was selected from a nationwide directory, totaling 1150 clinics. Clinics in closed or membership-restricted health systems were excluded. Researchers used a standardized script to pose as family members of uninsured patients calling for a kidney stone consultation. Calls were limited to 5 minutes and were conducted with front-office staff and/or billing personnel. Main Outcomes and Measures: The primary outcome was the self-pay price for a new patient appointment, adjusted for regional cost-of-living variability. Secondary outcomes included the availability and specific terms of financial assistance programs. Results: Among 1150 urology clinics, 865 (75.2%) provided a self-pay price. The national median (IQR) self-pay price was $265 ($208-$361). Compared with private practices, academic (odds ratio [OR], 0.28; 95% CI, 0.16-0.47; P < .001) and hospital-based (OR, 0.42; 95% CI, 0.28-0.65; P < .001) clinics were associated with lower odds of providing self-pay price information. Conversely, hospital-based (OR, 2.64; 95% CI, 1.57-4.44; P < .001) and academic (OR, 1.65; 95% CI, 1.01-2.69; P = .04) clinics were associated with higher odds of offering financial assistance. However, specific terms were often unspecified for discounts (76 [27.9%]) and payment plans (313 [75.8%]). Conclusions and Relevance: In this national cross-sectional study of 1150 urology clinics, most clinics provided self-pay appointment prices, although substantial price transparency gaps remained; hospital-based and academic clinics were associated with lower odds of providing self-pay prices but higher odds of offering financial assistance programs. Ambiguous financial assistance terms may limit the ability of self-pay patients to navigate self-pay prices, suggesting a need for standardized disclosure to improve access to urologic care.