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Old 08-02-2013, 10:23 AM
 
Location: Earth Wanderer, longing for the stars.
12,411 posts, read 15,968,527 times
Reputation: 8722

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Quote:
Originally Posted by jm31828 View Post
No, I don't think there are very many deadbeats paying nothing at the clinic. Before you go in for your appointment they ask for insurance information so they can bill the insurance company, and then you pay your copay right there. If you don't have insurance, you have to pay the whole bill right up front before going in. You have no chance to see the doctor before paying the bill. The only way that would work is if going to the ER. And the kicker is, without insurance you would pay MORE from my experience, because at least with insurance the bill is knocked down to a lower pre-arranged set price. For example they may initially bill $200 for the visit, insurance forces it down to $150, which you then pay if your insurance doesn't have copays and a high deductible, or they pay and you pay a copay. However with no insurance, you truly are stuck with that entire $200 bill. I know from experience, and they will not budge- I asked on one occurrence why we couldn't negotiate down to the price that insurance companies are charged and they said they are not allowed to, if they did it for me they would have to do it for everyone.
This is my understanding, too. There is one fee that the doctor or facility would like to charge, which is published often and which cash paying customers pay. Then there is the fee that insurance companies have bargained to pay. If you pay cash, you pay the higher fee. It really should not be so because cash payers are using less time from the office staff.
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Old 08-02-2013, 11:06 AM
 
8,334 posts, read 8,615,198 times
Reputation: 26050
Look, I appreciate what this doctor has done, but anyone who believes this is a solution to the high cost of health care hasn't examined these problems very carefully.

The truth is virtually everyone could pay for a visit to a primary care physician. Those visits are usually billed about between $80 and $120 a whack around here. Such care is not expensive and probably never will be.

Now, explain how the blessed free market will ever take care of problems like:

1. You are run over in a pedestrian lane by an uninsured driver, six weeks after being laid off at your factory job. Every nickel you have is going to pay rent. Even if you can get a "cash price" for your treatment, it still is going to cost thousands of dollars simply because of the complex services required. Also, when you went to the hospital you were unconscious and in no position to discuss price with the business office at that hospital

2. At age 30, you don't feel right and you go see your doctor. You are diagnosed with a rare form of cancer. You have exactly $3,000 in savings and the doctor says the only treatment is surgery and an expensive form of chemotherapy. Even at cash prices, the amount you have won't cover the R&D costs that make your chemotherapy so expensive.

3. Jones has a good family health history and regularly gets annual check ups from his family doctor for which he pays cash. At age 48, he has a severe stroke and requires 24 hour a day care for six weeks after which he will require extensive rehabilitation. Very few 48 year old men have this happen, but Jones is the exception. All his savings, and all his equity in his home won't pay for all the services that are required. Plus, its uncertain after his rehabilitation if he will be able to work again.

4. You are suddenly stricken with a kidney stone. Hospital A is 70 miles away, but will treat you for $1000. Hospital B is five miles away, but will treat you for $4,000. Which hospital are you going to go too? Before you answer this question, make sure you understand just how painful a kidney stone is. If you haven't had one (I've had several) I would think a long time before answering this question.

5. Smith is a neurosurgeon and in addition to going to medical school, completed a long residency afterwards. He has very good skills, but there are only a limited number of patients that need those skills. He can't really function with a "cash model" of reimbursement. What he needs to make a living is guaranteed reimbursement--at some set level--every time he performs a craniotomy or some other surgical procedure. The mere idea of abandoning insurance and going to a "cash model" has Smith thinking about other careers he could transfer into. This would be a shame after the huge investment made in training him.

The point I'm trying to make is that the market won't solve the health care cost problem because of the unique nature of health care services. We need most of them rarely. When we need them, we badly need them. We have limited information about things like whether the efficacy of this drug is better than that drug or whether surgery is a better solution to a problem than medication is. Because of the complexity of these issues we rely on physicians to answer our questions.

We don't have a "cash based system" for health care services because that didn't work for us in the past. What evolved was our patch-work system of private insurance that is expensive and not comprehensive. Yet, this was an improvement over what came before. The ACA is another step forward in that it seeks to make this coverage universal and comprehensive. A single payer system would probably be best of all, but that still lies in the future.
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Old 08-02-2013, 11:44 AM
 
4,830 posts, read 4,820,380 times
Reputation: 6172
Quote:
Originally Posted by markg91359 View Post
Look, I appreciate what this doctor has done, but anyone who believes this is a solution to the high cost of health care hasn't examined these problems very carefully.

The truth is virtually everyone could pay for a visit to a primary care physician. Those visits are usually billed about between $80 and $120 a whack around here. Such care is not expensive and probably never will be.
Try $250 in the heart of the Ohio Rustbelt + extras, like $20 to puncture your vein, $15 to attach electrodes to your chest. In my experience, doctors and "community" hospitals tend to rip off uninsured to shreds, cash discounts are exceptions, outrageous rip off is a norm (assuming they will take you without insurance). The insurance companies keep doctors&hospital appetites in check, only crooks can reason with crooks.

If not for labcorp (private corporation offering direct blood tests, no doctor referral required, at reasonable prices) I would be BROKE, I will never forgive and forget thousand$ of dollars in lab work rip off at a "community" hospital (for very basic stuff, you could get for less than $100 at labcorp), I didn't know any better at the time. How come that labcorp can offer a $100 blood test and "community" hospital would charge you $1000+ (for less thorough test)? It's not hightech and R&D, it's called greed. Many if not most states do NOT allow direct testing (without going through doctor racket first), too bad for the people of those states.

What "high tech" rationale they use to justify $20 to just puncture your vein to draw blood? They rip us all off, because they can, this is the only reason.
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Old 08-02-2013, 11:51 AM
 
Location: A place that's too cold
4,114 posts, read 4,071,143 times
Reputation: 10143
Quote:
Originally Posted by Ruth4Truth View Post
Plus, the doc doesn't make enough to maintain a staff. One reason insurance pays docs so much is that busy docs need at least a minimal staff; receptionist/file clerk, an assistant to take patients' temp/blood pressure, order supplies, etc.
Not necessarily. The primary care physician I went to a few years ago ran her own practice all by herself. She scheduled one patient at a time, and did everything for each patient, from weighing, taking blood pressure, doing the exam, taking my co-pay, and scheduling my next appointment. It seemed to work for her.
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Old 08-02-2013, 09:12 PM
 
Location: Brooklyn New York
15,239 posts, read 23,830,075 times
Reputation: 19917
my doctor has been saying this for years. if he didnt have this insurance crap he could just charge 20 bucks a visit, instead of 150.......

I think insurance companies here in America are way out of control.
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Old 08-02-2013, 10:40 PM
 
Location: State of Transition
72,985 posts, read 64,496,261 times
Reputation: 68928
Quote:
Originally Posted by nightcrawler View Post
my doctor has been saying this for years. if he didnt have this insurance crap he could just charge 20 bucks a visit, instead of 150.......

I think insurance companies here in America are way out of control.
It's not just the med insurance system; docs have to have malpractice insurance, pay rent, pay for Continuing Education courses and other expenses involved in maintaining their license, etc.

What I'd like to know is why the docs who are on the insurance system don't take their patients' concerns serioiusly, especially in cases of chronic illness? In order to resolve chronic problems, or even get advice on preventive measures, you have to pay out of pocket and go to one of the $400/hr. docs.
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Old 08-03-2013, 07:51 PM
 
24,770 posts, read 26,881,124 times
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Quote:
Originally Posted by Ceece View Post
I can see this working as for simple things. It get's more complicated if you actually have something wrong that won't go away with a simple ointment or whatever. Get another Dr. involved (surgeon, specialist, etc.) or need special tests....not so much.
That's why all health insurance should have deductibles of at least $2500. The more insurance covers, the more unaffordable it gets, and the less people care about the cost of their health care.
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Old 08-03-2013, 09:17 PM
 
Location: California
29,634 posts, read 31,993,748 times
Reputation: 24771
Quote:
Originally Posted by mysticaltyger View Post
That's why all health insurance should have deductibles of at least $2500. The more insurance covers, the more unaffordable it gets, and the less people care about the cost of their health care.
I don't mind a deductible. I think mine is already $1k or so, but it's a good plan thru a company and has different deductibles for different things and none for some things. I'll get my own private insurance soon and it will likely be a $3k deductible, but that still won't make it cheap or make my medical care less expensive.
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Old 08-04-2013, 11:00 AM
 
24,770 posts, read 26,881,124 times
Reputation: 22813
Quote:
Originally Posted by Ceece View Post
I don't mind a deductible. I think mine is already $1k or so, but it's a good plan thru a company and has different deductibles for different things and none for some things. I'll get my own private insurance soon and it will likely be a $3k deductible, but that still won't make it cheap or make my medical care less expensive.
High deductible insurance is not the complete solution, but it's a piece of the puzzle. If only high deductible plans existed, overall costs would be lower.
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Old 08-07-2013, 06:57 AM
 
Location: Annandale, VA
5,098 posts, read 4,133,104 times
Reputation: 4199
Quote:
Originally Posted by jm31828 View Post
No, I don't think there are very many deadbeats paying nothing at the clinic. Before you go in for your appointment they ask for insurance information so they can bill the insurance company, and then you pay your copay right there. If you don't have insurance, you have to pay the whole bill right up front before going in. You have no chance to see the doctor before paying the bill. The only way that would work is if going to the ER. And the kicker is, without insurance you would pay MORE from my experience, because at least with insurance the bill is knocked down to a lower pre-arranged set price. For example they may initially bill $200 for the visit, insurance forces it down to $150, which you then pay if your insurance doesn't have copays and a high deductible, or they pay and you pay a copay. However with no insurance, you truly are stuck with that entire $200 bill. I know from experience, and they will not budge- I asked on one occurrence why we couldn't negotiate down to the price that insurance companies are charged and they said they are not allowed to, if they did it for me they would have to do it for everyone.

When I am sick, I always go to the ER. Who gets sick on a schedule? I want treated NOW, not next week.
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