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If I may be so impolite to ask - why don't you have insurance? Doesn't the ACA require you to have it (or perhaps you fall into an "exception category")?
And - if you are dealing a lot with "cash" doctors - perhaps some of them are also not in compliance with the provisions of the ACA/Medicare/Medicaid/similar that might apply to them? For all I know - some - like many people in small businesses - might not be declaring all their income? Who knows?
Perhaps you are reaping the benefits of living in a "gray market" where no one is following all the regulatory rules (which of course is cheaper than following all the rules).
BTW - I suspect most people who mention single payer don't know what single payer is. The only 1st world countries that have anything approaching a true single payer system are the UK - Canada - and Australia. And each (with the possible exception of Australia - a country that has almost nothing in common with the US) has many more issues than the countries with various kinds of hybrid systems - like those in Germany and Switzerland.
As I already noted - Medicare will reimburse my PCP at the Mayo Clinic about $80 for a 1/2 hour appointment. So I am not sure paying $80 is a bargain. The big problem when it comes to paying money out of pocket isn't when you need a piddly little doctor's appointment. It's when you need expensive tests to determine if you're really sick. And surgery and/or perhaps other things like chemo/radiation therapy - expensive drugs - etc. - to treat you if you are really sick. You'd encounter similar if you were in something like a bad accident. And there are also things that won't kill you - but it's nice to have the medical resources to deal with them. Like about 5 years ago I got a benign female cyst the size of a lime that prolapsed into my vagina. Not life threatening - but UG-LY. And it made me waddle like a duck . Cost $20k to get rid of it (and I was very glad to be rid of it - thank you very much). I had a $10k insurance deductible. So I paid about $10k - insurance paid the rest. If you don't have insurance - you probably couldn't get anyone to take care of something like this - whether benign or cancerous - without coughing up a lot of money.
I think we should all be prepared to pay for small health care stuff - like routine doctor visits - out of pocket. But have insurance to pay for "the big stuff". Robyn
I've carried insurance all of my life until our most recent plan was cancelled for being non-aca compliant. Throughout those years the coverage has varied and I have had reasons to pay cash due to not having insurance coverage for various services and when asking if the office offered any kind of discount if the bill is paid in full at the time of service I have always been told yes with just one exception. The bills were always very reasonable and very much in line with what I would have paid in the past with insurance. My current doctor operates on a membership model and does not accept any insurance at all. That helps to keep her overhead low. We pay a very reasonable fee each month and that fee covers most everything we could possibly need. We joined a health sharing ministry for catastrophic events. I am not 100% confident that if it will really help us in the event of a big bill but it does make us in compliance with the law and it's very affordable. The post ACA plans that we have found are largely high premium, high deductible plans with narrow networks and I don't see them as being worth it at all. Going broke just to make a monthly payment to an insurance company for a high deductible plan with a narrow network does not seem like a good bet to me. We are following the law as are all of the providers I've mentioned above.
Last edited by MissTerri; 11-21-2015 at 09:41 PM..
There is also confusion over what is "charged" out. The doctor "charges" everyone the same, even the insurance company. But the insurance company pays a lesser amount because the doctor agreed to this in exchange for an influx of patients. Most people think the insurance rates are "negotiated" with doctors but they are only negotiated with large institutions like universities and hospitals. The individual doctors just have to sign up and hope they pay reasonably. When the doctors learn which insurance companies pay less then they decide to continue or drop that plan. For an in-network situation, the doctor sends the same bill to the insurance company as they send to everyone else. The doctor has agreed to not bill the patient for what the insurance company does not pay, minus deductibles, co-insurance, etc that the insurance patient agreed to. Cash patients don't have this agreement and there is no reason for the doctor to agree to this with a cash patient because they cannot provide the doctor with a steady stream of new patients like the insurance company does.
There is also confusion over what is "charged" out. The doctor "charges" everyone the same, even the insurance company. But the insurance company pays a lesser amount because the doctor agreed to this in exchange for an influx of patients. Most people think the insurance rates are "negotiated" with doctors but they are only negotiated with large institutions like universities and hospitals. The individual doctors just have to sign up and hope they pay reasonably. When the doctors learn which insurance companies pay less then they decide to continue or drop that plan. For an in-network situation, the doctor sends the same bill to the insurance company as they send to everyone else. The doctor has agreed to not bill the patient for what the insurance company does not pay, minus deductibles, co-insurance, etc that the insurance patient agreed to. Cash patients don't have this agreement and there is no reason for the doctor to agree to this with a cash patient because they cannot provide the doctor with a steady stream of new patients like the insurance company does.
Doctors in individual practices (and dentists, physical therapists, etc, etc.) most certainly DO negotiate with insurance companies. Even doctors in large practices are individually contracted with insurance companies. You will rarely find that a clinic is actually contracted with an insurance company outside of an HMO model for their actual MD/DO's. They will be contracted for employees of that clinic, speech therapists, labs, etc. but not for the actual physicians. This is one reason people have a hard time searching for in-network providers, they try to look up the clinic and not the individual doctor.
When I say "negotiate" I actually mean negotiate, not just signing up for insurance plans. There is no going back and forth on fees. The insurance company just says "this is what we pay, take it or leave it."
When I say "negotiate" I actually mean negotiate, not just signing up for insurance plans. There is no going back and forth on fees. The insurance company just says "this is what we pay, take it or leave it."
I've carried insurance all of my life until our most recent plan was cancelled for being non-aca compliant. Throughout those years the coverage has varied and I have had reasons to pay cash due to not having insurance coverage for various services and when asking if the office offered any kind of discount if the bill is paid in full at the time of service I have always been told yes with just one exception. The bills were always very reasonable and very much in line with what I would have paid in the past with insurance. My current doctor operates on a membership model and does not accept any insurance at all. That helps to keep her overhead low. We pay a very reasonable fee each month and that fee covers most everything we could possibly need. We joined a health sharing ministry for catastrophic events. I am not 100% confident that if it will really help us in the event of a big bill but it does make us in compliance with the law and it's very affordable. The post ACA plans that we have found are largely high premium, high deductible plans with narrow networks and I don't see them as being worth it at all. Going broke just to make a monthly payment to an insurance company for a high deductible plan with a narrow network does not seem like a good bet to me. We are following the law as are all of the providers I've mentioned above.
Thanks for sharing. And cripes - another ridiculous (and sad) story. At least the insurance part.
I like the membership or concierge model for primary care. And think it makes a whole lot of (dollars and) cents/sense. Both for providers and patients. My last PCP - a sole practitioner - had to hire an almost full-time employee just to deal with billing issues (she wound up closing her practice).
But - as you realize - it doesn't work for secondary or tertiary care. In that area - most people need some form of "catastrophic" insurance. But most don't need/want a lot of expensive bells and whistles. They just want coverage if they get cancer - need heart surgery - are hit by a truck - etc. Yet - even before the ACA (although the ACA made things worse) - most states had impressive lists of mandates - some very expensive - things that had to be included in insurance policies. They varied from state to state - but some of the most expensive were/are infertility treatment (including IVF) - "mental health" parity - behavioral therapy for autistic children - and care by chiropractors. I'm sure that you and most people in your position (and your numbers are increasing every day) would gladly eliminate all/a lot of these expensive mandates in return for affordable insurance.
I have read some messages here about the health sharing ministries - but honestly don't know anything about them other than what I've read in messages here. Things might get very interesting on this front if some large mainstream religious group - like say the Mormons - who are often very excellent when it comes to various forms of "self-sufficiency" - decided to get into this area "whole hog". Robyn
Very interesting, thanks for the link. I was unaware that a group had been able to make a fuss about this with insurance companies. I remember seeing this phenomenon described with a semi-slang contract name but I cannot remember it. It's a contract that is indeed signed, but nobody in their right mind would normally sign it unless they had no other choice due to external market conditions (which is exactly what happens when individual doctors sign up for insurance plans). This is the "take it or leave it" contract insurance companies offer.
Last edited by toofache32; 11-22-2015 at 03:28 PM..
One article doesn't make it "standard procedure"....doctors and practitioners most certainly do negotiate individual and for different discounts...
Can you provide an example? My group of 4 doctors has never been able to get an insurance company to even let us know what fees we are signing up for. Let me state this again....the insurance company doesn't even let us know what their fees are. I welcome any documentation or examples that show otherwise for individual doctors (not university/hospital settings). Otherwise your statement is one from just another member of the public who has been duped by the insurance companies who make the public believe there are actual negotiations.
Can you provide an example? My group of 4 doctors has never been able to get an insurance company to even let us know what fees we are signing up for. Let me state this again....the insurance company doesn't even let us know what their fees are. I welcome any documentation or examples that show otherwise for individual doctors (not university/hospital settings). Otherwise your statement is one from just another member of the public who has been duped by the insurance companies who make the public believe there are actual negotiations.
Well, no, I guess I can't provide you with specific documentation without losing my job...but yes, it happens, often. But, believe what you want.
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. Cost $20k to get rid of it (and I was very glad to be rid of it - thank you very much). I had a $10k insurance deductible. So I paid about $10k - insurance paid the rest. If you don't have insurance - you probably couldn't get anyone to take care of something like this - whether benign or cancerous - without coughing up a lot of money.
