More doctors are shunning insurance:
The proportion of physicians who don’t participate in managed care plans is rising in a development that may signal a trend toward higher patient costs and less access to doctors, a study to be released on Thursday said.
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{ 32 comments }
Lets get real here..
insurance companies are an oligarchy that controls the market. The VAST majority of doctors MUST accept insurance or they wont have a practice.
The only docs who can afford to dump insurance are the guys in Manhattan or Beverly Hills who cater to rich people who can afford to pay out of pocket. The market for that segment is VERY small, only a few doctors can take advantage of it
If people can afford nearly every other professional in this country out of pocket, why couldn’t they afford doctors?
Uh, newsflash: Plenty of people canNOT afford nearly other professional in this country out of pocket.
You’re not anywhere near as special as you think.
Sure they can, certainly for basic stuff. Physicians, like everyone else, can set up payment plans, or even retainer fees.
Clearly, we’re not talking about major medical here.
Why be an ass? Habit?
So what would a retainer fee cost? A couple thou a year?
Getting out of the insurance racket sounds like a good way to reduce the administrative hassles, but don’t think it’s gonna be any easier to deal with payment plans. You’re still going to have people who can’t or won’t pay – and now you’ll be on the hook for an even larger amount, since insurance isn’t picking up some of the slack.
The grass ain’t always greener on the other side of the fence.
I agree with anon 5:04..If Doctors stop taking ins. then they can close up shop and go home. Maybe some of you, really young Drs., that come from wealth and have never lived in the real world don’t believe it, but, when you try it you will find out.
Please don’t make that asinine remark about people paying for car repairs as though there is some relevance in that to human life. People may pay a couple hundred dollars occasionally to have a car repaired or a part replaced. Rarely do they pay thousands or tens of thousands of dollars on car repairs. At that point they trade it in on a new model. Not possible with human life..
Besides when we purchase services and NEW PARTS it is because we have made a decision to do that. Maybe we even planned and saved for a long time to do it. Thats not the way it works when a terrible illness strikes someone I have yet to hear anyone say, “Yes, I have cancer, I planned it this way..What of it?”
No one plans to get a catastrophic illness requiring expensive treatment; that is the purpose of insuring oneself. The same applies to catastrophic damage to cars and collision insurance. But routine service isn’t paid by your auto indemnity carrier, which is where the similarities between automobile insurance and health insurance diverge. You can predict that a driver who drives 20,000 miles a year will have a predictable consumption of oil changes, tires, brake jobs and other maintenance. The costs are predictable, and for the wise person, plannable. Why should the occasional outpatient problems be unpredictable? Even large-dollar car repairs can be partially insured, by basic and supplemental warranty, a form of maintenance insurance that covers unexpected and outsized repair bills.
As far as practicing without insurance, that is going to be highly dependent on the practice and location. Most communities don’t have enough people with sufficient disposable income to afford cash payment for large medical expenses. For small-expense-based practices, like outpatient IM and FP, there is more flexibility, and some are surviving on a straight cash model. Pricing has to be attractive and the lower prices have to be met with a staffing model that saves the practice the administrative costs of handling third-party payment, or at least attaching additional fees for those services where available.
The car analogy is hardly assinine. Perhaps you just did not really think it through well enough. Think of the amount of money you spend over the life of your vehicle on predictable maintenance (oil change, new tires, tune-up, radiator flush, etc.). It amounts to hundreds if not thousands in just a few years time. No one plans on their car being stolen or totaled in a wreck, but that is what auto insurance is for.
Similarly, people cannot predict when major illnesses or accidents will occur, and so this is the purpose of catastrophic coverage (for bills that would reach into the low thousands or higher). However, people can certainly anticipate the need for preventative physicials/gyn exams, eye exams, routine bloodwork, the occaisional cold or minor injury. Bills for these services would hover in the $100 range (possibly less), but people have an expectation that their health insurance should cover every last penny.
I think physicians (GPS especially) should adopt the model that most dentists use: Bill cash up front, then allow the patient to spend their time and energy submitting reimbursement claims through their insurance themselves. The claim forms could even be provided and partially filled out. If one or two doctors do it in an area they may lose business because its less convenient for patients, but if every doctor did it (as most or all dentists now do), then they wouldn’t have any choice.
anon 8:57, Yes, but your living in a dream world where you believe everyone drives a new car and has the money to plan accordingly. I repeat, that is not the real world. it is the real world for a certain % of people, but by far, the majority of people live from pay check to paycheck. This idea of forcing people to not have medical ins. and to pay for everything up front is not doable. Unless your goal is to wipe out all the population except for the wealthy class? I think there are very unkind words that would describe that behavior.
Oh, please. I’m not sure exactly how you’re defining living “paycheck to paycheck”, but the number of people living in true poverty in this nation is a minority, not a plurality. I’m sure a sizeable portion of those paycheck to paycheck people still find a way to buy two packs of cigarettes a day, since studied have shown overwhelmingly the that the highest proportion of smokers in this country are in the lowest income bracket. Just sayin…
The basic question comes down to whether you see healthcare on demand as a right (something people are owed from birth) or not. If healthcare is a right, the government should be paying for it for everyone. If it is not, then sacrifices can and should be made to get it. I’d bet that if people had more of a financial stake in the routine costs of their healthcare, we’d see a huge decline in the amount of wasteful health care spending. If you had to pay 60 or 80 bucks yourself to see a doctor about your toenail fungus, you may quickly decide that it is no longer worthwhile. Honestly, I’d say at LEAST 25% (some days 50%) of the patients I treat daily are there for bullshit, non-essential issues.
And just to be clear, I am talking about the billing procedure for commercial insurance and HMOs, not Medicaid and Medicare. Even dentists who accept medical assistance programs have to agree to accept the reimbursement through the state (or medicare) and not bill the patient directly. I’d be willing to concede that doctors should do the same, which would eliminate the issue for millions of the poorest.
Growing up, I can remember going to the doctor for my college physical, handing the receptionist a check for the visit, and having her fill out the diagnosis on the insurance form that my Dad then had to submit – NOT the doctor. If docs drop insurance, the patient pays up front and then should submit the claim to the insurance company. They’ll be responsible for the copay and whatever percent of the crappy UCR is allowed. And for those who claim to not be able to afford the upfront payment, think of what you willingly pay upfront to the vet, dentist, druggist, lottery ticket person, etc. Medicine is a business, not a charity. And healthcare “rights” don’t mean you stiff the doctor.
People that live pay check to paycheck would be offended by yoru explanation of poverty. You really don’t see reality. How can you think the majority don’t live pay check to pay check in this country?
Meaning they have money to pay their bills but they budget and plan. They own homes, cars, take care of their kids and they DO NOT live off of public assistance. Most of them could not afford, out of pocket, a cancer diagnosis or kidney dialysis. When you tell someone they have a hundred of thousand dollars illness, the majority cannot just say “Oh, OK, I’ll write you a check right now, up front, to cover all that.”
Your insane if you belive the majority of people could meet that obligation when you stop accepting ins. You seem to be referencing “WELL” people and their yearly wellness exams and preventative medicine. I’m talking about sick people.
I think unless you read the article you are missing the point. Nobody is expecting you to pick up the costs of cancer treatment or a cardiac bypass. And in reality if you don’t have the money/insurance you “spend down” until you qualify for medicaid (I agree not a great option but better than not getting treated). The article notes that the person is responsible for costs of the provider BEYOND what the insurance covers. A good question brought up by one of the previous Anons is whether medical care a right or not. I am not going to get involved in that discussion, if it is then clearly the government should be more involved, BUT THERE IS NO FREE LUNCH. We will pay for it in taxes. Unfortunately with most Americans I see a real disconnect between what they pay in “insurance” (if anything when you include medicaid recepients) and the TRUE cost of medicine. Yes the insurance costs are going up in relation to inflation but it is a pittance related to the true costs of medicine when you think a single CT scan is equal to three months of OUR payments of insurance. I am not saying I have the answers, I am saying it can’t continue indefinitely. Additionally, I have people who regularly DON’T pay their bills to me and the fact is if your insurance doesn’t pay then you are responsible. I regularly see people who would never consider stiffing their auto mechanic but have no problem stiffing me. It is how medicine is viewed by many in this country. I wan’tthe best but don’t expect me to pay.
Anon 12:31, have you even bothered to read anything that’s been written here??!! Unbelievable.
Cancer diagnosis or kidney failure– these are perfect examples of what a catastrophic policy is designed for! Absolutely no one here has tried to argue that middle class families should “plan ahead” and “budget” for something like that. And no one has had the idea of “forcing people to not have health insurance”. The proposals discussed consisted of two plans: purchase only catastrophic health coverage and pay out of pocket for minor expenses, or continue to carry regular insurance but submit the claims forms for reimbursement yourself. Pay attention.
Preventative and minor illness care is what we are discussing because it is the type of health care expense that people with high deductible policies (i.e. catastrophic coverage) and/or those who have to submit for reimbursement to their insurance themselves would need to pay for. And yes, these services are relatively forseeable and affordable (most being under $100), and no, I do not believe that they are an entitlement.
People with jobs, cars, families, mortgages, bills, etc. may be strapped for disposable income but that does not mean paying a $100 medical bill would be literally impossible, just inconvenient. I was once a broke grad student myself, and much later a $33k per year resident trying to support a small family. I know what sacrifices need to be made. But if you decide that you or your child truly NEED the medical care, what could be more important?
I really don’t think you’re even worth responding to anymore as you clearly can’t (or won’t) understand a word that anyone around you is saying anyway.
I have an interesting story that really isn’t relevent to the argument at hand, but since this is an insurance thread, I have to share.
Last winter I went to have some basic bloodwork done (my own GP had ordered it- CBC, CMP, TSH and lipid panel). I had just gotten a new policy that required a $20.00 co-pay for diagnostic testing, but they told me at the lab that they could not take the money, and that I’d receive a bill later in the mail for anything owed.
Well just last week a patient at our clinic brought in a lab bill from the same company for a CMP, TSH and lipid that showed he owed $287 for the service because we didn’t put the right ICD-9 code on the script, so my nurse ran it by me to get authorization for a new dx code. This reminded me about the $20.00 I thought I owed, and having never received anything in the mail, I called up the lab’s billing office to make sure I wasn’t going to be sent to collections next year over some lost bill. Turns out I never really owed a co-pay (don’t know why) and my account balance was at zero. She told me they had accepted a check from my insurance in March as “payment in full”.
Curious, I asked her if she could tell me the amount that my insurance had paid (keeping in mind my patient’s nearly $300 bill for less testing), and was floored when she told me: “Twenty nine dollars and ten cents, sir.”
With reimbursement agreements like that no wonder so many doctors and medical facilities are struggling to earn what they once did!
“With reimbursement agreements like that no wonder so many doctors and medical facilities are struggling to earn what they once did”
That’s because the poor saps without insurance are expected to “make up” for some of the lost revenue given for those sweetheart deals the insurance companies get thanks to their control over the marketplace in most markets. Look at United CEO. One BILLION dollars in compensation while the employees at that company who do most of the work don’t even get quality insurance. Talk about free-market run amuck
physicians (GPS especially) should adopt the model that most dentists use: Bill cash up front, then allow the patient to spend their time and energy submitting reimbursement claims through their insurance themselves.
For the record – most dentists nowadays belong to some group plans. I live in a pretty expensive area, and even here most dentists take group plans. They subnmit, get paid in negotiated rate, then bill for the negotiated rate – reimbursement. One dentist I know (my friend is his girlfriend) recently stopped taking all group plans. Within a month he lost most of his patients. He is now considering firing half of his stuff as well as another dentist that works for him because he can no longer afford the office.
My periodontist indeed asks for cash upfront. But there are not as many periodontists around. But he still keeps an employee who knows all the insurance plans, and who fills out forms and mails them so that we can get refunds. She is very good at what she does, by the way. I’ve never had any problems with being reimbursed at the appropriate percentage of his asking rates.
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I’d venture a guess. If doctors ask for cash up front, the number of visits for preventive care will drop. People will be much less likely to go to a doctor for minor things. This may not be such a bad thing, but seriously, what percentage of your patients’ visits are for major things? If nobody comes to a doctor for minor conditions and very few come for preventive care, would you still be occupied?
To answer your question, Anon 4:17, no I probably would not be as occupied. And that is a very good thing, considering how jam-packed most doctors’ appointment books are now. If the 25% or so of patients I currently see coming in each day for relatively insignificant complaints went away, I’d have more time to spend with those who really need it and would simply be a little less harried and stressed, too.
Obviously this raises the question of money too- but overall, I don’t expect that the reduction in patient visits would necessarily result in less income. It could go either way, of course, but considering I would not need at least two of the full-time staff members who currently do my billing, I would receive payment 100% of the time (rather than the 60-80% rate now), would most likely receive more per payment, wouldn’t have to wait months and months for reimbursements, etc., I think I’d still do okay.
I have a lot of thoughts and opinions on this issue, but instead of going into all of them, here’s just one “food for thought” thing. While I was in nursing school, I was also being treated for a few pretty complex medical problems. While I’m the last person who should have worked while going to school full-time, I took a job as a nurse extern not only to gain experience, but also to help pay my medical bills. And I’m not really talking uninsured medical bills… Copays and things I didn’t realize my crappy student-HMO plan didn’t cover.
I ran into a big problem at one point because I used home oxygen on occasion, and I had no idea that my policy at the time did not cover DME. It had previously been covered by the plan I was on before. I only realized this when getting a bill for $800 for two month’s oxygen equip rental. I must have called the insurance company a dozen times and also gone to talk to office staff at my prescribing doctor’s office as to what to do about this. Ultimately, I came to one conclusion:
The people who seem to have the most health insurance hassles are the ones who have a lot of health problems. This obviously makes sense because if you’re healthy, you don’t have insurance battles as a daily part of your life. However, I watched my own health decline and my performance suffer in school because of the extreme amount of stress I was suddenly under to pay bills and play ping pong ball between doctor’s office, insurance company, and pharmacy. I ended up signing all these papers so that my parents had the ability to talk to the insurance company and physician’s offices.
When you’re facing major health problems – the last thing you need is the stress of trying to fight these battles. It’s hard enough just to keep living sometimes. I sold all the stock I had since birth as well as had to borrow a large sum of money from my parents just to pay for unexpected medical bills I ran into while covered by an HMO – on top of working a job every other weekend. All while I was pretty sick.
I still hold to that as one of the worst periods in my life. I couldn’t get what I needed, and I really couldn’t get anyone to help me. In the long run, I was getting physically worse and emotionally strung out.
I understand that dealing with the insurance company is a large hassle to doctor’s offices, but everybody needs to remember that the people who need the doctor the most are the ones who probably are the least capable to do battle with insurance companies. At least the offices usually have someone who understands the system and knows what they are doing.
I have Doc’s that actually charge me about 1/2 their fee for office calls because I pay them cash. I had a $1000.00 dopler echocardiogram at my Cardio’s for $400.00 etc., etc., etc.. They get there fee THEN and don’t have to wait for the ’surance company to pay them. Works out for both of us. I’m 56 male
There are always going to be sob stories. Imagine how much worse off you would have been if you were uninsured completely, as millions in this country are.
What I don’t understand is why you seem to imply that your problem should have been anyone else’s problem but your own. It is not your doctor’s fault that you had crappy insurance, I know that sounds harsh, but it is the truth. If something is not covered by your plan (DME), no amount of effort or haggling on the part of your doctor’s office is going to make it covered.
People will take out loans in the tens of thousands without hesitation to get an education, house or car but when they need medical care and have trouble paying, they think it should be free. Medicine is not charity, unless you’re getting treatment at a community free clinic.
Again, where you fall in this debate almost certainly relates back to the fundamental question about whether you see healthcare (especially for the sick) as an entitlement.
anon 12:48, Thats all well and good for you to pay 400.00 out of pocket for a test with negative results. What if you or a fmily member is hit with an illness that costs you hundreds of thousands of dollars to treat. You still gonna write that check for half and go about your business?
“What if you or a fmily member is hit with an illness that costs you hundreds of thousands of dollars to treat”
J@#(s Chr(*t Can you read? that is what major medical is for. Do you actually read other posters?
Actually, my insurance company told me that all I needed to get the O2 covered was an appeal on my part and an appeal on the part of the doctor’s office. It would have been through a special exception. But I never could get the office to make an appeal. I submitted mine via the phone in 5 minutes. Ultimately, the insurance company messed up billing and accidentally dropped me from their plan, which I found out when trying to get a refill on an antiseizure med. They corrected the situation and sent a notice of apology, but at that point I’d changed back to a PPO plan and told them “no thanks.” Was I fortunate? Yes.
Why do I think I couldn’t go it alone? Because I was in the hospital for 17 days, had 3 major surgeries in 3 months, and several ER visits for serious med reactions and complications of illness. I could barely get out of bed alone…let alone figure out all the insurance mess.
But then – that’s why we have a need for patient advocates nowadays… I’m lucky that I had my family.
I don’t think I should get medical care for free by any means, but it’s easy to say that patients should have to deal with the hassle of insurance all on their own when you’re not the one having to do that while struggling to stay alive, too. The fact of the matter is that there are people in most offices who know the ins and outs of insurance and while these people are available to patients, why just delete them and force patients to struggle with this alone? I’m very grateful that there are a number of people I met along my path who helped me sort through the insurance stuff because I definitely could not have done it by myself.
Just my 2 cents.
anon 8:56, J*&^% C$&#@*, did YOU read anon 12:48s post. He states he pays in cash, up front and his Dr. gives him a discount. His 1,000.00 office bill was reduced to 400.00 because he was paying up front (CASH).
I assumed he didn’t have ins. because not many people with ins. will pay hundreds of dollars up front unless they have too..
“I assumed he didn’t have ins. because not many people with ins. will pay hundreds of dollars up front unless they have too..”
You would be WRONG with that statement. Many people have major medical (especially those without reasonable employee insurance) in which doctor visits, labs etc are payed out of pocket while hospitalization/surgery’s are covered in the plan. Maybe you fall into the group that does not pay more than a token copy. Many people do not fall into that category. Given the fact he is getting an echo (and likely has health problems) he could be making a huge mistake by not having some type of catastrophic plan.
“The fact of the matter is that there are people in most offices who know the ins and outs of insurance and while these people are available to patients, why just delete them and force patients to struggle with this alone? “
For the simple reason that they are very costly to employ: they require salaries, benefits, vacations, workspace, computers and support, all of which has to be paid for in full and on time, unlike the payments of many private and public medical insurers. Practices that expect to shift to a non-insurance-based business model have to price competetively to attract the cash-paying patient, and the ability to do that requires cost containment. Salaries are the largest component of overhead expense for most outpatient medical practices. If chasing insurance payment is no longer necessary, then why pay he expenses needed to do that?
I think patients should realize that having someone else navigate the claims process on their behalf is a valuable service in itself, and one worth paying for. Usually they are not asked to do so, but that should change, especially in a cash-for-service model that ordinarily leaves the claims filing to the person who pays for the insurance coverage. A separate claims-filing business would be a reasonable alternative, and could be paid for by those who wanted the convenience and service.
“I think patients should realize that having someone else navigate the claims process on their behalf is a valuable service in itself, and one worth paying for”
LMAO LMAO. You really think someone complaining about a 20$ copay will pay for that “service”. I highly doubt it.
“LMAO LMAO. You really think someone complaining about a 20$ copay will pay for that “service”. I highly doubt it.”
I doubt it, too. But if they wanted that, they would see that in fact it comes at a price. They could pay, or not. Those who think a copay of $20.00 is onerous probably wouldn’t. But then again, there would no longer be a copay for them; they would have to pay for their service in full at the time of the visit.
All the processing chargewould cover, if they paid it, would be the filing paperwork. They could still do it themselves if they didn’t want to pay.
Just out of curiosity, how would you account for those who can’t afford to pay up front but still are in dire need of health care? With this plan of having patients do their own insurance filing, a patient would have to come up with the fee up front and wait for reimbursement. I had to do that once on a prescription and it was over $400 for just one month. I never got the money from the insurance company, but I ran into a lot of subsequent problems after losing that money. If I had to come up with every price on every bill up front before the office visit, there is no way I could afford the care I need.
Would doctor’s offices allow payment plans for those who couldn’t do that? Wouldn’t that then require office staff who could handle that, too?
Just curious!
“Just out of curiosity, how would you account for those who can’t afford to pay up front but still are in dire need of health care? With this plan of having patients do their own insurance filing, a patient would have to come up with the fee up front and wait for reimbursement.”
Do you expect everyone from whom you seek services to lend you money as well? If not, then why is your doctor supposed to also be your short-term lender? Small office bills need to be budgeted so you have money available, just like other expenses for which savings are supposed to cover. If you need credit, use a credit card. Honestly, people would not expect to pay for a car repair for a vehicle on which they depend by asking the mechanic to wait until a warranty claim was paid; they just don’t get their car backuntil the bill is paid.
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