My Doc Doesn't Do Insurance- Am I the Only One?

[AgeOfEnlightenmentSCP]

My doc doesn't do insurance. Period. If you're insured, and you can get re-imbursed, good for you. But she won't be bothered with it. She went from 14 on staff down to 6 (including her).

Payment is due when services are rendered. Period.

She sent a letter out about a year ago notifying us of the changes. Everything is all-around better.

[NomoreDramaQ1015]

My medical doctors do insurance, but the dentist DH went to does not. He gives you the paperwork and you file for reimbursement.

The Oral Surgeon I went to requires a percentage up front and then they file. If the insurance covers more than they thought you get a refund, if not they either bill you or keep it. I should be getting about $100 back from my wisdom teeth removal.

My dentist is the same only they calculate out exactly how much I owe after insurance and require it up front.

[NomoreDramaQ1015]

This message has been deleted.

[herekittykitty]

So far, this has not hit my part of Ohio, but I think this is the way we are headed. Those docs who can do this, will, because it will significantly decrease their overhead. My DH's allergist won't bill our secondary, which irritates me. I'll pay you up front, and you are already submitting 1 bill, so good grief!

[magichat]

Parents doctor just did the same thing. No longer accepts insurance and requires an upfront fee of something like $3k for the year.

[alabamagal]

May 16, 2011 14:54:31 GMT -5 NomoreDramaQ1015 said:

My medical doctors do insurance, but the dentist DH went to does not. He gives you the paperwork and you file for reimbursement.

The Oral Surgeon I went to requires a percentage up front and then they file. If the insurance covers more than they thought you get a refund, if not they either bill you or keep it. I should be getting about $100 back from my wisdom teeth removal.

My dentist is the same only they calculate out exactly how much I owe after insurance and require it up front.

Just keep an eye on the reimbursement. My oral surgeon, I had to request the refund several times. I got the feeling I wouldn't have got my money back if I hadn't asked.

[ladylove]

May 16, 2011 14:51:22 GMT -5 AgeOfEnlightenmentSCP said:

My doc doesn't do insurance. Period. If you're insured, and you can get re-imbursed, good for you. But she won't be bothered with it. She went from 14 on staff down to 6 (including her).

Payment is due when services are rendered. Period.

She sent a letter out about a year ago notifying us of the changes. Everything is all-around better.

Of course because she can charge less and you can negotiate with her and she'll still make money! This is actually the key to lowering health care costs. Under Obamacare it will go up as it has already and doctors will just get out of the business.

[Deleted]

May 16, 2011 14:56:56 GMT -5 @magichat said:

Parents doctor just did the same thing. No longer accepts insurance and requires an upfront fee of something like $3k for the year.

That's something different- it's called "concierge care" and they supposedly take fewer patients and are more accessible to the ones they have.

I wouldn't have a big problem with having to file for my own insurance reimbursements, as long as the doc provided all the necessary paperwork (including any requested in follow-up correspondence) promptly. To me, it's just more points on my credit cards. I'd feel differently if I were carrying a credit card balance, had no emergency funds, or had a doctor or insurance company that was slow in responding.

[thyme4change]

I think this is a great way for the medical community to disentangle themselves from the insurance companies and the whole mess of problems that come along with that. However, all the doctors around here that are trying it are asking for upfront annual fees that make it unreasonable for a healthy family like mine. If they asked for a retainer, and then subtracted fees out of it, maybe - but not just taking a big chunk of money and then charging me for every visit.

[NancysSummerSip]

Paul, we have had that in the county for awhile. The fancy name for it is "concierge medicine." If your doctor works like my ex-doctor, he is basically on call 24/7 for a set number of patients admitted to his practice (I think he set his limit at 500). Patients pay $1,500 per year for access to him. No paperwork, no insurance, just him, you and money. You are supposed to be guaranteed access whenever you need it. If you want to, you send in your own paperwork. He won't touch it.

The annual fee covers nothing else except him. No hospitalization, no specialists are covered.

[❤ mollymouser ❤]

My doctors take my insurance (Tricare Prime Remote.)

[DVM gone riding]

I think it is GREAT, I think making consumers more aware will decrease prices more then anything else! If you know it costs 150 to go to the doctor NOT 30 you might think twice, if you have to do the paperwork you might think your insurance company charges you to much and reimburses to little. someone will then develop something better-unless gov gets to much in the mix.

[Deleted]

I don't think it's as "great" as many of you are assuming. Reimbursement for medical services is low because the insurance company negotiates for us. There is strength in numbers. Blue Cross/Blue Shield gets a much better rate for medical services than an uninsured person does. They pay sticker price. Sure, you could probably negotiate a discount for cash, but it won't be the fraction you pay now.

[bobbysgirl]

What the OP stated is the future. Doctors have been beaten with the insurance company, Medicare noodle for years now. Medicare reduces the reimbursements every 2 years. And to get paid, they pull some pretty nasty tricks. Like , sorry you didn't 'bundle' the charges. Then they accuse you of fraud after changing the rules every month. Often times they don't even tell you the rules changed.

I go to my doctor in VA still. He charges me a decent rate and directs me to the cheapest pharmacy if I need one. He doesn't book 4 visits in a 15 minute span, as do providers who take insurance. It's the only way they can cover costs these days.

As I have said before, it's a power turn around. Doctors use to hold all the cards and acted likes asses. The insurance companies and government systematically beat them at their own game.

[lulubean]

You've already posted about this Paul.

[bobbysgirl]

NAGGIE, Great avatar Is he yours?

[busymom]

I can understand why doctors are doing this. Both my own physician & my kid's pediatrician get bombarded with paperwork, and the insurance companies are always questioning the doctors, requiring call backs & more paperwork, which takes up more of the doctor's time, and requires more staff to deal with the paper shuffle. Do you think medical costs would go down if we got rid of the insurance companies?

[Deleted]

May 16, 2011 15:50:35 GMT -5 DVM gone riding said:

I think it is GREAT, I think making consumers more aware will decrease prices more then anything else! If you know it costs 150 to go to the doctor NOT 30 you might think twice, if you have to do the paperwork you might think your insurance company charges you to much and reimburses to little. someone will then develop something better-unless gov gets to much in the mix.

I agree. If you realize that your meds cost $150, not the $25 copay, you might think about whether they do enough good to make them worth the cost. Same for all the other services. I also think that it's good to know if your insurer is prompt and reasonable about paying claims, or if they drag their feet. If it takes your doc 6 months to get reimbursed, you may never know. If it takes you that long, you're gonna be on the phone to HR telling them the insurance company isn't holding up their end of the contract and calling the insurance company and threatening to report them to your state Insurance Commissioner.

[Deleted]

But, Athena, what makes you so sure that your meds will cost $150? That is probably a negotiated price. If consumers are willing to cut the insurance companies' negotiators out of the loop, that medicine probably will cost $250. The insurance company will give you the $150 minus the $25 copay. So now you are paying $125. Excited?

If medical services were one price, I would absolutely agree that this would draw attention to the true cost of medical care. But it doesn't work that way. If your doctor is cutting the insurance company out of the loop, you will pay higher just as uninsured patients do. That's why they really want to cut them out. You may negotiate a discount for paying cash (not for paying upfront . . . they will require that), but you will never match the insurance companies' negotiations.

Sorry, but I don't have that much money.

The six months reimbursement you mention . . . you are right about shifting the frustration to the consumer. But that doesn't guarantee it will change anything, trust me. Sorry, but would I rather be frustrated or let my doctor's office who is used to the frustration and knows the hoops to jump through be frustrated?

You would have to change to a "fixed cost" system before I would buy in.

[lulubean]

Nah moon found it for me, I do have a BHT and a red/white just not my avatar.

[Mardi Gras Audrey]

susana,

I don't think that most docs would raise their rates that high. Remember that they are people too and they are working directly with you as a customer/patient. If they knew that they were going to get paid (due to cash up front), they would be able to reduce staffing levels and have less cash on hand for expenses (cash flow would be more predictable). This would enable them to lower prices for everyone. Competition would prevent them from raising the rates to ridiculous amounts ("You want to raise my cost to $300 a visit? Fine, I will go to the doc across the street instead"). This would work particularly well in urban and suburban areas where there are many doctors to choose from. As far as rural areas, where there are provider shortages, I think that the consumer would still do good. Those kind of communities ( I grew up in one) tend to have everyone know everyone's business. If the town doc is overcharging everyone (think $500 primary care visits), the whole town will know it and he/she will be shunned. Additionally, the town may look at recruiting another doc to increase the competition and reduce prices. Most of the docs that I knew who practiced in rural communities didn't do it because they wanted to maintain a monopoly on their services-they did it because they wanted to fill a health care shortage need (good guys) or wanted to live in a small community or grew up there and their families were there. When you are doing it for those reasons, raising your prices to astronomical amounts would be counterproductive, as the negative pressure from the community would be great.

[Deleted]

May 16, 2011 17:43:57 GMT -5 @southernsusana said:

If your doctor is cutting the insurance company out of the loop, you will pay higher just as uninsured patients do. That's why they really want to cut them out. You may negotiate a discount for paying cash (not for paying upfront . . . they will require that), but you will never match the insurance companies' negotiations.

That's not how I see this working. Example: I have Aetna. The doc has an agreement with Aetna that he/she will charge $X for an office visit but just won't do the paperwork for me. I pay the doc $X and then submit the claim to Aetna and get back $X, minus my co-payment.

If you're saying that the doc has made no agreement with any insurance company, then I agree that he/she can charge whatever they want and your insurance company will reimburse at out-of-network rates and you could get stuck with a big out-of-pocket cost. I'd be surprised if many doctors can do that, though. My sister is an OB-Gyn in SC and is being squeezed to death by the puny reimbursement rates of Blue Cross/Blue Shield and her skyrocketing Med Mal coverage costs. She'd love to refuse to accept BC/BS patients but they have a lock on the area and she wouldn't have any patients, period.

[fairlycrazy23]

Seems like a long time ago this is how it worked. But this is how it should work you directly pay the charge then get reimbursed.

[schildi]

May 16, 2011 17:32:18 GMT -5 @athena53 said:

If it takes your doc 6 months to get reimbursed, you may never know.

You'll know if that happens. Because the doctors office will bill you for it. They are very quick with that, I've had it happen. It won't take 6 months ....

[schildi]

May 16, 2011 19:56:37 GMT -5 @athena53 said:

That's not how I see this working. Example: I have Aetna. The doc has an agreement with Aetna that he/she will charge $X for an office visit but just won't do the paperwork for me. I pay the doc $X and then submit the claim to Aetna and get back $X, minus my co-payment.

I don't think it would be that easy. The doctor may have an agreement that says $X, but bill as you for $Y. They do this now, with every single bill they send to insurance companies. You'd know if you were on a HDHP, there you see all of this. $Y can be off by 2x or more from $X. I have seen close to 10x from labs for tests (the most extreme cases). E.G. the lab submist a $250 charge, and the insurance approves $25 or $30, that's what their agreement says. Good luck to you then to get the remaining $220 back from them after you paid the full amount.

I am on an HDHP and use a spreadsheet to track our spending. Here are a few recent real life examples from our visits:

what / billed by doctor / agreed to amount with insurance
Dr. visit sore throat / $152.00 / $110.07
annual blood test / $175.00 / $29.35
strep throat test / $49.00 / $8.87

Yeah, good luck getting the difference back. I prefer not paying it in the first place.

[schildi]

And yes, Paul, I remember you posting this a long time ago, as somebody else has pointed out.

[TheOtherMe]

Isn't happening around here yet either.

I don't know if I'm going to be using $3K of a doctor's services in a calendar year. I wouldn't pay them that money upfront.

[cubefarmer]

My son had a doctor do this and she only lasted 5 years. She just couldn't find enough patients willing to pay cash.

[bobbysgirl]

May 16, 2011 17:22:38 GMT -5 busymom said:

I can understand why doctors are doing this. Both my own physician & my kid's pediatrician get bombarded with paperwork, and the insurance companies are always questioning the doctors, requiring call backs & more paperwork, which takes up more of the doctor's time, and requires more staff to deal with the paper shuffle. Do you think medical costs would go down if we got rid of the insurance companies?

Yes, I do think so. There has to be a ceiling on costs though. I have been advocating a personal fund for health care costs vs the outlandish premiums we pay for quite a while. With catastrophic insurance for hospital stays. As it stands now there is quite a lower cost for self pay patients at the time of the visit.

Take your own blood pressure at home (keep a record) and your own temp and keep a weight record. These things are all extra charges that can be billed. See the doctor for one thing, say the flu or a gash or whatever and the bill will be a level 1. Tell them you want a level one. I do this and my doctor throws in the weight and temp. I keep a record of my BP so he goes by that. Keep healthy and your odds are slim that you will get ill. Bring the responsibility back into your hands.

It amazes me how people allow all their health information go into those computers, that the government paid for. They pay, they control. They also have the permission to go into your records whenever they want. From you. Those new HIPPA laws that were made for your protection were also developed for easy access by any government entity.

[share88]

I fired my doctor when they started charging a fee to be on the patient list. I have forgotten what it was maybe $1500 or $2K for a year. They did still take insurance but still I just could not get myself to do it.

Edited to add that the fee was per person, not for a whole family.