Cash Only: What Happens When Your Doctor Doesn’t Accept Insurance?

I read somewhere, years ago, that if insurance companies had one universal form, the cost of a doctor’s visit would go down because filing claims would be that much simpler.  I have also heard of offices that have gone insurance-free, and offer services at a much more reasonable rate than practices which take insurance.  The sheer cost of administering insurance forms and supporting claims adds a great deal to the cost of providing medical care.

My son’s employer is encouraging its employees to go to high-deductible ($4,000) insurance plans.  These plans, like most dental insurance policies, will cover an annual physical and one or two other preventive care visits, but other visits are the insured’s responsibility up to $4000.  The employer will even give $2000 to an employee who switches over to go toward a medical savings account.  The difference in premiums is that great.  I suspect that this would be a far better model than a “first dollar” payment coverage that is universally required.

So am I right, AnglicanXn, in supposing in that this translates into the equivalent of a premium of $330 a month (assuming one were sufficiently sick).

What happens beyond $4,000? Does it cover a percentage of additional costs or the whole?

There is another side to this: insurance companies often define how diagnosis occurs which affects treatment. After much aggravation with being boxed in to a treatment plan, I prefer to separate the visit from insurance. I fill out the reimbursement forms myself and have found the process efficient and quick to be reimbursed. There is the occasional test or treatment that gets disallowed due to the insurance companies board saying it is not part of standard diagnosis or treatment protocols. I’d say we’re batting 95%. IMHE time with the doctors and the staff is much different than offices that take insurance and treatment is much more personalized.

This is cetainly happening all over.  If a doctor is in a poverty area the patients can’t pay and the doctors leaves.  My group of doctors have figured that 45% of the fee goes to clerical stuff to collect on insurance.  Many doctors are just opting out and retiring. Electronic Records is devastating our doctors. It cuts their productivity in half.  Our only two urologist in a 50 mile radius just announce their retirements because EMR was breaking thim.  Last week I ran into a friend who is an Ophthalmologist in a near by Delta town.  He told me his partner just walked in and said he was retiring next month.  In the next town thirty miles away the two eye docs just retired, so my friend is the only one left standing and he is the only one in a 100 mile radius that takes care of trauma.  His big corporate owned hospital just contracted with a managed care company and they now have all the Medicare, Medicaid, Blue cross patinets.  They came to his office and told him the payment scale.  $40 for a complete ophthamologic exam and refraction.  He told them he had a $175 per hour overhead cost and he couldn’t do it.  They said OK then you won’t have these patients.  He asked where could they go.  They said they had contracted with Pearl Vision in Memphis 80 miles away. 
  He told me he hated to move and leave his patients without emergency care.  I told hei that his patients had left him and signed up for that and also voted to have Obamacare, so now they could enjoy it.  He is a great compashionate and skille surgeon.  Oh well…...

AnglicanXn - I believe high deductible plans such as this will no longer be allowed under the new law
Jeremy Bonner - Our offices plan covers all but a copay of $20 or so after the high deductable is reached - you can actually game the system a little if you know you will reach the deductable - if you do the preventive care visits early the cost comes off the dedcutable without anything actually being paid by the patient - Our company puts some cash in the savings account to pay the bills - we keep any unspent balance for future years (hopefully for after I retire)

Paul, I make no pretense of knowing what is in Obamacare, but this plan was only recently rolled out, so I guess it is OK.  After the deductible is reached, the plan covers 100%.  Any funds from the medical savings account that are not used get rolled over and are available for the next year - and after a time, when one reaches retirement age, it gets treated like an IRA or something of that sort.  Or so Andrew briefly described to me.

I think such policies would be far superior because of lesser complexity than the usual plan that has been offered, and better than Obamacare.

I have many thoughts on the insurance situation, more than I can write now. But one thing is for sure: the more the government messes with it, the worse the situation will get.  They have already skewed the market and are about to skew it even more. You cannot repeal the law of supply and demand.

Warning to all those who will are on Medicare now or will be by around 2018:

The compensation for physicians for Medicare patients is shrinking quickly and costs associated are rising dramatically. Currently there are incentives for electronic medical records and meeting quality measures (most of which are founded in evidence based medicine). But the carrot will become a stick over the next few years. “Pay for performance” will become “Not pay for not meeting arbitrary measurements laid out by bureaucrats”.

As a result, by about 2018, Medicare will actually be paying less than Medicaid. You can find many articles on patients on Medicaid not being able to find physicians accepting the “insurance”. All the physicians I know either refuse to take Medicaid patients or limit their practice to one Medicaid patient a week or month or something.

People on or going Medicare should be very afraid, not of the Ryan plan, but the Obama plan to “change Medicare as we know it.”