The magic of self-pay

I tried something new at a doctor's office today.  I'm trying out a new GP in a nearby community, someone with great patient ratings.  I went to see him today, not because I needed anything, but to put myself in his office system so that if I do need something, there's some chance of my getting an appointment before I die of whatever it is.  My more local doctor never seems to be available any more in an emergency.  Though I can generally get in to see a P.A. on a same-day basis, and his P.A.'s are very nice, they haven't had much of a track record in the last couple of years diagnosing anything usefully.  So I'll see how things go with the new guy.

The really new thing is that I told the office staff to treat me as self-pay.  I told them I have insurance, but I'm not going to burden you with the knowledge of who it is, so you won't have to worry about whether you're complying with your contract.  Just tell me what the prices of things are going to pay, and I'll pay you cash.  If I get remotely close to my deductible, I'll gather up my bills and send them in and see whether my insurance company will acknowledge them, but you don't ever have to fool with that part of it.

Like magic, for the first time I can remember, I got a prompt and unequivocal answer to my question "How much is this visit costing?"  It was a very reasonable fee, which I paid on the spot by check.  The doctor recommended a standard blood panel, which would cost about $400 if I went through Blue Cross, but will cost only $84 if I self-pay.  In the past, I've had similar blood panels done through a doctor's office to whom I had incautiously confessed my affiliation with Blue Cross.  Suddenly it became "illegal" for them to treat me as self-pay, even though I'm going to pay in cash, because (as always) I'm nowhere near my deductible.  Apparently the only way out of this trap is never to tell them you're insured in the first place.  Some offices won't take you as a new patient on that basis.  They aren't likely to get my business.  What do you guys want from me?  A cash retainer to prove I won't stiff you on my bills?

I'm faintly hopeful that, as more people are shoved into the new style of mandatory health plan with very high deductibles, they will begin to approach things my way, so we'll see more of a transparent, cash-basis market at least for ordinary stuff like exams and blood tests.

The doctor seemed sensible, had practical advice to offer about various minor ailments, and didn't pester me with any questions about spousal abuse or guns in the home.  It was such a rational and worthwhile experience that I got through the whole thing without exploding with rage about Obamacare!

On that subject, though, here is the latest thinking from the President's apologists:  When he told us we could keep our plans, that was 99% true, and it was shockingly unfair to make a fuss about the tiny, unimportant sense in which that was a  lie.  The people who aren't getting to keep their plans are an insignificant sliver of the marketplace, most of whom aren't even going to see their premiums go up, so don't believe what you read.  Besides, the old plans are terrible; nobody in his right mind would keep them if he were offered something better.  But when we ask the President to support bills in Congress to ensure that we'll keep our plans, it turns out that letting us do that would be a dagger at the very heart of Obamacare.  If even a minuscule fraction of the market doesn't sign up for the new plans, the entire creaky edifice will crash and burn.   And it won't be a few customers, it will be a stampede, because almost everyone will want to keep his old bad plan instead of taking the priceless gift of the wonderful new plans.  Also, although the financial harm suffered by this inconsequential backwater of the market, just a few Americans, 15 million tops, is hardly worth mentioning, the fact remains that denying this stupendous influx of revenue to the grand nationwide Obamacare experiment will starve it of its lifeblood and leave the brilliant social experiment in smoking ruins.


raven said...

I just love it when the "small percentage" excuses come out. So it's wrong to harm many, but it is OK to harm a few? These people would not know a principle if it bit them in the ass.
Good job on finding the new Doc- Is the good doctor independent or part of a group?

Miss Ladybug said...

"It's only 5%".

Gays are less than 2% of the population, but they certainly bend over backwards to pander to them.

E Hines said...

We have met the 1%, and they is us.

Eric Hines

Elise said...

Pretty funny. I just got back from a consult with a physical therapist who doesn't participate with any insurer. In the past, physical therapy has always been 3x a week for 6 weeks - amazing how that's what's wrong for whatever ails me or anyone else.

This guy is talking about one long session to do evaluation and introduce some exercises, four follow-up sessions over the next couple of weeks, then I come in only if I need a touch-up. And his website and he in person told me straightforwardly exactly what each session would cost me. It was ... odd.

And thank you for the point about the tiny sliver being hurt also somehow being the massive influx needed. I hadn't thought about it that way and it's a useful idea if I'm ever again insane enough to talk about this whole mess with any of the ObamaCare supporters I know. Also known as when pigs fly and whistle while they do it.

douglas said...

Clearly, one of the biggest problems with the current health care system is that there is almost no connection between the payer and the payee, and so very little price/cost accountability. It also goes to show you how much it costs the doctors to push all the paperwork and fulfill all the requirements of the Insurance companies and government regulations (is that redundant?).

The best thing that could happen is if we went to some kind of reimbursable or fixed amount the insurance would pay you for whatever, and you shop around, and if you want a doctor that' costs more, you pay the difference- but if you're o.k. with one that costs less, you can keep the difference- costs would plummet, I'd think- well, if we did that and tort reform. The way things are now, we've taken true market forces out of the system.

I've gone to doctors to pay cash even with insurance because they were cheaper that way when I had a high deductible, and my experience was quite similar. One difference was that sometimes the receptionist didn't know the cash costs, because almost no one paid cash, so it was an unusual situation for them.

douglas said...
This comment has been removed by the author.
Texan99 said...

Raven--he's got his own office.

Miss L & Eric--yes, I had fun yesterday telling a progressive, "Shame on me for discounting me simply because I'm in a minority!"

Elise--It's been cracking me up all day, almost putting me in a good mood. The disarray in the talking points has reached a point of frantic incoherence I can't remember every seeing before. The vote on this bill should be real entertainment on Friday. They must be absolutely desperate to keep it from coming to a vote, but the Dems are stampeding.

I never, ever dreamed this thing would blow up so obviously and so fast.

Texan99 said...

I meant, "Shame on you . . . ."

Dad29 said...

There are a number of MD's in SE Wisconsin who are now taking a $10K one-time payment plus $25.00/visit, unlimited visits, (and HOUSECALLS!!) for routine stuff.

No insurance accepted, period.

Texan99 said...

I'm really interested in some variation on concierge practices, but I haven't seen one that can address the really scary scenario, which is a major, expensive illness requiring hospitalization, multiple surgeries, etc.

E Hines said...

The best thing that could happen is if we went to some kind of reimbursable or fixed amount the insurance would pay you for whatever, and you shop around, and if you want a doctor that' costs more, you pay the difference....

Actually, the best would be to instate an actual free market in the health insurance and in health care industries. Then, if there were a market for that sort of flat fee insurance coverage, or doctors that took the subscription route, we'd have it, and those of us who didn't want insurance would go without, without penalty.

The vote on this bill should be real entertainment on Friday. They must be absolutely desperate to keep it from coming to a vote....

The House Dems have sent a letter to Obama telling him to propose a fix by Friday, or too many of them will have to vote for the Upton bill.

As you say, who votes which way will be entertaining. George Will was saying on Special Report that either the Upton Bill or the Landrieu Bill in the Senate would be an effective repeal of Obamacare. I'm not sure he's right, but he's close.

Eric Hines

raven said...

Some links of interest- this one of doctors who will accept payment directly from patients and avoid insurance co.

This is to the Surgery center of Oklahoma, cash price surgery.

DL Sly said...

I love how the "5%" that are losing their insurance is no big deal, but if you recall, the percentage of people who couldn't be bothered to get off their butt and apply for Medicaid beforehand...err were uninsured was essentially the same. Soooo, apparently *your* percentage* isn't as important as *theirs*.
Of course, what all these 5%-spouters deliberately elide over is the reality of 300 days from now when employers start cancelling plans for everyone still considered to be full-time workers. (Funny how that works these days with the enemedia.) Then, that percentage is estimated to be closer to 25-30%. I wonder how they plan to diminish the meaning of a quarter of the population being uninsured whereas before it was "only 5%".
Yanno...just thinking in pixels.

Larry said...

When we were arguing for more stringent gun laws, the standard was "saving just one life." Now we're canceling policies on "just 5%,"


douglas said...

"Actually, the best would be..."

Yes, of course I agree, Eric- but I severely doubt the likelihood that the ideal solution will even be proposed, much less come to pass. So, we let not the imperfect be the enemy of the good.

J. Sterling Ellison said...

Yes, we mustn't fall into the trap of discounting the plight of millions of Americans. Between 2007 and 2011, five million Americans lost their homes to foreclosure, which seems to me a staggering number, and it's still much less than 5% of the total population. The only way to play the numbers game with human lives is the RIGHT way, if you get my meaning.