Does anyone bypass insurance for primary care?

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toofache32
Posts: 1957
Joined: Sun Mar 04, 2012 6:30 pm

Re: Does anyone bypass insurance for primary care?

Post by toofache32 » Sat Feb 15, 2020 2:57 am

smectym wrote:
Sat Feb 15, 2020 2:50 am
toofache32 wrote:
Sat Feb 15, 2020 1:37 am
mega317 wrote:
Sat Feb 15, 2020 1:10 am
I appreciate the conversation. You are confusing me--do you think the cell phone access does or doesn't improve care? I would agree that an ER visit that could be prevented by a phone call is not good. Clearly if two patients have the same minor complaint, one is triaged over the phone by a physician who knows them and medicine well, the other is sent to the ER where they are likely to wait a long time, may get unnecessary testing and treatment, etc, are getting different quality health care, not just service. I would also feel that's true about hospital clinic patients and concierge patients equally (not knowing anything about the respective populations). So why do some of your patients get that and not others? If my understanding of the model is correct, you wouldn't be paid extra for either phone call. And I never said any patients are getting inadequate care.
The ER visit is less efficient and more costly but does not result in less care. Quite the opposite.... perhaps it's too much care as a result of decreased efficiency. You are correct that this decreased efficiency can result in unnecessary testing in the ER from an ER doc that doesn't fully know the patient. The patient should be upset that their insurance doesn't encourage better efficiency. If insurance would pay me to be available (in my hospital practice), then I would be. But they don't. When they pay only 1/3rd of my regular fee and make me fight and spend money just to get that 1/3rd, this is what happens. For my private practice, this added service of availability is built into the fees and business model. The economics are actually very simple.

My point is that everyone seems to want to go to Best Buy and get a 60 inch TV but some only pay for a 30 inch TV. And they wonder why they can't get the 60 inch TV for the cost of a 30 inch TV. Both will show the same movies and accomplish the same outcome, but one is obviously more desirable. But there is nothing wrong with the 30 inch TV. We have a 2-tiered healthcare system. And there is nothing wrong with that. The lower tier is still getting at least the minimal standard of care. If you want the 60 inch TV, guess what? It costs more and is available.
My comment relates to the observation above that sometimes ER care results in too much rather than too little care. There are cases in which what’s really going on is “defensive medicine”: i.e., the MD is prescribing outlandish tests and going the extra 10 to 20 miles for fear of getting sued if any possible test is omitted, which alleged omission might then form the gravamen of some lawsuit, even if the suit is essentially frivolous.

An unfortunate consequence of our legal system, which places few or no obstacles to the filing of low-merit lawsuits, which usually end in settlement to the profit of the plaintiffs attorney—because from the standpoint of the defense, it’s often simply cheaper to settle rather than go the far more costly route of final adjudication on the merits.
Yes I sometimes practice "defensive medicine" like most and we can think our attorneys for this. I haven't bee sued yet but have seen some ridiculous lawsuits among colleagues. While not all attorneys are like this, it's unfortunate that the 99% that ruins if for the 1%.

ScubaHogg
Posts: 222
Joined: Sun Nov 06, 2011 3:02 pm

Re: Does anyone bypass insurance for primary care?

Post by ScubaHogg » Sat Feb 15, 2020 5:58 am

We have a subscription/conceriage-lite service with our PCP. It lets them keep a much smaller client base and remain viable. We pay a monthly fee and they don’t take any insurance.

I love it. You can text the doctor anytime (not a nurse, the doctor) and they respond within 30 minutes. Same day appointments. I won’t go back to the old way.

fru-gal
Posts: 1386
Joined: Wed Jan 02, 2019 9:48 pm
Location: New England

Re: Does anyone bypass insurance for primary care?

Post by fru-gal » Sat Feb 15, 2020 6:55 am

dm200 wrote:
Fri Feb 14, 2020 6:24 pm
cyclist wrote:
Fri Feb 14, 2020 6:02 pm
We're recently retired and not yet eligible for Medicare. The cost to us (after premium tax credits) of the best HMO plan available through our state's exchange was about half of the cost of a good PPO plan, but DW has long-term relationships with some of her docs. It was cheaper for us to go the HMO route and pay her docs out of pocket than to buy the PPO insurance that would cover them.
Cyclist
Just my two cents -- but I feel that keeping a relationship with a particular doctor is very, very overrated, as long as you do not have to switch all your physicians every year. A few years ago, when I went on Medicare and moved to the Kaiser plan, I had to switch 4 or 5 doctors - all of whom I was happy with. With 20/20 hindsight, I now have concluded that my Primary Care Doctor now is much better than my previous PCP. All of the others are fine - some a little better and some a little worse -- but all very competent.

My wife feels the same way as well.
There are some terrible primary care doctors in my area, My least fav was the one who told me about a decade ago that I had six months to live. My internist is worth her weight in gold and knows my complex history. If nothing much is ever wrong with you, probably any competent doctor will be suitable.

Blue456
Posts: 354
Joined: Tue Jun 04, 2019 5:46 am

Re: Does anyone bypass insurance for primary care?

Post by Blue456 » Sat Feb 15, 2020 7:35 am

sergio wrote:
Fri Feb 14, 2020 5:12 pm
testicular cancer check, full upper/lower body exam, oxygen level check, (optional) prostate exam, and so on.
What it really comes down is that good customer service does not always means good patient service. Not everything that patient perceives as thorough is necessary and some tests, exams may cause more harm than benefit.

mega317
Posts: 3236
Joined: Tue Apr 19, 2016 10:55 am

Re: Does anyone bypass insurance for primary care?

Post by mega317 » Sat Feb 15, 2020 9:55 am

I get that the reality is patients get different care based on insurance /payment models. And I'm trying to reserve judgement having never walked in anyone else's shoes. But I can't imagine an individual doctor providing better care, in factors he/she can control, to some patients based solely on how they paid.
https://www.bogleheads.org/forum/viewtopic.php?t=6212

SteveinVanvcouverWA
Posts: 43
Joined: Sun Feb 17, 2008 12:26 pm

Re: Does anyone bypass insurance for primary care?

Post by SteveinVanvcouverWA » Sat Feb 15, 2020 10:54 am

sawhorse wrote:
Sat Feb 15, 2020 2:40 am
SteveinVanvcouverWA wrote:
Sat Feb 15, 2020 1:19 am
I am a family physician and started a Direct Primary Care practice 19 months ago. Happily, I don't take insurance, rather, my patients pay a monthly fee like a gym membership. Instead of rushed visits like in my previous 19 years of practice, I can spend 30-60 minutes with patients. Labs and prescriptions are deeply discounted. We do labs and dispense most of our patients' meds right in the office. I take off suspicious skin lesions and inject painful joints at no extra charge to patients. My patients can reach me by phone, video or text 24/7 and we do home visits. Patients have unlimited office visits. They wait less than 5 minutes and we greet them by name. I work for the patient, not the insurance companies. In my former rushed insurance-based practice, I scarcely had time to ask a patient how their fishing trip was or how their family is doing. Now I have ample time. My fees are reasonable, based on age and averaging $57/month per patient. I love practicing medicine again.
That's a really great rate. What does it include? I still don't think my very mediocre current primary care doctor is worth that, but I've had two excellent primary care doctors in the past who knew how to handle almost everything on their own and would definitely have been worth more than that.

There's a concierge practice around here that charges $6k, and they don't even do home visits, not even for an extra fee :shock:
These services are included with all paid monthly memberships at no extra charge:

Office visits
Urgent care - same or next business day
Exceptional access through email, text, video and phone calls
Preventive visits
Comprehensive physical exams, including exams for school, sports, well child, well-woman, etc
(Female physician available for GYN exams and pap smears.)
Discounted medications
Discounted laboratory testing
Management of chronic medical issues
Oximetry
Blood pressure monitoring
Travel Medicine consults and vaccination recommendations (vaccinations not included)
In-office procedures including:
Splinting
Joint injections
Skin tag removal
Wart removal
In-grown toenail treatment
Mole removal
Cyst removal
Cortisone injections
Urinalysis
EKG testing
Spirometry
Glucose testing
Strep Throat testing
Pap smears (patients pays for pathologist reading at discounted rate)
Breathing treatments
Pregnancy tests
Skin cryotherapy
Stitches
Blood draws
Childhood vaccinations

Services not included:
Hospital-based care
Emergency services
Specialist services
Major surgery
Delivery of babies

SteveinVanvcouverWA
Posts: 43
Joined: Sun Feb 17, 2008 12:26 pm

Re: Does anyone bypass insurance for primary care?

Post by SteveinVanvcouverWA » Sat Feb 15, 2020 11:05 am

sawhorse wrote:
Sat Feb 15, 2020 2:34 am
With concierge primary care doctors, how do referrals work? If your plan requires specialist referrals, will the plan accept a referral from a primary care doctor not in the network for a specialist in the network?
As a Direct Primary Care physician, I have no problem referring to specialists for patients who are in PPO's (Preferred Provider Organizations), Medicare, or with High Deductible Health Plans (HDHPs). But with HMO's, like Kaiser, the patient has to see a PCP in their system for a referral. Despite that, I have many Kaiser patients signing up with me because they are frustrated by the long wait to see their Kaiser PCP. They prefer the easy access and longer visits with me. I warn them up front that it will be clunky if they need a referral, as they have to see the Kaiser PCP. They understand and sign up with me anyway. But my practice is most popular for people with no health insurance, HDHP's, or health sharing ministries.

bbqguru
Posts: 95
Joined: Sat Sep 17, 2011 8:31 pm

Re: Does anyone bypass insurance for primary care?

Post by bbqguru » Sat Feb 15, 2020 12:28 pm

sawhorse wrote:
Sat Feb 15, 2020 2:34 am
With concierge primary care doctors, how do referrals work? If your plan requires specialist referrals, will the plan accept a referral from a primary care doctor not in the network for a specialist in the network?
We've yet to run into any issue with a specialist not taking a referral from our doctor. In fact, when we let our doctor know we need a referral, it is usually sent over the same day and more often than not, the specialists office calls later in the day or the very next.

One specialist we saw required a packet of paperwork to be filled out by the referring doctor. It wasn't an issue, but I know if we were with our old "insurance" PCP it would have taken a few weeks to get done.

sawhorse
Posts: 3511
Joined: Sun Mar 01, 2015 7:05 pm

Re: Does anyone bypass insurance for primary care?

Post by sawhorse » Sat Feb 15, 2020 1:14 pm

SteveinVanvcouverWA wrote:
Sat Feb 15, 2020 10:54 am
sawhorse wrote:
Sat Feb 15, 2020 2:40 am
SteveinVanvcouverWA wrote:
Sat Feb 15, 2020 1:19 am
I am a family physician and started a Direct Primary Care practice 19 months ago. Happily, I don't take insurance, rather, my patients pay a monthly fee like a gym membership. Instead of rushed visits like in my previous 19 years of practice, I can spend 30-60 minutes with patients. Labs and prescriptions are deeply discounted. We do labs and dispense most of our patients' meds right in the office. I take off suspicious skin lesions and inject painful joints at no extra charge to patients. My patients can reach me by phone, video or text 24/7 and we do home visits. Patients have unlimited office visits. They wait less than 5 minutes and we greet them by name. I work for the patient, not the insurance companies. In my former rushed insurance-based practice, I scarcely had time to ask a patient how their fishing trip was or how their family is doing. Now I have ample time. My fees are reasonable, based on age and averaging $57/month per patient. I love practicing medicine again.
That's a really great rate. What does it include? I still don't think my very mediocre current primary care doctor is worth that, but I've had two excellent primary care doctors in the past who knew how to handle almost everything on their own and would definitely have been worth more than that.

There's a concierge practice around here that charges $6k, and they don't even do home visits, not even for an extra fee :shock:
These services are included with all paid monthly memberships at no extra charge:

Office visits
Urgent care - same or next business day
Exceptional access through email, text, video and phone calls
Preventive visits
Comprehensive physical exams, including exams for school, sports, well child, well-woman, etc
(Female physician available for GYN exams and pap smears.)
Discounted medications
Discounted laboratory testing
Management of chronic medical issues
Oximetry
Blood pressure monitoring
Travel Medicine consults and vaccination recommendations (vaccinations not included)
In-office procedures including:
Splinting
Joint injections
Skin tag removal
Wart removal
In-grown toenail treatment
Mole removal
Cyst removal
Cortisone injections
Urinalysis
EKG testing
Spirometry
Glucose testing
Strep Throat testing
Pap smears (patients pays for pathologist reading at discounted rate)
Breathing treatments
Pregnancy tests
Skin cryotherapy
Stitches
Blood draws
Childhood vaccinations

Services not included:
Hospital-based care
Emergency services
Specialist services
Major surgery
Delivery of babies
That sounds like a good value. I assume home visits are an extra charge?

What happens if you have patients who need too many services? If all your patients needed a lot of time and services, you wouldn't have enough time to see them all and run your office profitably. Do you limit the number of very high needs patients? Do you accept all patients who are willing to pay, or do you require them to answer questions about their level of need?

User avatar
Sandtrap
Posts: 9021
Joined: Sat Nov 26, 2016 6:32 pm
Location: Hawaii No Ka Oi , N. Arizona

Re: Does anyone bypass insurance for primary care?

Post by Sandtrap » Sat Feb 15, 2020 1:19 pm

fru-gal wrote:
Sat Feb 15, 2020 6:55 am
. . . .
There are some terrible primary care doctors in my area, My least fav was the one who told me about a decade ago that I had six months to live. My internist is worth her weight in gold and knows my complex history. If nothing much is ever wrong with you, probably any competent doctor will be suitable.
Excellent point.
If one's medical conditions fall within the greater part of the bell curve, then competent medical care may be adequate.
But, if one's medical history is complex and requires ongoing care and modification as needed, then the right specialist is priceless.

j :happy
Wiki Bogleheads Wiki: Everything You Need to Know

Luckywon
Posts: 712
Joined: Tue Mar 28, 2017 10:33 am

Re: Does anyone bypass insurance for primary care?

Post by Luckywon » Sat Feb 15, 2020 1:22 pm

SteveinVanvcouverWA wrote:
Sat Feb 15, 2020 10:54 am
sawhorse wrote:
Sat Feb 15, 2020 2:40 am
SteveinVanvcouverWA wrote:
Sat Feb 15, 2020 1:19 am
I am a family physician and started a Direct Primary Care practice 19 months ago. Happily, I don't take insurance, rather, my patients pay a monthly fee like a gym membership. Instead of rushed visits like in my previous 19 years of practice, I can spend 30-60 minutes with patients. Labs and prescriptions are deeply discounted. We do labs and dispense most of our patients' meds right in the office. I take off suspicious skin lesions and inject painful joints at no extra charge to patients. My patients can reach me by phone, video or text 24/7 and we do home visits. Patients have unlimited office visits. They wait less than 5 minutes and we greet them by name. I work for the patient, not the insurance companies. In my former rushed insurance-based practice, I scarcely had time to ask a patient how their fishing trip was or how their family is doing. Now I have ample time. My fees are reasonable, based on age and averaging $57/month per patient. I love practicing medicine again.
That's a really great rate. What does it include? I still don't think my very mediocre current primary care doctor is worth that, but I've had two excellent primary care doctors in the past who knew how to handle almost everything on their own and would definitely have been worth more than that.

There's a concierge practice around here that charges $6k, and they don't even do home visits, not even for an extra fee :shock:
These services are included with all paid monthly memberships at no extra charge:

Office visits
Urgent care - same or next business day
Exceptional access through email, text, video and phone calls
Preventive visits
Comprehensive physical exams, including exams for school, sports, well child, well-woman, etc
(Female physician available for GYN exams and pap smears.)
Discounted medications
Discounted laboratory testing
Management of chronic medical issues
Oximetry
Blood pressure monitoring
Travel Medicine consults and vaccination recommendations (vaccinations not included)
In-office procedures including:
Splinting
Joint injections
Skin tag removal
Wart removal
In-grown toenail treatment
Mole removal
Cyst removal
Cortisone injections
Urinalysis
EKG testing
Spirometry
Glucose testing
Strep Throat testing
Pap smears (patients pays for pathologist reading at discounted rate)
Breathing treatments
Pregnancy tests
Skin cryotherapy
Stitches
Blood draws
Childhood vaccinations

Services not included:
Hospital-based care
Emergency services
Specialist services
Major surgery
Delivery of babies
Congratulations on taking control of your destiny, very inspiring, and sounds like a win-win cutting out middlemen. One thing I'm surprised is that your practice does not get overburdened with "high maintenance" patients. Have you ever had to "fire" a patient for these reason?

SteveinVanvcouverWA
Posts: 43
Joined: Sun Feb 17, 2008 12:26 pm

Re: Does anyone bypass insurance for primary care?

Post by SteveinVanvcouverWA » Sat Feb 15, 2020 1:26 pm

sawhorse wrote:
Sat Feb 15, 2020 1:14 pm
SteveinVanvcouverWA wrote:
Sat Feb 15, 2020 10:54 am
sawhorse wrote:
Sat Feb 15, 2020 2:40 am
SteveinVanvcouverWA wrote:
Sat Feb 15, 2020 1:19 am
I am a family physician and started a Direct Primary Care practice 19 months ago. Happily, I don't take insurance, rather, my patients pay a monthly fee like a gym membership. Instead of rushed visits like in my previous 19 years of practice, I can spend 30-60 minutes with patients. Labs and prescriptions are deeply discounted. We do labs and dispense most of our patients' meds right in the office. I take off suspicious skin lesions and inject painful joints at no extra charge to patients. My patients can reach me by phone, video or text 24/7 and we do home visits. Patients have unlimited office visits. They wait less than 5 minutes and we greet them by name. I work for the patient, not the insurance companies. In my former rushed insurance-based practice, I scarcely had time to ask a patient how their fishing trip was or how their family is doing. Now I have ample time. My fees are reasonable, based on age and averaging $57/month per patient. I love practicing medicine again.
That's a really great rate. What does it include? I still don't think my very mediocre current primary care doctor is worth that, but I've had two excellent primary care doctors in the past who knew how to handle almost everything on their own and would definitely have been worth more than that.

There's a concierge practice around here that charges $6k, and they don't even do home visits, not even for an extra fee :shock:
These services are included with all paid monthly memberships at no extra charge:

Office visits
Urgent care - same or next business day
Exceptional access through email, text, video and phone calls
Preventive visits
Comprehensive physical exams, including exams for school, sports, well child, well-woman, etc
(Female physician available for GYN exams and pap smears.)
Discounted medications
Discounted laboratory testing
Management of chronic medical issues
Oximetry
Blood pressure monitoring
Travel Medicine consults and vaccination recommendations (vaccinations not included)
In-office procedures including:
Splinting
Joint injections
Skin tag removal
Wart removal
In-grown toenail treatment
Mole removal
Cyst removal
Cortisone injections
Urinalysis
EKG testing
Spirometry
Glucose testing
Strep Throat testing
Pap smears (patients pays for pathologist reading at discounted rate)
Breathing treatments
Pregnancy tests
Skin cryotherapy
Stitches
Blood draws
Childhood vaccinations

Services not included:
Hospital-based care
Emergency services
Specialist services
Major surgery
Delivery of babies
That sounds like a good value. I assume home visits are an extra charge?

What happens if you have patients who need too many services? If all your patients needed a lot of time and services, you wouldn't have enough time to see them all and run your office profitably. Do you limit the number of very high needs patients?
Very insightful question. This type of practice does tend to attract some needy patients. We balance it by having employer accounts in which employers pay the monthly membership fee for their employees and family members. More than a third of our 443 patients are from these 6 small companies. These employees tend to be low utilizers. Also, my panel size is smaller- the average family doc has a panel of about 2300 patients. So we have more margin to spend time with needy patients. We get the needy patients in with our mental health counselor (low fee per visit to see her), who helps them move forward in life, since it is often past emotionally traumatic events that make them so needy.

We reserve the home visits for when it is difficult for the patient to get in to the practice and do not charge extra.

User avatar
JoeRetire
Posts: 4796
Joined: Tue Jan 16, 2018 2:44 pm

Re: Does anyone bypass insurance for primary care?

Post by JoeRetire » Sat Feb 15, 2020 1:28 pm

fru-gal wrote:
Sat Feb 15, 2020 6:55 am
If nothing much is ever wrong with you, probably any competent doctor will be suitable.
True. Of course if nothing is ever wrong with you, then you may not need a doctor at all.

So, how lucky do you feel?

(Nothing much was ever wrong with me, until it was. Fortunately, after 1 1/2 years of infusions, my cancer is no longer detectable.)
Very Stable Genius

SteveinVanvcouverWA
Posts: 43
Joined: Sun Feb 17, 2008 12:26 pm

Re: Does anyone bypass insurance for primary care?

Post by SteveinVanvcouverWA » Sat Feb 15, 2020 1:32 pm

Luckywon wrote:
Sat Feb 15, 2020 1:22 pm
SteveinVanvcouverWA wrote:
Sat Feb 15, 2020 10:54 am
sawhorse wrote:
Sat Feb 15, 2020 2:40 am
SteveinVanvcouverWA wrote:
Sat Feb 15, 2020 1:19 am
I am a family physician and started a Direct Primary Care practice 19 months ago. Happily, I don't take insurance, rather, my patients pay a monthly fee like a gym membership. Instead of rushed visits like in my previous 19 years of practice, I can spend 30-60 minutes with patients. Labs and prescriptions are deeply discounted. We do labs and dispense most of our patients' meds right in the office. I take off suspicious skin lesions and inject painful joints at no extra charge to patients. My patients can reach me by phone, video or text 24/7 and we do home visits. Patients have unlimited office visits. They wait less than 5 minutes and we greet them by name. I work for the patient, not the insurance companies. In my former rushed insurance-based practice, I scarcely had time to ask a patient how their fishing trip was or how their family is doing. Now I have ample time. My fees are reasonable, based on age and averaging $57/month per patient. I love practicing medicine again.
That's a really great rate. What does it include? I still don't think my very mediocre current primary care doctor is worth that, but I've had two excellent primary care doctors in the past who knew how to handle almost everything on their own and would definitely have been worth more than that.

There's a concierge practice around here that charges $6k, and they don't even do home visits, not even for an extra fee :shock:
These services are included with all paid monthly memberships at no extra charge:

Office visits
Urgent care - same or next business day
Exceptional access through email, text, video and phone calls
Preventive visits
Comprehensive physical exams, including exams for school, sports, well child, well-woman, etc
(Female physician available for GYN exams and pap smears.)
Discounted medications
Discounted laboratory testing
Management of chronic medical issues
Oximetry
Blood pressure monitoring
Travel Medicine consults and vaccination recommendations (vaccinations not included)
In-office procedures including:
Splinting
Joint injections
Skin tag removal
Wart removal
In-grown toenail treatment
Mole removal
Cyst removal
Cortisone injections
Urinalysis
EKG testing
Spirometry
Glucose testing
Strep Throat testing
Pap smears (patients pays for pathologist reading at discounted rate)
Breathing treatments
Pregnancy tests
Skin cryotherapy
Stitches
Blood draws
Childhood vaccinations

Services not included:
Hospital-based care
Emergency services
Specialist services
Major surgery
Delivery of babies
Congratulations on taking control of your destiny, very inspiring, and sounds like a win-win cutting out middlemen. One thing I'm surprised is that your practice does not get overburdened with "high maintenance" patients. Have you ever had to "fire" a patient for these reason?
Very insightful of you. The "high maintenance" patients usually settle down after a few visits when they know we are there for them. Paradoxically, some of these actually become some of our favorite patients. We have firm boundaries, so the ones who don't settle down and are never satisfied end up firing us and moving on to yet another doctor.

jayk238
Posts: 627
Joined: Tue Jan 31, 2017 1:02 pm

Re: Does anyone bypass insurance for primary care?

Post by jayk238 » Sat Feb 15, 2020 1:37 pm

SteveinVanvcouverWA wrote:
Sat Feb 15, 2020 1:32 pm
Luckywon wrote:
Sat Feb 15, 2020 1:22 pm
SteveinVanvcouverWA wrote:
Sat Feb 15, 2020 10:54 am
sawhorse wrote:
Sat Feb 15, 2020 2:40 am
SteveinVanvcouverWA wrote:
Sat Feb 15, 2020 1:19 am
I am a family physician and started a Direct Primary Care practice 19 months ago. Happily, I don't take insurance, rather, my patients pay a monthly fee like a gym membership. Instead of rushed visits like in my previous 19 years of practice, I can spend 30-60 minutes with patients. Labs and prescriptions are deeply discounted. We do labs and dispense most of our patients' meds right in the office. I take off suspicious skin lesions and inject painful joints at no extra charge to patients. My patients can reach me by phone, video or text 24/7 and we do home visits. Patients have unlimited office visits. They wait less than 5 minutes and we greet them by name. I work for the patient, not the insurance companies. In my former rushed insurance-based practice, I scarcely had time to ask a patient how their fishing trip was or how their family is doing. Now I have ample time. My fees are reasonable, based on age and averaging $57/month per patient. I love practicing medicine again.
That's a really great rate. What does it include? I still don't think my very mediocre current primary care doctor is worth that, but I've had two excellent primary care doctors in the past who knew how to handle almost everything on their own and would definitely have been worth more than that.

There's a concierge practice around here that charges $6k, and they don't even do home visits, not even for an extra fee :shock:
These services are included with all paid monthly memberships at no extra charge:

Office visits
Urgent care - same or next business day
Exceptional access through email, text, video and phone calls
Preventive visits
Comprehensive physical exams, including exams for school, sports, well child, well-woman, etc
(Female physician available for GYN exams and pap smears.)
Discounted medications
Discounted laboratory testing
Management of chronic medical issues
Oximetry
Blood pressure monitoring
Travel Medicine consults and vaccination recommendations (vaccinations not included)
In-office procedures including:
Splinting
Joint injections
Skin tag removal
Wart removal
In-grown toenail treatment
Mole removal
Cyst removal
Cortisone injections
Urinalysis
EKG testing
Spirometry
Glucose testing
Strep Throat testing
Pap smears (patients pays for pathologist reading at discounted rate)
Breathing treatments
Pregnancy tests
Skin cryotherapy
Stitches
Blood draws
Childhood vaccinations

Services not included:
Hospital-based care
Emergency services
Specialist services
Major surgery
Delivery of babies
Congratulations on taking control of your destiny, very inspiring, and sounds like a win-win cutting out middlemen. One thing I'm surprised is that your practice does not get overburdened with "high maintenance" patients. Have you ever had to "fire" a patient for these reason?
Very insightful of you. The "high maintenance" patients usually settle down after a few visits when they know we are there for them. Paradoxically, some of these actually become some of our favorite patients. We have firm boundaries, so the ones who don't settle down and are never satisfied end up firing us and moving on to yet another doctor.
I provide the same level of care. My practice is insurance based and I am employed. I spend 40 minutes w new pt and 20 for established and happily spend more time if need be.

One doesnt need dpm to provide high quality service. Just an employer that is not specialty driven.

jbuzolich
Posts: 340
Joined: Tue Jun 24, 2014 9:52 pm

Re: Does anyone bypass insurance for primary care?

Post by jbuzolich » Sat Feb 15, 2020 1:41 pm

Kenkat wrote:
Fri Feb 14, 2020 1:30 pm
I’ve been bypassing my insurance more and more for prescription drug coverage and using GoodRX instead. One recent prescription $70+ through my insurance, $20 through GoodRX.
+1 GoodRX. Haven't been able to use them other than pet meds but I love price checking.

Luckywon
Posts: 712
Joined: Tue Mar 28, 2017 10:33 am

Re: Does anyone bypass insurance for primary care?

Post by Luckywon » Sat Feb 15, 2020 1:42 pm

SteveinVanvcouverWA wrote:
Sat Feb 15, 2020 1:32 pm
Luckywon wrote:
Sat Feb 15, 2020 1:22 pm


Congratulations on taking control of your destiny, very inspiring, and sounds like a win-win cutting out middlemen. One thing I'm surprised is that your practice does not get overburdened with "high maintenance" patients. Have you ever had to "fire" a patient for these reason?
Very insightful of you. The "high maintenance" patients usually settle down after a few visits when they know we are there for them. Paradoxically, some of these actually become some of our favorite patients. We have firm boundaries, so the ones who don't settle down and are never satisfied end up firing us and moving on to yet another doctor.
Thanks, good to hear these issues have been handled successfully. Best wishes for continued success.

Unladen_Swallow
Posts: 440
Joined: Tue Dec 10, 2019 6:12 pm

Re: Does anyone bypass insurance for primary care?

Post by Unladen_Swallow » Sat Feb 15, 2020 1:42 pm

mega317 wrote:
Sat Feb 15, 2020 9:55 am
I get that the reality is patients get different care based on insurance /payment models. And I'm trying to reserve judgement having never walked in anyone else's shoes. But I can't imagine an individual doctor providing better care, in factors he/she can control, to some patients based solely on how they paid.
I see the judgment.

Doctors are required to provide a certain amount of care. That is covered at any price point, and is dictated by insurance in terms of time spent, patients seen etc. If concierge provides something beyond, so be it. They are paying for it. Sharing a phone number is beyond basic care. Doctors are not required to sacrifice their entire personal time for no compensation. I don't have my doctors phone number. I don't own her time if I don't compensate for it. And if I want to own her time, she might charge me a fee so that she can see fewer patients. Basically set up a different type of practice. Life work balance.

Doctors are like any other profession. They are trying to earn their living too. Trying to morally shame them is unnecessary.
Last edited by Unladen_Swallow on Sat Feb 15, 2020 1:51 pm, edited 1 time in total.
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SteveinVanvcouverWA
Posts: 43
Joined: Sun Feb 17, 2008 12:26 pm

Re: Does anyone bypass insurance for primary care?

Post by SteveinVanvcouverWA » Sat Feb 15, 2020 1:43 pm

jbuzolich wrote:
Sat Feb 15, 2020 1:41 pm
Kenkat wrote:
Fri Feb 14, 2020 1:30 pm
I’ve been bypassing my insurance more and more for prescription drug coverage and using GoodRX instead. One recent prescription $70+ through my insurance, $20 through GoodRX.
+1 GoodRX. Haven't been able to use them other than pet meds but I love price checking.
It's important to present the GoodRX coupon to the pharmacist first and ask for cash pricing. If you tell them your insurance coverage first, the pharmacist may be reluctant to tell you the cash pricing because of gag orders they have been forced to sign with big health insurance companies.

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Sandtrap
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Re: Does anyone bypass insurance for primary care?

Post by Sandtrap » Sat Feb 15, 2020 2:08 pm

SteveinVanvcouverWA wrote:
Sat Feb 15, 2020 1:43 pm
jbuzolich wrote:
Sat Feb 15, 2020 1:41 pm
Kenkat wrote:
Fri Feb 14, 2020 1:30 pm
I’ve been bypassing my insurance more and more for prescription drug coverage and using GoodRX instead. One recent prescription $70+ through my insurance, $20 through GoodRX.
+1 GoodRX. Haven't been able to use them other than pet meds but I love price checking.
It's important to present the GoodRX coupon to the pharmacist first and ask for cash pricing. If you tell them your insurance coverage first, the pharmacist may be reluctant to tell you the cash pricing because of gag orders they have been forced to sign with big health insurance companies.
I did not know this.
Picked up a RX the other day and had a RX coupon. I think it worked out to a few dollars less than my copay for the RX. But, as I was on autopilot (routine), I got the stuff, they rang me up minus insurance coverage, and that was that.
Next time I'll try the coupon first.

Thanks for posting this.
j :happy
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EnjoyIt
Posts: 3384
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Re: Does anyone bypass insurance for primary care?

Post by EnjoyIt » Sat Feb 15, 2020 3:03 pm

mega317 wrote:
Sat Feb 15, 2020 9:55 am
I get that the reality is patients get different care based on insurance /payment models. And I'm trying to reserve judgement having never walked in anyone else's shoes. But I can't imagine an individual doctor providing better care, in factors he/she can control, to some patients based solely on how they paid.
I wish I can help you understand. Think about your own job and try doing something in 15 minutes that normally takes you 30 to do well. Add in some red tape to the mix followed by after hours completing that project. Now do this all day long for 10 hours. That is the difference. Basically you are required to do twice as much if not more in the same day with more BS in the process. Do you think your output will be consistently the same in both models?

fru-gal
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Re: Does anyone bypass insurance for primary care?

Post by fru-gal » Sat Feb 15, 2020 3:15 pm

SteveinVanvcouverWA wrote:
Sat Feb 15, 2020 1:43 pm
jbuzolich wrote:
Sat Feb 15, 2020 1:41 pm
Kenkat wrote:
Fri Feb 14, 2020 1:30 pm
I’ve been bypassing my insurance more and more for prescription drug coverage and using GoodRX instead. One recent prescription $70+ through my insurance, $20 through GoodRX.
+1 GoodRX. Haven't been able to use them other than pet meds but I love price checking.
It's important to present the GoodRX coupon to the pharmacist first and ask for cash pricing. If you tell them your insurance coverage first, the pharmacist may be reluctant to tell you the cash pricing because of gag orders they have been forced to sign with big health insurance companies.
I am unaware of this. I get my prescriptions filled at a major chain pharmacy and they always as far as I know tell me about cash options and OTC options.

toofache32
Posts: 1957
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Re: Does anyone bypass insurance for primary care?

Post by toofache32 » Sat Feb 15, 2020 8:56 pm

mega317 wrote:
Sat Feb 15, 2020 9:55 am
I get that the reality is patients get different care based on insurance /payment models. And I'm trying to reserve judgement having never walked in anyone else's shoes. But I can't imagine an individual doctor providing better care, in factors he/she can control, to some patients based solely on how they paid.
It's not how they paid. It's how much they paid. Fees paid vary dramatically and many insurances only pay 20-30% of my fee. They are only paying for the office visit. Only the office visit. Gotta come back for another office visit to get the biopsy results, etc because I cannot get paid with a phone call which takes the same amount of time I could use to see another patient. Insurance only pays for office visits, not being available 24/7 via cell phone and certainly not for me to call you with biopsy results to avoid another visit. If insurance would pay for that, I would offer it to their patients. But they don't. My cash pay patients have this added service built in to my fee. They are paying for this. Is it better care? Maybe so. But this does not mean the other patients are getting inadequate care. Sorry I'm not sure what's so difficult to understand about this.
Last edited by toofache32 on Sat Feb 15, 2020 11:24 pm, edited 1 time in total.

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sergio
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Re: Does anyone bypass insurance for primary care?

Post by sergio » Sat Feb 15, 2020 9:40 pm

toofache32 wrote:
Sat Feb 15, 2020 8:56 pm
mega317 wrote:
Sat Feb 15, 2020 9:55 am
I get that the reality is patients get different care based on insurance /payment models. And I'm trying to reserve judgement having never walked in anyone else's shoes. But I can't imagine an individual doctor providing better care, in factors he/she can control, to some patients based solely on how they paid.
It's not how they paid. It's how much they paid. Fees paid vary dramatically and many insurances only pay 20-30% of my fee. They are only paying for the office visit. Only the office visit. Gotta come back for another office visit to get the biopsy results, etc because I cannot get paid with a phone call which takes the same amount of time I could use to see another patient. Insurance only pays for office visits, not being available 24/7 via cell phone and certainly not for me to call you with biopsy results to avoid another visit. If insurance would pay for that, I would offer it to their patients. But they don't. My cash pay patients have this added service built in to my fee. They are paying for this. Is it better care? Maybe so. But this does not mean the other patients are getting inadequate care. Sorry I'm not sure what's so difficult to understand about this.
I later googled the cash-only physician I saw and there was an article that featured him as being one of the pioneers of "direct pay" primary care (NOT concierge) in our area. In the article he says that by charging $120 cash for a 30-minute visit, he basically makes the same amount of money as he did when he accepted insurance. Except now sees 2 patients per hour rather than the 3 or 4 per hour he used to when he was part of a corporate owned clinic. And he doesn't have to deal with bosses or "MBA bean counters" as he's quoted in the article. He charges $40 for a 10-minute phone (or skype) call which wasn't even allowed at his previous clinic (which had a nursing hotline). Makes me wonder why insurance is even involved in primary care if a 30-minute visit can be had for $120 and is apparently enough to keep primary care doctors interested.

Godot
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Re: Does anyone bypass insurance for primary care?

Post by Godot » Sat Feb 15, 2020 11:07 pm

SteveinVanvcouverWA wrote:
Sat Feb 15, 2020 11:05 am
sawhorse wrote:
Sat Feb 15, 2020 2:34 am
With concierge primary care doctors, how do referrals work? If your plan requires specialist referrals, will the plan accept a referral from a primary care doctor not in the network for a specialist in the network?
As a Direct Primary Care physician, I have no problem referring to specialists for patients who are in PPO's (Preferred Provider Organizations), Medicare, or with High Deductible Health Plans (HDHPs). But with HMO's, like Kaiser, the patient has to see a PCP in their system for a referral. Despite that, I have many Kaiser patients signing up with me because they are frustrated by the long wait to see their Kaiser PCP. They prefer the easy access and longer visits with me. I warn them up front that it will be clunky if they need a referral, as they have to see the Kaiser PCP. They understand and sign up with me anyway. But my practice is most popular for people with no health insurance, HDHP's, or health sharing ministries.
You sound like a dream physician! Are you accepting new patients? I'm interested.
Estragon: I can't go on like this. | Vladimir: That's what you think. | ― Samuel Beckett, Waiting for Godot

SteveinVanvcouverWA
Posts: 43
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Re: Does anyone bypass insurance for primary care?

Post by SteveinVanvcouverWA » Sat Feb 15, 2020 11:30 pm

Godot wrote:
Sat Feb 15, 2020 11:07 pm
SteveinVanvcouverWA wrote:
Sat Feb 15, 2020 11:05 am
sawhorse wrote:
Sat Feb 15, 2020 2:34 am
With concierge primary care doctors, how do referrals work? If your plan requires specialist referrals, will the plan accept a referral from a primary care doctor not in the network for a specialist in the network?
As a Direct Primary Care physician, I have no problem referring to specialists for patients who are in PPO's (Preferred Provider Organizations), Medicare, or with High Deductible Health Plans (HDHPs). But with HMO's, like Kaiser, the patient has to see a PCP in their system for a referral. Despite that, I have many Kaiser patients signing up with me because they are frustrated by the long wait to see their Kaiser PCP. They prefer the easy access and longer visits with me. I warn them up front that it will be clunky if they need a referral, as they have to see the Kaiser PCP. They understand and sign up with me anyway. But my practice is most popular for people with no health insurance, HDHP's, or health sharing ministries.
You sound like a dream physician! Are you accepting new patients? I'm interested.
Thank you. There are more than 1200 Direct Primary Care practices in the US now. Most of them allow you to have a free Meet and Greet visit to see if you and the doctor are a good fit. You can find one near you at
https://mapper.dpcfrontier.com

Ornery Old Guy
Posts: 50
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Re: Does anyone bypass insurance for primary care?

Post by Ornery Old Guy » Sun Feb 16, 2020 1:33 am

oldfatguy wrote:
Fri Feb 14, 2020 3:55 pm
go140point6 wrote:
Fri Feb 14, 2020 3:53 pm
My wife has been having issues with her hip, affecting her running (we're both active as my handle suggests) and after almost a year of dealing with the HMO provided care and physical therapy, she started going to a cash-only place recommended to her. We live in Southern California, and she has to drive up to Hollywood (so that sucks) but she has been amazed at the difference in care and the level of care. One PT on the HMO plan had a piece of paper with "exercises" for her to do that he had ready before he had even met her or discussed her problem with her! The cash-only place actually examined her before suggesting treatment. Needless to say, the new place is money well spent (happy wife, happy life). To avoid the traffic this week, she made the appointment for 6 AM... try and do that with an HMO provided office visit.
Anyone NOT doing that should be reported to their licensing agency.
A physician, yes. NOT a physical therapist. The job of the physician is diagnosis and treatment. The physician tells the therapist what is the diagnosis and exactly what he wants done. If the therapist examines and comes to a different conclusion as to the physician, of course you could ask questions, but that is not the training or function of a therapist. The training and function of a therapist is to do and teach the appropriate therapy exercises.

A lot of responses to a lot of problems on this board are "report to the licensing agency," which is a very aggressive step to take. Probably a verbal question or phone call is more appropriate.

Ornery Old Guy
Posts: 50
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Re: Does anyone bypass insurance for primary care?

Post by Ornery Old Guy » Sun Feb 16, 2020 1:37 am

For essentially all of medicine that runs through insurance, everything is charged a million dollars, and the insurance company pays out whatever the contracted rate is. When you go for an MRI, the facility will charge around $1000 and the insurance will pay between $300-400. If you call the facility and ask for the cash price they will usually quote around $300-400, whatever the insurance pays.

IF YOU HAVE A HIGH DEDUCTIBLE POLICY the facility will charge the usual rate - say $1000. If you have a high deductible you will pay $1000 for your MRI. Had you called and asked for the cash price and paid cash, you would have paid $300-400. So if you have a high deductible policy and it's not clear if you will hit the deductible you are usually better off paying cash and saving your receipt to claim at the end of the year if you do hit the deductible.

FYI.

A lot of physicians and facilities will charge less if you ask for the cash price.

sawhorse
Posts: 3511
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Re: Does anyone bypass insurance for primary care?

Post by sawhorse » Sun Feb 16, 2020 1:38 am

sergio wrote:
Sat Feb 15, 2020 9:40 pm
I later googled the cash-only physician I saw and there was an article that featured him as being one of the pioneers of "direct pay" primary care (NOT concierge) in our area. In the article he says that by charging $120 cash for a 30-minute visit, he basically makes the same amount of money as he did when he accepted insurance. Except now sees 2 patients per hour rather than the 3 or 4 per hour he used to when he was part of a corporate owned clinic. And he doesn't have to deal with bosses or "MBA bean counters" as he's quoted in the article. He charges $40 for a 10-minute phone (or skype) call which wasn't even allowed at his previous clinic (which had a nursing hotline). Makes me wonder why insurance is even involved in primary care if a 30-minute visit can be had for $120 and is apparently enough to keep primary care doctors interested.
I see two doctors in different specialties that I pay out of pocket for. One charges $150 for appointments that take about half an hour. She's one of the very top specialists for a highly specific condition. The other charges $250 for one hour. He's a psychiatrist, so his appointments take an hour.

Your primary care doctor's fee is in a similar range, suggesting that there is a prevailing market rate for physicians when prices are transparent. That suggests that physicians who non-transparently charge $1000 for 15 minutes because they can, such as some ER physicians or radiologists who have patients at their mercy and hit them with surprise bills, are taking advantage of their position of market power. But the biggest culprits are the hospitals who refuse to give prices in advance no matter how many times you ask because they know patients would flip out when they realize they're being charged $40 for a pill of ibuprofen.

It seems that costs could go down significantly if they were forced to be transparent. As a bonus, perhaps people would stop blaming the wrong things. $250 per hour isn't much at all for a consultation with a professional with so much training. $40 ibuprofen at the hospital on the other hand is beyond outrageous. But as it stands, patients don't realize that it's the hospital ibuprofen problematically inflating costs more than your primary care doctor's salary.

SeekingAPlan
Posts: 177
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Re: Does anyone bypass insurance for primary care?

Post by SeekingAPlan » Sun Feb 16, 2020 9:47 am

Ornery Old Guy wrote:
Sun Feb 16, 2020 1:37 am
For essentially all of medicine that runs through insurance, everything is charged a million dollars, and the insurance company pays out whatever the contracted rate is. When you go for an MRI, the facility will charge around $1000 and the insurance will pay between $300-400. If you call the facility and ask for the cash price they will usually quote around $300-400, whatever the insurance pays.

IF YOU HAVE A HIGH DEDUCTIBLE POLICY the facility will charge the usual rate - say $1000. If you have a high deductible you will pay $1000 for your MRI. Had you called and asked for the cash price and paid cash, you would have paid $300-400. So if you have a high deductible policy and it's not clear if you will hit the deductible you are usually better off paying cash and saving your receipt to claim at the end of the year if you do hit the deductible.

FYI.

A lot of physicians and facilities will charge less if you ask for the cash price.
I have a high deductible policy and the bolded portion above is not true. You get the lower contracted rate but you pay for it out of pocket until you hit your high deductible.

toofache32
Posts: 1957
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Re: Does anyone bypass insurance for primary care?

Post by toofache32 » Sun Feb 16, 2020 8:15 pm

sawhorse wrote:
Sun Feb 16, 2020 1:38 am
sergio wrote:
Sat Feb 15, 2020 9:40 pm
I later googled the cash-only physician I saw and there was an article that featured him as being one of the pioneers of "direct pay" primary care (NOT concierge) in our area. In the article he says that by charging $120 cash for a 30-minute visit, he basically makes the same amount of money as he did when he accepted insurance. Except now sees 2 patients per hour rather than the 3 or 4 per hour he used to when he was part of a corporate owned clinic. And he doesn't have to deal with bosses or "MBA bean counters" as he's quoted in the article. He charges $40 for a 10-minute phone (or skype) call which wasn't even allowed at his previous clinic (which had a nursing hotline). Makes me wonder why insurance is even involved in primary care if a 30-minute visit can be had for $120 and is apparently enough to keep primary care doctors interested.
I see two doctors in different specialties that I pay out of pocket for. One charges $150 for appointments that take about half an hour. She's one of the very top specialists for a highly specific condition. The other charges $250 for one hour. He's a psychiatrist, so his appointments take an hour.

Your primary care doctor's fee is in a similar range, suggesting that there is a prevailing market rate for physicians when prices are transparent. That suggests that physicians who non-transparently charge $1000 for 15 minutes because they can, such as some ER physicians or radiologists who have patients at their mercy and hit them with surprise bills, are taking advantage of their position of market power. But the biggest culprits are the hospitals who refuse to give prices in advance no matter how many times you ask because they know patients would flip out when they realize they're being charged $40 for a pill of ibuprofen.

It seems that costs could go down significantly if they were forced to be transparent. As a bonus, perhaps people would stop blaming the wrong things. $250 per hour isn't much at all for a consultation with a professional with so much training. $40 ibuprofen at the hospital on the other hand is beyond outrageous. But as it stands, patients don't realize that it's the hospital ibuprofen problematically inflating costs more than your primary care doctor's salary.
Do you wonder the reason for those outrageous prices nobody pays?
Insurance companies require (by contract) for hospitals to have a single fee schedule. They have to charge the same fee to everyone. But in-network insurance companies are also (by contract) given write-offs to only pay the contracted fees and the hospital accepts that as payment in full.

So where do the inflated prices come from?
Every once in a while, the insurance pays the hospital's full charged fee. This means they would have paid more, because the insurance will not pay more than you bill them for. So the hospital increases that fee to capture that extra revenue next time that insurance plan comes around. A few months later, another plan pays that full fee for some reason, so the fee is raised again. Multiple this by thousands of codes and now all the fees are ridiculously inflated to levels the hospital doesn't expect anyone to pay.

Why do insurance companies want it this way? Because now uninsured patients get billed for ridiculous fees which makes them think "dang I need some insurance!" So the insurance companies are using hospitals so push patients back to them as customers. Quite genius actually.

oldfatguy
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Re: Does anyone bypass insurance for primary care?

Post by oldfatguy » Sun Feb 16, 2020 9:01 pm

Ornery Old Guy wrote:
Sun Feb 16, 2020 1:33 am

A physician, yes. NOT a physical therapist. The job of the physician is diagnosis and treatment. The physician tells the therapist what is the diagnosis and exactly what he wants done.
I think would come as a surprise to most PTs and most physicians.

HoneyBee
Posts: 70
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Re: Does anyone bypass insurance for primary care?

Post by HoneyBee » Sun Feb 16, 2020 9:31 pm

I am enjoying reading this exchange, especially seeing the perspective of the primary care physicians. (except for the crack about attorneys as I have been an attorney for 39 years with the last 10-15 years in healthcare law).

I would be interested in a concierge or private pay primary care physician, especially one who is not stressed out from big-corporate medicine and under the thumb of for-profit insurance companies. But, as one physician noted, they do not provide the following:

Services not included:
Hospital-based care
Emergency services
Specialist services
Major surgery
Delivery of babies

Since most people cannot self-pay for these types of very high-priced services, we have to carry health insurance in our current healthcare system. This is a significant monthly expense which includes primary care so it is hard to justify another $60 or 100 dollars a month for a private primary care physician. In addition, the ACA requires my insurer to cover an annual physical (albeit sometimes conducted by a grumpy/rushed doc or a PA or a NP) and all my preventative care without any co-pay or deductible.

So my question for the physicians, if the ACA is struck down what type of model do you think we should replace it with? I'm not asking about politics or candidates as that is a no-no (as it should be). I agree that for-profit insurance companies have complicated our healthcare system and generally raised the cost to the consumer/taxpayer but how would you take them out of the equation?

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MP123
Posts: 1174
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Re: Does anyone bypass insurance for primary care?

Post by MP123 » Sun Feb 16, 2020 9:37 pm

SeekingAPlan wrote:
Sun Feb 16, 2020 9:47 am
Ornery Old Guy wrote:
Sun Feb 16, 2020 1:37 am
For essentially all of medicine that runs through insurance, everything is charged a million dollars, and the insurance company pays out whatever the contracted rate is. When you go for an MRI, the facility will charge around $1000 and the insurance will pay between $300-400. If you call the facility and ask for the cash price they will usually quote around $300-400, whatever the insurance pays.

IF YOU HAVE A HIGH DEDUCTIBLE POLICY the facility will charge the usual rate - say $1000. If you have a high deductible you will pay $1000 for your MRI. Had you called and asked for the cash price and paid cash, you would have paid $300-400. So if you have a high deductible policy and it's not clear if you will hit the deductible you are usually better off paying cash and saving your receipt to claim at the end of the year if you do hit the deductible.

FYI.

A lot of physicians and facilities will charge less if you ask for the cash price.
I have a high deductible policy and the bolded portion above is not true. You get the lower contracted rate but you pay for it out of pocket until you hit your high deductible.
That has been my experience too on a HDHP.

I had a blood test for a routine physical. The lab charged $632, when all was said and done I paid $30. Pretty crazy pricing but no penalty for the high deductible.

EnjoyIt
Posts: 3384
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Re: Does anyone bypass insurance for primary care?

Post by EnjoyIt » Sun Feb 16, 2020 9:48 pm

SeekingAPlan wrote:
Sun Feb 16, 2020 9:47 am
Ornery Old Guy wrote:
Sun Feb 16, 2020 1:37 am
For essentially all of medicine that runs through insurance, everything is charged a million dollars, and the insurance company pays out whatever the contracted rate is. When you go for an MRI, the facility will charge around $1000 and the insurance will pay between $300-400. If you call the facility and ask for the cash price they will usually quote around $300-400, whatever the insurance pays.

IF YOU HAVE A HIGH DEDUCTIBLE POLICY the facility will charge the usual rate - say $1000. If you have a high deductible you will pay $1000 for your MRI. Had you called and asked for the cash price and paid cash, you would have paid $300-400. So if you have a high deductible policy and it's not clear if you will hit the deductible you are usually better off paying cash and saving your receipt to claim at the end of the year if you do hit the deductible.

FYI.

A lot of physicians and facilities will charge less if you ask for the cash price.
I have a high deductible policy and the bolded portion above is not true. You get the lower contracted rate but you pay for it out of pocket until you hit your high deductible.
I have the high deductible plan and I found it to be true for me. I guess it varies based on plan and the facility you are getting testing done.

We also noticed getting labs done paying cash and not using insurance is less expensive as well.

User avatar
whodidntante
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Re: Does anyone bypass insurance for primary care?

Post by whodidntante » Sun Feb 16, 2020 9:55 pm

HDHP here. I recently needed an MRI on my second favorite knee. The place where the doctor sent the order, a hospital, took three days to tell me it would cost $3,800. A place five miles away told me over the phone that it would be $480. Lesson learned, shop around.

perikleez
Posts: 40
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Re: Does anyone bypass insurance for primary care?

Post by perikleez » Sun Feb 16, 2020 9:56 pm

sergio wrote:
Fri Feb 14, 2020 1:26 pm
For the last two years I've gone to one of the large clinics near my house for annual physicals. The visits were super rushed, doctors were seemed somewhat uninterested, the physical exams seemed superficial. To top it off, one year I got hit with a $200 "office visit" charge because I asked about an intermittent hand cramp I was having. The physician looked at it for a minute and said it'd go away on its own. :x

At the suggestion of a friend I went to a cash-only physician a few days ago. The waiting area looked like the lobby of 4/5-star hotel, the visit was nearly 30 minutes long and much more thorough, the doctor seemed incredibly relaxed and more of a friend or ally. And shockingly, the whole only cost $160 which included a bunch of labs and a 10-minute follow up call with him if I want.

Apparently he charges straight time ($120/half hour visit + any labs or fees) and you can talk about anything you want in that time.

This got me thinking - are there other opportunities like this in health care to get better service by paying cash? Does anyone bypass insurance for all but the most severe issues?
As noted by others, given your current access to medical care needs, your solution is a combination of HDHP/HSA and VIP type contract services (concierge, direct primary care, etc.). I've been doing this for over 5 years and it's amazing how much you save on monthly health plan benefits, along with giving you greater options in providers and quality of care.

SteveinVanvcouverWA
Posts: 43
Joined: Sun Feb 17, 2008 12:26 pm

Re: Does anyone bypass insurance for primary care?

Post by SteveinVanvcouverWA » Sun Feb 16, 2020 10:20 pm

HoneyBee wrote:
Sun Feb 16, 2020 9:31 pm
I am enjoying reading this exchange, especially seeing the perspective of the primary care physicians. (except for the crack about attorneys as I have been an attorney for 39 years with the last 10-15 years in healthcare law).

I would be interested in a concierge or private pay primary care physician, especially one who is not stressed out from big-corporate medicine and under the thumb of for-profit insurance companies. But, as one physician noted, they do not provide the following:

Services not included:
Hospital-based care
Emergency services
Specialist services
Major surgery
Delivery of babies

Since most people cannot self-pay for these types of very high-priced services, we have to carry health insurance in our current healthcare system. This is a significant monthly expense which includes primary care so it is hard to justify another $60 or 100 dollars a month for a private primary care physician. In addition, the ACA requires my insurer to cover an annual physical (albeit sometimes conducted by a grumpy/rushed doc or a PA or a NP) and all my preventative care without any co-pay or deductible.

So my question for the physicians, if the ACA is struck down what type of model do you think we should replace it with? I'm not asking about politics or candidates as that is a no-no (as it should be). I agree that for-profit insurance companies have complicated our healthcare system and generally raised the cost to the consumer/taxpayer but how would you take them out of the equation?
Most of us physicians in the direct primary care movement recommend health insurance be structured the same way as automobile or homeowners' insurance. Insurance should be used for less common, high priced items; in the case of healthcare: major surgery, chemotherapy, specialist procedures, hospitalization, etc. You don’t use your automobile insurance to fill up the gas tank, nor do you use your homeowners' Insurance to pay to replace a window screen. Imagine how expensive automobile and homeowners' insurance would be if you did try to include these things.

Primary care physicians can take care of 80 to 90% of the health issues for which people commonly go to the physician. These are common, every day health problems. Direct primary care could then form one option for primary care for patients that would be a predictable budget item in a person's budget. So one would go to their direct primary care physician for the common problems and then use their health insurance for the less common, high ticket items. You would typically end up needing to be referred less often, though, because if your primary care physician has more time, he or she can sort out more things for you without having to send you to a specialist.

toofache32
Posts: 1957
Joined: Sun Mar 04, 2012 6:30 pm

Re: Does anyone bypass insurance for primary care?

Post by toofache32 » Sun Feb 16, 2020 10:46 pm

SteveinVanvcouverWA wrote:
Sun Feb 16, 2020 10:20 pm
HoneyBee wrote:
Sun Feb 16, 2020 9:31 pm
I am enjoying reading this exchange, especially seeing the perspective of the primary care physicians. (except for the crack about attorneys as I have been an attorney for 39 years with the last 10-15 years in healthcare law).

I would be interested in a concierge or private pay primary care physician, especially one who is not stressed out from big-corporate medicine and under the thumb of for-profit insurance companies. But, as one physician noted, they do not provide the following:

Services not included:
Hospital-based care
Emergency services
Specialist services
Major surgery
Delivery of babies

Since most people cannot self-pay for these types of very high-priced services, we have to carry health insurance in our current healthcare system. This is a significant monthly expense which includes primary care so it is hard to justify another $60 or 100 dollars a month for a private primary care physician. In addition, the ACA requires my insurer to cover an annual physical (albeit sometimes conducted by a grumpy/rushed doc or a PA or a NP) and all my preventative care without any co-pay or deductible.

So my question for the physicians, if the ACA is struck down what type of model do you think we should replace it with? I'm not asking about politics or candidates as that is a no-no (as it should be). I agree that for-profit insurance companies have complicated our healthcare system and generally raised the cost to the consumer/taxpayer but how would you take them out of the equation?
Most of us physicians in the direct primary care movement recommend health insurance be structured the same way as automobile or homeowners' insurance. Insurance should be used for less common, high priced items; in the case of healthcare: major surgery, chemotherapy, specialist procedures, hospitalization, etc. You don’t use your automobile insurance to fill up the gas tank, nor do you use your homeowners' Insurance to pay to replace a window screen. Imagine how expensive automobile and homeowners' insurance would be if you did try to include these things.

Primary care physicians can take care of 80 to 90% of the health issues for which people commonly go to the physician. These are common, every day health problems. Direct primary care could then form one option for primary care for patients that would be a predictable budget item in a person's budget. So one would go to their direct primary care physician for the common problems and then use their health insurance for the less common, high ticket items. You would typically end up needing to be referred less often, though, because if your primary care physician has more time, he or she can sort out more things for you without having to send you to a specialist.
Exactly. Insurance is something you hope you never need. But we want it to pay for every little thing, which is one reason why it's so expensive. Who here asks their auto mechanic to see if your auto insurance will pay for your oil change?
Our culture has trained us to request medical insurance to pay for Advil. Yes, I have patients request for me to write a prescription for Advil because their insurance will cover it if it's a prescription.

Topic Author
sergio
Posts: 468
Joined: Sat Jun 20, 2015 6:52 pm

Re: Does anyone bypass insurance for primary care?

Post by sergio » Sun Feb 16, 2020 11:40 pm

SteveinVanvcouverWA wrote:
Sun Feb 16, 2020 10:20 pm
HoneyBee wrote:
Sun Feb 16, 2020 9:31 pm
I am enjoying reading this exchange, especially seeing the perspective of the primary care physicians. (except for the crack about attorneys as I have been an attorney for 39 years with the last 10-15 years in healthcare law).

I would be interested in a concierge or private pay primary care physician, especially one who is not stressed out from big-corporate medicine and under the thumb of for-profit insurance companies. But, as one physician noted, they do not provide the following:

Services not included:
Hospital-based care
Emergency services
Specialist services
Major surgery
Delivery of babies

Since most people cannot self-pay for these types of very high-priced services, we have to carry health insurance in our current healthcare system. This is a significant monthly expense which includes primary care so it is hard to justify another $60 or 100 dollars a month for a private primary care physician. In addition, the ACA requires my insurer to cover an annual physical (albeit sometimes conducted by a grumpy/rushed doc or a PA or a NP) and all my preventative care without any co-pay or deductible.

So my question for the physicians, if the ACA is struck down what type of model do you think we should replace it with? I'm not asking about politics or candidates as that is a no-no (as it should be). I agree that for-profit insurance companies have complicated our healthcare system and generally raised the cost to the consumer/taxpayer but how would you take them out of the equation?
Most of us physicians in the direct primary care movement recommend health insurance be structured the same way as automobile or homeowners' insurance. Insurance should be used for less common, high priced items; in the case of healthcare: major surgery, chemotherapy, specialist procedures, hospitalization, etc. You don’t use your automobile insurance to fill up the gas tank, nor do you use your homeowners' Insurance to pay to replace a window screen. Imagine how expensive automobile and homeowners' insurance would be if you did try to include these things.

Primary care physicians can take care of 80 to 90% of the health issues for which people commonly go to the physician. These are common, every day health problems. Direct primary care could then form one option for primary care for patients that would be a predictable budget item in a person's budget. So one would go to their direct primary care physician for the common problems and then use their health insurance for the less common, high ticket items. You would typically end up needing to be referred less often, though, because if your primary care physician has more time, he or she can sort out more things for you without having to send you to a specialist.
If primary care moved to direct pay, how much overhead would you eliminate, both on the provider side and on the insurer's side? I'm not an insurance expect but I imagine the vast majority of claims are for routine office visits, physicals, child well checks etc.

I would be absolutely thrilled if more and more primary care physicians went direct-pay rather than being absorbed into the mega corporate health systems. And I'm not talking about the nursing "minute clinics" but rather MDs/DOs. But I imagine it's an uphill battle with people so used to getting "free" or "discounted" primary care through their insurance.

toofache32
Posts: 1957
Joined: Sun Mar 04, 2012 6:30 pm

Re: Does anyone bypass insurance for primary care?

Post by toofache32 » Mon Feb 17, 2020 12:06 am

sergio wrote:
Sun Feb 16, 2020 11:40 pm
SteveinVanvcouverWA wrote:
Sun Feb 16, 2020 10:20 pm
HoneyBee wrote:
Sun Feb 16, 2020 9:31 pm
I am enjoying reading this exchange, especially seeing the perspective of the primary care physicians. (except for the crack about attorneys as I have been an attorney for 39 years with the last 10-15 years in healthcare law).

I would be interested in a concierge or private pay primary care physician, especially one who is not stressed out from big-corporate medicine and under the thumb of for-profit insurance companies. But, as one physician noted, they do not provide the following:

Services not included:
Hospital-based care
Emergency services
Specialist services
Major surgery
Delivery of babies

Since most people cannot self-pay for these types of very high-priced services, we have to carry health insurance in our current healthcare system. This is a significant monthly expense which includes primary care so it is hard to justify another $60 or 100 dollars a month for a private primary care physician. In addition, the ACA requires my insurer to cover an annual physical (albeit sometimes conducted by a grumpy/rushed doc or a PA or a NP) and all my preventative care without any co-pay or deductible.

So my question for the physicians, if the ACA is struck down what type of model do you think we should replace it with? I'm not asking about politics or candidates as that is a no-no (as it should be). I agree that for-profit insurance companies have complicated our healthcare system and generally raised the cost to the consumer/taxpayer but how would you take them out of the equation?
Most of us physicians in the direct primary care movement recommend health insurance be structured the same way as automobile or homeowners' insurance. Insurance should be used for less common, high priced items; in the case of healthcare: major surgery, chemotherapy, specialist procedures, hospitalization, etc. You don’t use your automobile insurance to fill up the gas tank, nor do you use your homeowners' Insurance to pay to replace a window screen. Imagine how expensive automobile and homeowners' insurance would be if you did try to include these things.

Primary care physicians can take care of 80 to 90% of the health issues for which people commonly go to the physician. These are common, every day health problems. Direct primary care could then form one option for primary care for patients that would be a predictable budget item in a person's budget. So one would go to their direct primary care physician for the common problems and then use their health insurance for the less common, high ticket items. You would typically end up needing to be referred less often, though, because if your primary care physician has more time, he or she can sort out more things for you without having to send you to a specialist.
If primary care moved to direct pay, how much overhead would you eliminate, both on the provider side and on the insurer's side? I'm not an insurance expect but I imagine the vast majority of claims are for routine office visits, physicals, child well checks etc.

I would be absolutely thrilled if more and more primary care physicians went direct-pay rather than being absorbed into the mega corporate health systems. And I'm not talking about the nursing "minute clinics" but rather MDs/DOs. But I imagine it's an uphill battle with people so used to getting "free" or "discounted" primary care through their insurance.
While I am not a PCP but am a physician who was previously in-network with insurance, I can give my experience. I don't think insurance companies would suffer much and here's why. An office visit with insurance may get $80. This is just an average and varies. About 20% of all claims are denied the first time they are submitted for no identifiable reason. I had to pay my staff about $15 an hour to file an appeal. Much of this involves sitting on the phone for up to an hour waiting for someone at the insurance company to take the call. About 25% of the time, the call would be suspiciously disconnected and we would have to start over. In the end, most of the profit from the office visit is eaten up just trying to get paid. So instead of hiring more staff just to fight appeals, it was cheaper to just let those go and chase higher paying claims such as surgical procedures. So the insurance company never even has to pay for many of their claims which add up to tons of money as a whole. Insurance companies know this and it's part of their strategy. I can't get through to an insurance person in a reasonable amount of time, but my patients can call their patient number and get someone on the phone right away. I wonder why? It's because the patient is the customer, not me.

I was at the Broadmoor in Colorado on vacation a few years ago. They were having a conference for insurance companies. I snuck in to some of the presentations and was astonished by what I learned. Claims paid are considered a "loss" on their business statements and they presented strategies on how to minimize "losses". "Be quick to collect premiums and slow to pay out" was advocated. Insurance companies are NOT in the business of paying claims. They are in the business of NOT paying claims.

Ornery Old Guy
Posts: 50
Joined: Tue Feb 04, 2020 2:55 pm

Re: Does anyone bypass insurance for primary care?

Post by Ornery Old Guy » Mon Feb 17, 2020 12:32 am

SeekingAPlan wrote:
Sun Feb 16, 2020 9:47 am
Ornery Old Guy wrote:
Sun Feb 16, 2020 1:37 am
For essentially all of medicine that runs through insurance, everything is charged a million dollars, and the insurance company pays out whatever the contracted rate is. When you go for an MRI, the facility will charge around $1000 and the insurance will pay between $300-400. If you call the facility and ask for the cash price they will usually quote around $300-400, whatever the insurance pays.

IF YOU HAVE A HIGH DEDUCTIBLE POLICY the facility will charge the usual rate - say $1000. If you have a high deductible you will pay $1000 for your MRI. Had you called and asked for the cash price and paid cash, you would have paid $300-400. So if you have a high deductible policy and it's not clear if you will hit the deductible you are usually better off paying cash and saving your receipt to claim at the end of the year if you do hit the deductible.

FYI.

A lot of physicians and facilities will charge less if you ask for the cash price.
I have a high deductible policy and the bolded portion above is not true. You get the lower contracted rate but you pay for it out of pocket until you hit your high deductible.
In every situation I'm aware of when you give the MRI facility your card they charge the insurance rate. Your insurance then sends you a bill saying $X is covered (which is 0 because it's a high deductible policy) and you are responsible for the remainder. The MRI facility has no idea as to whether you have a gold plated plan or high deductible. They charge what they charge. IF HOWEVER you tell them you are paying cash they will get the office manager and either give you the cash rate or negotiate a cash rate with you. So if you have a high deductible policy and you think you may not hit the limit you are almost always better off asking to pay cash and keep the receipt.

I do this for a living. But I would not claim I know how every single MRI facility (or lab facility or whatever) works everywhere. My bet is you and I are miscommunicating and not understanding what the other is saying. It is true of every facility I'm aware of - and I'm aware of a lot - but I'm not saying my knowledge is exhaustive. To be honest though, I don't know how an MRI facility (eg) would know to charge you a special low rate because you have a high deductible policy. They would charge you the usual and customary rate. The lower cash price is specifically because you're saving them billing time and effort so they're giving you a deal. If you're going through the insurance, every facility I'm aware of would charge the insurance price, which because it's a high deductible, becomes the cash price you pay out of pocket.

I guess I'm not getting what you're saying. It is not compatible with my experience.

Ornery Old Guy
Posts: 50
Joined: Tue Feb 04, 2020 2:55 pm

Re: Does anyone bypass insurance for primary care?

Post by Ornery Old Guy » Mon Feb 17, 2020 12:34 am

toofache32 wrote:
Sun Feb 16, 2020 8:15 pm
sawhorse wrote:
Sun Feb 16, 2020 1:38 am
sergio wrote:
Sat Feb 15, 2020 9:40 pm
I later googled the cash-only physician I saw and there was an article that featured him as being one of the pioneers of "direct pay" primary care (NOT concierge) in our area. In the article he says that by charging $120 cash for a 30-minute visit, he basically makes the same amount of money as he did when he accepted insurance. Except now sees 2 patients per hour rather than the 3 or 4 per hour he used to when he was part of a corporate owned clinic. And he doesn't have to deal with bosses or "MBA bean counters" as he's quoted in the article. He charges $40 for a 10-minute phone (or skype) call which wasn't even allowed at his previous clinic (which had a nursing hotline). Makes me wonder why insurance is even involved in primary care if a 30-minute visit can be had for $120 and is apparently enough to keep primary care doctors interested.
I see two doctors in different specialties that I pay out of pocket for. One charges $150 for appointments that take about half an hour. She's one of the very top specialists for a highly specific condition. The other charges $250 for one hour. He's a psychiatrist, so his appointments take an hour.

Your primary care doctor's fee is in a similar range, suggesting that there is a prevailing market rate for physicians when prices are transparent. That suggests that physicians who non-transparently charge $1000 for 15 minutes because they can, such as some ER physicians or radiologists who have patients at their mercy and hit them with surprise bills, are taking advantage of their position of market power. But the biggest culprits are the hospitals who refuse to give prices in advance no matter how many times you ask because they know patients would flip out when they realize they're being charged $40 for a pill of ibuprofen.

It seems that costs could go down significantly if they were forced to be transparent. As a bonus, perhaps people would stop blaming the wrong things. $250 per hour isn't much at all for a consultation with a professional with so much training. $40 ibuprofen at the hospital on the other hand is beyond outrageous. But as it stands, patients don't realize that it's the hospital ibuprofen problematically inflating costs more than your primary care doctor's salary.
Do you wonder the reason for those outrageous prices nobody pays?
Insurance companies require (by contract) for hospitals to have a single fee schedule. They have to charge the same fee to everyone. But in-network insurance companies are also (by contract) given write-offs to only pay the contracted fees and the hospital accepts that as payment in full.

So where do the inflated prices come from?
Every once in a while, the insurance pays the hospital's full charged fee. This means they would have paid more, because the insurance will not pay more than you bill them for. So the hospital increases that fee to capture that extra revenue next time that insurance plan comes around. A few months later, another plan pays that full fee for some reason, so the fee is raised again. Multiple this by thousands of codes and now all the fees are ridiculously inflated to levels the hospital doesn't expect anyone to pay.

Why do insurance companies want it this way? Because now uninsured patients get billed for ridiculous fees which makes them think "dang I need some insurance!" So the insurance companies are using hospitals so push patients back to them as customers. Quite genius actually.
Ha! When you asked the question I was about to answer it except you answered it. That's exactly the reason. The problem is that you and I recognize it's fantasy, and when someone comes in paying cash we just charge them whatever the insurance company would have reimbursed us - not the fantasy price. The hospitals and many physicians don't seem to get it and seem to think it's reasonable to screw cash patients. I think this is abhorrent.

Ornery Old Guy
Posts: 50
Joined: Tue Feb 04, 2020 2:55 pm

Re: Does anyone bypass insurance for primary care?

Post by Ornery Old Guy » Mon Feb 17, 2020 12:37 am

oldfatguy wrote:
Sun Feb 16, 2020 9:01 pm
Ornery Old Guy wrote:
Sun Feb 16, 2020 1:33 am

A physician, yes. NOT a physical therapist. The job of the physician is diagnosis and treatment. The physician tells the therapist what is the diagnosis and exactly what he wants done.
I think would come as a surprise to most PTs and most physicians.
I don't think so but as they say on the internet ... YMMV. The PT isn't supposed to be a dummy and blindly do what the paper says. But he is supposed to make sure the diagnosis and treatment are in line with his sense of what is going on. If you are dependent on your therapist making the diagnosis of what you have you are in trouble. There's a reason medical school is four years and surgical specialties are at minimum five years thereafter, working 80-100 hours a week. I don't think anyone would argue a three year physical therapy program is in any way even remotely comparable.

Ornery Old Guy
Posts: 50
Joined: Tue Feb 04, 2020 2:55 pm

Re: Does anyone bypass insurance for primary care?

Post by Ornery Old Guy » Mon Feb 17, 2020 12:41 am

HoneyBee wrote:
Sun Feb 16, 2020 9:31 pm
I am enjoying reading this exchange, especially seeing the perspective of the primary care physicians. (except for the crack about attorneys as I have been an attorney for 39 years with the last 10-15 years in healthcare law).

I would be interested in a concierge or private pay primary care physician, especially one who is not stressed out from big-corporate medicine and under the thumb of for-profit insurance companies. But, as one physician noted, they do not provide the following:

Services not included:
Hospital-based care
Emergency services
Specialist services
Major surgery
Delivery of babies

Since most people cannot self-pay for these types of very high-priced services, we have to carry health insurance in our current healthcare system. This is a significant monthly expense which includes primary care so it is hard to justify another $60 or 100 dollars a month for a private primary care physician. In addition, the ACA requires my insurer to cover an annual physical (albeit sometimes conducted by a grumpy/rushed doc or a PA or a NP) and all my preventative care without any co-pay or deductible.

So my question for the physicians, if the ACA is struck down what type of model do you think we should replace it with? I'm not asking about politics or candidates as that is a no-no (as it should be). I agree that for-profit insurance companies have complicated our healthcare system and generally raised the cost to the consumer/taxpayer but how would you take them out of the equation?
I've thought about this for a while. High deductible policy for everyone. They're not expensive. If you can't afford it, the government will pay for you - cheaper than medicaid. Then a sliding scale free money program from the government to make up the donut between 0 and your deductible. If you have a job and can afford it you pay for it. If you are on welfare the government can pay it. Make it an HSA. If medicine is "free" you will use as much as you can. Make the donut payment an HSA that you can save and accumulate and after 70Y old you can take out a percentage for fun stuff like a retirement account. That will incentivize responsible people not to overuse healthcare.

I am not a socialist. I am big time conservative and capitalist. But the cat is out of the bag for government involvement in medicine. This would be way cheaper than running medicaid, the VA, etc.

Ornery Old Guy
Posts: 50
Joined: Tue Feb 04, 2020 2:55 pm

Re: Does anyone bypass insurance for primary care?

Post by Ornery Old Guy » Mon Feb 17, 2020 12:42 am

EnjoyIt wrote:
Sun Feb 16, 2020 9:48 pm
SeekingAPlan wrote:
Sun Feb 16, 2020 9:47 am
Ornery Old Guy wrote:
Sun Feb 16, 2020 1:37 am
For essentially all of medicine that runs through insurance, everything is charged a million dollars, and the insurance company pays out whatever the contracted rate is. When you go for an MRI, the facility will charge around $1000 and the insurance will pay between $300-400. If you call the facility and ask for the cash price they will usually quote around $300-400, whatever the insurance pays.

IF YOU HAVE A HIGH DEDUCTIBLE POLICY the facility will charge the usual rate - say $1000. If you have a high deductible you will pay $1000 for your MRI. Had you called and asked for the cash price and paid cash, you would have paid $300-400. So if you have a high deductible policy and it's not clear if you will hit the deductible you are usually better off paying cash and saving your receipt to claim at the end of the year if you do hit the deductible.

FYI.

A lot of physicians and facilities will charge less if you ask for the cash price.
I have a high deductible policy and the bolded portion above is not true. You get the lower contracted rate but you pay for it out of pocket until you hit your high deductible.
I have the high deductible plan and I found it to be true for me. I guess it varies based on plan and the facility you are getting testing done.

We also noticed getting labs done paying cash and not using insurance is less expensive as well.
My bet is "seeking a plan" and I are talking past each other and not understanding what the other is saying.

Ornery Old Guy
Posts: 50
Joined: Tue Feb 04, 2020 2:55 pm

Re: Does anyone bypass insurance for primary care?

Post by Ornery Old Guy » Mon Feb 17, 2020 12:44 am

SteveinVanvcouverWA wrote:
Sun Feb 16, 2020 10:20 pm
HoneyBee wrote:
Sun Feb 16, 2020 9:31 pm
I am enjoying reading this exchange, especially seeing the perspective of the primary care physicians. (except for the crack about attorneys as I have been an attorney for 39 years with the last 10-15 years in healthcare law).

I would be interested in a concierge or private pay primary care physician, especially one who is not stressed out from big-corporate medicine and under the thumb of for-profit insurance companies. But, as one physician noted, they do not provide the following:

Services not included:
Hospital-based care
Emergency services
Specialist services
Major surgery
Delivery of babies

Since most people cannot self-pay for these types of very high-priced services, we have to carry health insurance in our current healthcare system. This is a significant monthly expense which includes primary care so it is hard to justify another $60 or 100 dollars a month for a private primary care physician. In addition, the ACA requires my insurer to cover an annual physical (albeit sometimes conducted by a grumpy/rushed doc or a PA or a NP) and all my preventative care without any co-pay or deductible.

So my question for the physicians, if the ACA is struck down what type of model do you think we should replace it with? I'm not asking about politics or candidates as that is a no-no (as it should be). I agree that for-profit insurance companies have complicated our healthcare system and generally raised the cost to the consumer/taxpayer but how would you take them out of the equation?
Most of us physicians in the direct primary care movement recommend health insurance be structured the same way as automobile or homeowners' insurance. Insurance should be used for less common, high priced items; in the case of healthcare: major surgery, chemotherapy, specialist procedures, hospitalization, etc. You don’t use your automobile insurance to fill up the gas tank, nor do you use your homeowners' Insurance to pay to replace a window screen. Imagine how expensive automobile and homeowners' insurance would be if you did try to include these things.

Primary care physicians can take care of 80 to 90% of the health issues for which people commonly go to the physician. These are common, every day health problems. Direct primary care could then form one option for primary care for patients that would be a predictable budget item in a person's budget. So one would go to their direct primary care physician for the common problems and then use their health insurance for the less common, high ticket items. You would typically end up needing to be referred less often, though, because if your primary care physician has more time, he or she can sort out more things for you without having to send you to a specialist.
Agree.
I've been wondering and have to ask...
Where is Vanvcouver? Is it near Vancouver?
(I'm the only one who thinks I'm hilarious By the way)

sawhorse
Posts: 3511
Joined: Sun Mar 01, 2015 7:05 pm

Re: Does anyone bypass insurance for primary care?

Post by sawhorse » Mon Feb 17, 2020 1:03 am

Ornery Old Guy wrote:
Mon Feb 17, 2020 12:37 am
oldfatguy wrote:
Sun Feb 16, 2020 9:01 pm
Ornery Old Guy wrote:
Sun Feb 16, 2020 1:33 am

A physician, yes. NOT a physical therapist. The job of the physician is diagnosis and treatment. The physician tells the therapist what is the diagnosis and exactly what he wants done.
I think would come as a surprise to most PTs and most physicians.
I don't think so but as they say on the internet ... YMMV. The PT isn't supposed to be a dummy and blindly do what the paper says. But he is supposed to make sure the diagnosis and treatment are in line with his sense of what is going on. If you are dependent on your therapist making the diagnosis of what you have you are in trouble. There's a reason medical school is four years and surgical specialties are at minimum five years thereafter, working 80-100 hours a week. I don't think anyone would argue a three year physical therapy program is in any way even remotely comparable.
When I was referred to a physical therapist, the physician had the physical therapist do the examination and come up with her own treatment plan. I'm sure it depends on the specialty level of the physician and perhaps the physician's personal preference in terms of micromanagement. Orthopedic surgeons may be more involved, but I doubt a general surgeon who performs a mastectomy and refers the patient to post-surgery physical therapy is going to be that involved in the patient's physical therapy. When my mother went through that, I think she saw the surgeon for a single follow up appointment, and that was it.
Last edited by sawhorse on Mon Feb 17, 2020 1:08 am, edited 1 time in total.

toofache32
Posts: 1957
Joined: Sun Mar 04, 2012 6:30 pm

Re: Does anyone bypass insurance for primary care?

Post by toofache32 » Mon Feb 17, 2020 1:05 am

Ornery Old Guy wrote:
Mon Feb 17, 2020 12:32 am
SeekingAPlan wrote:
Sun Feb 16, 2020 9:47 am
Ornery Old Guy wrote:
Sun Feb 16, 2020 1:37 am
For essentially all of medicine that runs through insurance, everything is charged a million dollars, and the insurance company pays out whatever the contracted rate is. When you go for an MRI, the facility will charge around $1000 and the insurance will pay between $300-400. If you call the facility and ask for the cash price they will usually quote around $300-400, whatever the insurance pays.

IF YOU HAVE A HIGH DEDUCTIBLE POLICY the facility will charge the usual rate - say $1000. If you have a high deductible you will pay $1000 for your MRI. Had you called and asked for the cash price and paid cash, you would have paid $300-400. So if you have a high deductible policy and it's not clear if you will hit the deductible you are usually better off paying cash and saving your receipt to claim at the end of the year if you do hit the deductible.

FYI.

A lot of physicians and facilities will charge less if you ask for the cash price.
I have a high deductible policy and the bolded portion above is not true. You get the lower contracted rate but you pay for it out of pocket until you hit your high deductible.
In every situation I'm aware of when you give the MRI facility your card they charge the insurance rate. Your insurance then sends you a bill saying $X is covered (which is 0 because it's a high deductible policy) and you are responsible for the remainder. The MRI facility has no idea as to whether you have a gold plated plan or high deductible. They charge what they charge. IF HOWEVER you tell them you are paying cash they will get the office manager and either give you the cash rate or negotiate a cash rate with you. So if you have a high deductible policy and you think you may not hit the limit you are almost always better off asking to pay cash and keep the receipt.

I do this for a living. But I would not claim I know how every single MRI facility (or lab facility or whatever) works everywhere. My bet is you and I are miscommunicating and not understanding what the other is saying. It is true of every facility I'm aware of - and I'm aware of a lot - but I'm not saying my knowledge is exhaustive. To be honest though, I don't know how an MRI facility (eg) would know to charge you a special low rate because you have a high deductible policy. They would charge you the usual and customary rate. The lower cash price is specifically because you're saving them billing time and effort so they're giving you a deal. If you're going through the insurance, every facility I'm aware of would charge the insurance price, which because it's a high deductible, becomes the cash price you pay out of pocket.

I guess I'm not getting what you're saying. It is not compatible with my experience.
Insurance companies don't send bills. You pay them with your premiums. I wonder if you are confusing this with the insurance EOB (explanation of benefits). These are sent after the claim has been adjudicated and the determination is made of the total bill (negotiated rate) and how much is paid by the insurance and how much is paid by you, depending on your deductible. The imaging center should make an estimate of your portion which you pay up front which is never correct by definition of estimate.

sawhorse
Posts: 3511
Joined: Sun Mar 01, 2015 7:05 pm

Re: Does anyone bypass insurance for primary care?

Post by sawhorse » Mon Feb 17, 2020 1:19 am

sawhorse wrote:
Mon Feb 17, 2020 1:03 am
Ornery Old Guy wrote:
Mon Feb 17, 2020 12:37 am
oldfatguy wrote:
Sun Feb 16, 2020 9:01 pm
Ornery Old Guy wrote:
Sun Feb 16, 2020 1:33 am

A physician, yes. NOT a physical therapist. The job of the physician is diagnosis and treatment. The physician tells the therapist what is the diagnosis and exactly what he wants done.
I think would come as a surprise to most PTs and most physicians.
I don't think so but as they say on the internet ... YMMV. The PT isn't supposed to be a dummy and blindly do what the paper says. But he is supposed to make sure the diagnosis and treatment are in line with his sense of what is going on. If you are dependent on your therapist making the diagnosis of what you have you are in trouble. There's a reason medical school is four years and surgical specialties are at minimum five years thereafter, working 80-100 hours a week. I don't think anyone would argue a three year physical therapy program is in any way even remotely comparable.
When I was referred to a physical therapist, the physician had the physical therapist do the examination and come up with her own treatment plan. I'm sure it depends on the specialty level of the physician and perhaps the physician's personal preference in terms of micromanagement. Orthopedic surgeons may be more involved, but I doubt a general surgeon who performs a mastectomy and refers the patient to post-surgery physical therapy is going to be that involved in the patient's physical therapy. When my mother went through that, I think she saw the surgeon for a single follow up appointment, and that was it.
By the way, when I was referred to the PT, I got my medical records from the physician's office and took them to the PT, and there was no indication that "the physician tells the therapist what is the diagnosis and exactly what he wants done". The notes were something like, "Patient reports pelvic pain and urinary incontinence. [Some notes mentioning of diagnoses determined to be less likely such as UTI.] PFD? (acronym for pelvic floor dysfunction) Referred to PT." That was the extent of the mention of PT.

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