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Return to 1930's Cash Primary Healthcare a Solution?
Old 05-05-2011, 09:50 AM   #1
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Return to 1930's Cash Primary Healthcare a Solution?

No not to 1930's science but to cash only primary health care. Dr Forrest claims ridding the office of insurance reduces overhead significantly & end the "need" to see 30 patients a day to remain profitable. This free up a doctor's time to spend more time with a patient w/o following the concietge model & nicking patients $1500/$2000 annually to gain access. But is able to provide affordable health care.

IdeaLab: Cash-only Healthcare Still Works - Physicians Practice

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I’m often asked how I can afford to keep charges so low at my primary-care practice. The answer is simple. Only the administration of primary care is expensive, not its provision, so I keep charges low — for example, I can take care of a chronically ill, hypertensive, hyperlipidemic, diabetic patient for $25 per month and $20 per visit — by refusing to deal with healthcare’s primary creators of administrative costs: insurance companies. My overhead is low, so my services are cheap, which makes it possible for middle- and low-income families (including some who are insured, and others who are not) to afford me.

Our overhead is exceptionally low[$150,000] because we do not file insurance and only have one staff person for every two providers.

You might be thinking that only uninsured patients would come to see me, to gain access to affordable primary care. Why, you might ask, would insured patients pay me $300 on top of their own insurance premiums? In fact, about 42 percent of my patients have traditional insurance through their employers; another 10 percent are on Medicare. They see me anyway, because my $20 per visit fee is slightly less than their in-network copay, and it often includes lab tests that their copay does not cover, so they still save money.

About 30 percent of my patients are uninsured. Another 15 percent don’t have conventional insurance but have heeded my advice to purchase high-deductible, low-premium plans with health savings accounts to cover any unforeseen hospitalizations or catastrophic costs.
His website for his practice:http://acchealth.com/
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Lab work: Blood tests are processed by LABCORP-We offer a significant discount for our patients regardless of insurance- can be as much as 85% off standard LABCORP prices.

A complete list of our prices is available for our patients upon request and are also posted in our waiting room. We believe price transparency helps patients to know what to expect about costs before they have an appointment at our office. Most services are $29 or $49, with more complex procedures like skin biopsies or suturing (getting stitches) being $149.
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Old 05-05-2011, 10:00 AM   #2
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Sounds good to me. I would like to see more transparent pricing in healthcare and a single point of payment coordination. Just last night I was trying to figure out what we owe for a single simple doctor's visit for my DW. The single visit created five separate bills eight insurance claims (3 were denied by the insurance co and had to be resubmitted by the various doctor's office(s) and lab companies). I consider myself a reasonably intelligent, detail oriented person, and it is still difficult for me to figure out what all these bills and charges are for and to ensure that we are paying for what we get.
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Old 05-05-2011, 10:18 AM   #3
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This may not be the solution to our healthcare problems but I have to agree that insurance companies are a big part of the problem. They provide no medical cares but represent a big part of the costs. Getting rid of insurance companies will certainly reduce costs and allow for true market system to work.
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Old 05-05-2011, 01:35 PM   #4
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I like it. Basically, I'm anti-insurance except for coverage for catastrophic occurances. IMHO, insurance simply raises (dramatically) the cost of everything it touches. Look at car repairs, I'd bet body shops wouldn't cost 1/3 as much for typical repairs if insurance wasn't in involved. Same with medical services . . . insurance simply drives up the cost. The insurance industry is largely parasitic and is where real reform should start.
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Old 05-06-2011, 05:36 PM   #5
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In 1992, I participated in a weekend training session with surgeons while working for JNJ. One of the surgeons remarked the worst thing that ever happened to healthcare was insurance. I didn't understand his comment and asked him to explain.

He used the car maintenance example and asked how much I thought an oil change would cost if it was paid for by insurance. He said health insurance should follow the car insurance model. We pay for the normal maintenace to our bodies and insurance would cover the big stuff.

I've never forgotten his comment and have purchased high deductible policies whenever possible at employers and as our individual health insurance.
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Old 05-24-2011, 08:12 AM   #6
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This system would prob work well for most primary care, but it's problematic for major surgical facilities. Cash primary falls apart where most patient encounters are "catastrophic" (very high cost). It's one thing to pay $100 for simple office visit/labs/etc., but very few patients can afford $50-100+k cash for heart stents or major operation.
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Old 05-24-2011, 06:54 PM   #7
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This system would prob work well for most primary care, but it's problematic for major surgical facilities. Cash primary falls apart where most patient encounters are "catastrophic" (very high cost). It's one thing to pay $100 for simple office visit/labs/etc., but very few patients can afford $50-100+k cash for heart stents or major operation.
I imagine that we'd see the 1930's approach to such major problems. The few who could afford treatment would receive it, and others would just live with the problems if possible, or receive lesser treatment and care.

I still have vivid memories of my grandfather lying in the open ward of the railroad hospital, dying from leukemia with no treatment past morphine. No fancy chemo or hospice care was available.
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Old 05-24-2011, 09:38 PM   #8
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This system would prob work well for most primary care, but it's problematic for major surgical facilities.
Too true. One would have to combine cash health care for routine/preventative health care with a high deductible catastrophic insurance policy.
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Old 05-25-2011, 03:55 AM   #9
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I agree with the idea of paying out of pocket for primary care. All of the cost associated with third parties is the big down fall of our health care system. These third parties provide no health care but eat up a lot of dollars.

One doctors group I visited had 4 doctors and about 5 clerical staff to handle the billing process.
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Old 05-25-2011, 07:53 AM   #10
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I agree with the idea of paying cash for primary care. My health insurance has a $1200 deductible, but ironically without the health insurance affiliation, I would be charged a great deal more for the same service.

Example: I recently went in for a simple blood test and lab bill was $608, but negotiated rate (what I had to pay) was $69.
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Old 05-25-2011, 09:16 AM   #11
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I agree with the idea of paying cash for primary care. My health insurance has a $1200 deductible, but ironically without the health insurance affiliation, I would be charged a great deal more for the same service.

Example: I recently went in for a simple blood test and lab bill was $608, but negotiated rate (what I had to pay) was $69.
And you actually cost them more than a person handing over cash because they have to do the billing and have the infrastructure to do it!
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Old 05-25-2011, 09:36 AM   #12
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And you actually cost them more than a person handing over cash because they have to do the billing and have the infrastructure to do it!
Thus the great paradox... it'd be cheaper for my provider to let me pay cash, but it's cheaper for me to use my insurance even if I have a high deductible.

Which means they need to bill my carrier, get the payment rejected, then bill me at the negotiated rate. Means they double-handle all my billing and have to add a two-four month lag to getting paid.
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Old 05-25-2011, 01:40 PM   #13
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Example: I recently went in for a simple blood test and lab bill was $608, but negotiated rate (what I had to pay) was $69.
Now folks have outlets such as :
http://http://www.directlabs.com/
That people can utilize to obtains low cost blood tests. I use the outfit link, but there are others. I order the test[s], pay by credit card, then pick a lab Direct Labs have a relationship. Receive an order from Direct Labs by email to hand to the lab. Wait about 48 hours, then download the results from the Direct Labs website. Easy peezey.

Since age 50[am now 60], I've been monitoring my cholesterol, PSA, glucose numbers. I also utilize a home blood pressure machine to check myself.
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Old 05-25-2011, 04:38 PM   #14
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And you actually cost them more than a person handing over cash because they have to do the billing and have the infrastructure to do it!
It is worse than that. The bill showed the same test was run three times on the blood sample on the same day @ $120 per test. I have appealed it and now they have to investigate and answer my inquiry. That should burn up their $69 pretty quick.
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