Cash-friendly doctor experience with labs

So after about a five-year interval, I finally went in for an annual physical last week. I found a local doctor who is cash-friendly, which means he still takes insurance but also has a clear and simple fee schedule for those of us who are self-pay. All in all, I was very pleased and satisfied with the doctor (no, I’m not telling you who it was).

There was one thing that I discovered however, and pointed out to the doctor – his charges for labs were generally higher than what I could have had them done for had I gone elsewhere for the tests. They weren’t radically higher though, so it’s not like I was getting hit with ‘list’ prices that are normally used with insured patients (who of course get a ‘discount’ off of the inflated list price in our crazy world of health care prices).

He was surprised when I told him his lab prices were more than they needed to be, and said he’d love to find lower-cost labs since so many of his patients are self-pay. I spoke with him today, letting him know what I found. I thought it might be of interest to readers at The Self-Pay Patient as well. Continue reading

Posted in Cash-Only Doctors, Labs & Imaging, Prescription Drugs | Tagged , , | 3 Comments

Must-read op-ed in today’s Wall Street Journal: ‘Health Care and the $20,000 Bruise’

The Wall Street Journal has a stellar and informative (and slightly depressing) op-ed today by Dr. Eric Michael David, recounting his recent experience taking his son to the hospital after discovering a bruise on his head. Self-pay patients who have ever had to haggle with a hospital over charges will recognize the story easily:

Health Care and the $20,000 Bruise

As a doctor and a lawyer, I like to think I’m pretty good at navigating the health-care system. So when my wife and I found a large swollen bruise on our 3-year-old son’s head more than a week after he had fallen off his scooter, I was confident we could get him a CT scan at a reasonable cost.

We live near one of the top pediatric emergency rooms in the country. The care was spectacular. My son was diagnosed with a small, 11-day-old bleed inside his head, which was healing, and insignificant…

Then the bill arrived, and you know where this is going: $20,000. Our insurance had already paid $17,000, and we owed $3,000 out-of-pocket. What for? Among the items listed on the printout was a $10,000 charge for a “trauma team activation.”  Continue reading

Posted in Emergency/Urgent Care, Hospitals, Negotiating Medical Bills | Tagged , | 16 Comments

Guest Post: Regardless of ObamaCare, “Self-Pay” Primary Care Practice Models Will Thrive!

The other day I was going through the comments that had been submitted recently in response to various blog posts. This is actually one of the more enjoyable parts of maintaining this web site, because I often get to find out how people are finding affordable care options as self-pay patients, or respond to questions or comments they have. I also get to wade through a lot of spam (although if I ever need a mail-order-bride from Russia, I now know there are sites I can turn to).

Reviewing the comments that had been left on one of my recent posts about cash-only and cash-friendly doctors, I found one by Dr. Efrain Arroyave, a retired doctor in the Miami region. Dr. Arroyave in recent years has been very active in the self-pay healthcare world, helping to launch companies catering to self-pay patients like econoLABS, NextImage Direct, and opening in September, SelfPayMD, a chain of primary care practices in the Miami area that are cash-only.

I thought Dr. Arroyave’s comments were pretty interesting, and I thought they deserved a wider audience than whomever might stumble across them on that blog post. So, with his permission, I’ve re-posted his comments here as a stand-alone guest piece. It reads a little different than most pieces, because it was written in part to explain the ‘business case’ for SelfPayMd (or at least that’s how it reads to me), but it’s still a very informative commentary and I hope you all get as much out of his comments as I did!

Regardless of ObamaCare, “Self-Pay” Primary Care Practice Models Will Thrive!

Even before ObamaCare, as a direct result of diminishing reimbursements and rising overhead costs, many Primary Care Physicians (PCPs) retired early, abandoned their practice or joined primary care groups to share overhead. Some refused to accept government or private insurance, opting to change their insurance-based practice to a “direct-pay” business model (self-pay). Currently in the USA, direct-pay accounts for 4%-6% of primary care medical practices – and growing. Even in England, where they have had socialized medicine for several decades, it is growing at 5% per year.

Stressed Primary Care Physicians

Today PCPs typically get paid about 20% – 25% of their billed amount, while shouldering labor-intensive collections effort. Thus, by not accepting any form of health insurance, we  eliminate unnecessary employees, which allows for a lower overhead, which in turn allows us [SelfPayMD] to charge only $75 per visit. Continue reading

Posted in Uncategorized | 4 Comments

Symbiosis Health brings transparency to self-pay prices

I recently learned about a new company bringing price transparency and discount pricing to self-pay patients who need imaging, labs, and a few other services. This is extremely important not just for uninsured self-pay patients but also for those with high-deductible plans, since one of the things I’ve observed is that medical imaging services like an MRI, CT scan, or ultrasound are commonly paid for out of pocket by people with insurance. Unfortunately, many of these insured self-pay patients don’t know that they can very easily overpay if they go to their local hospital or don’t shop around.

Symbiosis Health not only shows you the prices being offered to self-pay patients, they also allow you to schedule an appointment with the provider you chose and pay online. Here’s the image from their web site explaining how the process works:

Symbiosis Health image - How it Works

(I’m probably violating their copyright by pasting this image, but I think they’ll forgive me!) Continue reading

Posted in Labs & Imaging, Price Transparency | 2 Comments

Self-Pay Patient book event in Chicago

I put it out on The Self-Pay Patient Facebook and Twitter feeds before, but haven’t yet announced here on the blog that The Heartland Institute will be hosting me for a book event next week Wednesday, August 6 in downtown Chicago. The event starts at 11:30am with a lunch, and I’ll be speaking and answering questions starting at around 12:20 or so. Things should wrap up by 1:30.

I’m looking forward to this event, especially since my first introduction to some of the self-pay patient options that I write about in my book and here happened while I was at Heartland. If you’re in the Chicago area on August 6, I hope you can come by!

Further event details, including how to register to attend, are here: Sean Parnell and The Self-Pay Patient, hosted by The Heartland Institute

Posted in The Self-Pay Patient book | 1 Comment

More cash-only and cash-friendly doctor’s offices, Part III

Two weeks ago I began what is intended to be a multi-part series about cash-only and cash-friendly doctor’s offices. Here is Part III of the series, introducing two more medical practices on the East Coast that cater to self-pay patients.

Dr. Kordonowy, Fort Meyers, Florida

Dr. Raymond Kordonowy’s practice in southwest Florida, Internal Medicine of Southwest Florida, offers patients both a fee-for-service option where he is paid for each individual treatment or visit as well as an annual plan that includes a number of benefits. Here’s a bit of his bio from his web site:

Board certified by the American Board of Internal Medicine and the American Board of Clinical Lipidology, Dr. Kordonowy has been practicing medicine as a partner of Internal Medicine of Southwest Florida in Fort Myers since 1993.  Recognized as an outstanding physician by the American College of Physicians, Dr. Kordonowy earned his degree from the University of Kansas School of Medicine in Kansas City, and completed his residency as Chief Resident at the Orlando Regional Hospital System.

…Dr. Kordonowy understands how best to treat his patients, ensuring that they get the highest quality care for competitive, market based prices.  His practice, Internal Medicine of Southwest Florida, provides a full-fledged “medical home” model, with comprehensive labs, diagnostic equipment, and primary care all within one conveniently located office in Fort Myers, Florida.  A firm believer in preventative care and a holistic approach to delivering healthcare, Dr. Kordonowy promotes a healthy lifestyle of longevity for each of his valued patients.

In keeping with his holistic approach to healthcare, Dr. Kordonowy has a certified dietitian available for consults, coaching, and strategies for helping his patients lose weight, gain cardiovascular health, and have more energy.

 In addition to his Internal Medicine expertise, Dr. Kordonowy is a specialist in complex cholesterol disorders

 As you’d expect from a doctor that caters to self-pay patients, the pricing at Dr. Kordonowy’s office is pretty straightforward, with one oversight (more on that in a second). Here are his prices for a visit by a new patient: Continue reading

Posted in Cash-Only Doctors, Direct Care Practice | Tagged , , , | 3 Comments

St. Jude, a self-pay option for substance abuse treatment

The following is a guest post by Michelle Dunbar, Executive Director at Saint Jude Retreats, an alternative to traditional substance use treatment that that I thought may be of interest to readers at The Self-Pay Patient blog. St. Jude Retreats is not affiliated in any way with St. Jude Children’s Research Hospital.

 The Self-Pay Patient and Addiction Treatment

 The concept of addiction treatment is relatively young.   As a matter of fact, it has only become part of the mainstream lexicon for about three generations.   Contrary to popular belief, for the thousands of years prior to drug and alcohol treatment programs existing, people did overcome drug and alcohol problems.   And contrary to much conventional wisdom about drug and alcohol treatment, most people actually overcome addiction on their own, without ever going to treatment.

While addiction treatment is readily available in virtually every county in every state in the country, and millions of people are cycled through the treatment system annually, the addiction problem seems to be more prevalent than ever. And many people who have tried treatment only to fail over and over again have lost hope in ever being able to change their lives. Continue reading

Posted in Mental Health | Tagged , | 4 Comments

More cash-only and cash-friendly doctor’s offices, Part II

Yesterday I wrote about four cash-only and cash-friendly doctor’s offices. Without further introduction, here’s four more that self-pay patients should know about.

Dr. Kathleen Brown, Coos Bay, Oregon

As a native Oregonian, I’m always pleased to run into someone else from the rain-drenched state. I was fortunate enough to do so at a recent meeting of the Association of American Physicians & Surgeons (AAPS), Dr. Kathleen Brown of Coos Bay, Oregon. She’s a dermatologist who in 2011 decided she’d had it with bureaucratic medicine and instead set up her own cash-only practice on the Oregon Coast. Here’s how The Lund Report, an Oregon-specific site focused on health care, reported on her switch:

Coos Bay Dermatologist Strikes Out on Her Own, Abandons Billing Codes

December 15, 2011 – In July, Dr. Kathleen Brown decided to leave the Coos Bay clinic where she’d been practicing since 1997 and open her own dermatology practice. [Brown] …decided to eschew the use of CPT codes, a set of medical billing codes required by the American Medical Association for reimbursement by insurers.

Processing patients according to the codes was eating up too much time, she said. Instead, she switched to a time-based model that bills patients in five-minute increments, using a tiered pricing structure that adjusts the costs based on what type of procedure is needed. Prices are listed on her website. Although patients pay out of pocket, the price is still lower than it might be if they billed insurers themselves.

Brown sees a mix of insured and uninsured patients, and she now sees herself as working for the patient — not insurance companies and not the government. “I think something pretty much everyone agrees on is that the way we pay for healthcare is broken,” she said. Continue reading

Posted in Cash-Only Doctors, Direct Care Practice | Tagged , , , , , , , | 1 Comment

More cash-only and cash-friendly doctor’s offices, Part I

First things first – It’s been nearly 2 weeks since my last post here at The Self-Pay Patient. Between the July 4th holiday, business matters, and family time, I just haven’t been able to get anything out recently. So, I owe my regular readers an apology, which I hope they’ll quickly accept.

This also means, among other things, that I’ve got a boatload of things to share with readers of The Self-Pay Patient.

One of the things that is crowding my ‘blog post to-do’ list is a number of cash-only and cash-friendly medical practices that I’ve recently found out about. Since the number one question I’m typically asked is some variation of ‘where can I find a cash-only doctor near me?’ I thought a blog post with information about these practices would be helpful. Then, after starting to write the article I realized that there was no way I could fit all of them into a single blog post, so this is the first in what will hopefully be several posts I hope to get out over the next week reporting on doctors that cater to self-pay patients.

 As regular readers of The Self-Pay Patient know, a cash-only practice is a doctor that does not accept any insurance at all. Instead, they simply ask to be paid at the time of service, just like most other professionals such as a lawyer, a plumber, or a mechanic. In nearly all cases, because cash-only doctors don’t have the expensive overhead associated with having to bill and process insurance claims, they are able to charge much less than a conventional doctor’s office.

Some medical practices are what I call cash-friendly which means that while they do accept some insurance, they also cater to self-pay patients. The basic test I use to determine if a practice is cash-friendly is whether or not they can easily tell you how much something will cost, say a routine visit to the doctor or a test. If they can’t answer the question ‘how much will that cost,’ they aren’t cash-friendly.

Needless to say, for self-pay patients needing access to affordable primary care, finding a cash-only or cash-friendly doctor is a necessity. Below is a roundup of several I’ve recently found, if you’re a self-pay patient hopefully you live near one of these doctors. If not, I encourage you to look at the listings of cash-only and cash-friendly doctors at either the Association of American Physicians and Surgeons or SimpleCare.

Dr. Susan Wasson, Osakis, Minnesota

I recently had the pleasure of meeting a number of cash-only and cash-friendly doctors at an event sponsored by the Association of American Physicians and Surgeons (AAPS). One of them was Dr. Susan Wasson, who practices cash-only medicine in the rural community of Osakis, Minnesota, located in the central part of the state. Here’s how one local newspaper described her practice: Continue reading

Posted in Cash-Only Doctors | Tagged , , , | 4 Comments

Birth control & self-pay patients

Like a lot of people who regularly follow health care policy and news, I spent part of yesterday digesting the U.S. Supreme Court’s ruling in Burwell v. Hobby Lobby, the case that determined that closely-held companies can opt-out of including some or all forms of birth control in their employee health plans if there is a religious objection on the part of the company’s owners.

Plenty of ink and many an electron will be used over the next few days arguing why the Supreme Court was right or wrong in its ruling, and what it does or does not mean for women, employers, religious liberty, and (of course) the next few election cycles. As a rule I try to avoid using this blog to share my views on policy and politics, and I’ll stick to that rule here.

That said, the ruling does mean that some women who do want birth control will now be self-pay patients when it comes to obtaining it. And that falls very much within the subject matter of this blog. So while others share their joy or outrage over the decision, I’ll move past that to try to offer some useful information on how women shopping for birth control can get the best deal as self-pay patients.

A quick note – I’m going to just stick with birth control pills, since it seems like that’s about 99% of the issue involved here. There are other forms of birth control as well, ranging from pretty cheap (condoms) to fairly expensive (intrauterine devices), but to keep things simple and to focus on what most people seem to be concerned with, I’m just going to stick with birth control pills.

Another quick note – I’m not endorsing the use of birth control, or suggesting it is or isn’t morally appropriate for some to use or not use. I have my views on the topic, but I’ll keep that to myself and just stick with what this blog is about, which is explaining to self-pay patients how they can obtain the medical services they want or need.

The first (and pretty much only) thing for people to understand is that shopping for birth control pills as a self-pay patient is no different than shopping for any other sort of prescription medicine as a self-pay patient. If you can shop for Xanax or Cambia, you can shop for birth control pills. Continue reading

Posted in Prescription Drugs | Tagged , , , , , , , , , , , | 6 Comments