What is up with Dr's office not taking self pay patients?

[ChocolateReignRemix]

Is this only going to get worse?

 

Why do you believe this is a trend?

Why do you feel it could get worse?

[creekland]

I don't have any experience with a health share program, so I can't comment on that, but I agree with you on the ideas that we need to dump for-profit insurance and that health care is a right, not a privilege. This may be the first time we've ever agreed on something.  :cheers2:

 

You are right that the cost of insurance is a huge factor in the absolute price of healthcare. For us, going without insurance was never an option because one of our children has HIV, Hep B, chronic anemia, and depression, and another has asthma, needs speech/occupational/physical therapy, and has chronic ear issues/hearing loss. We consume far more health care than we pay for, but even we were in the position of my husband needing to switch jobs because the insurance had become so unaffordable to us. At one point our insurance cost $1800 a month, and that year we spent more than 50% of my husband's gross pay on health care expenses. It was insane. 

 

I don't think there's anyone on this board that I'd disagree with 100%.  At the very least, perhaps we could agree on liking broccoli? or steak? or seeing our kids do well?   ;)

 

Your expenses are insane... and no one should have to spend that much just because of health issues IMO. 

 

Our insurance method of doing things only profits insurance companies (CEOs, stockholders, etc) at the expense of both the people and the providers.  Why our country insists on keeping it is beyond me - except for the sneaky suspicion that many of the powers that be who are making the laws are likely also stockholders - AND they don't have to worry about their own healthcare expenses.  I wish they had to live in other shoes for a little bit.  Then they might start to "get it."

[Lisbeth]

Here's hoping for consierge medicine to take off! Shared wards at the hospital? MRSA and flu patients rooming with post op patients,with breathing issues? Yeah, no.

[Mama Geek]

Here's hoping for consierge medicine to take off! Shared wards at the hospital? MRSA and flu patients rooming with post op patients,with breathing issues? Yeah, no.

 

You have to be realistic, there are now going to be a whole lot more people without insurance.  ACA is a mess and private insurance is dropping people left and right.  I imagine the doctors that will take self pay will be busy.

[creekland]

You have to be realistic, there are now going to be a whole lot more people without insurance.  ACA is a mess and private insurance is dropping people left and right.  I imagine the doctors that will take self pay will be busy.

 

I know membership in our health share has been growing like crazy.  If there were more of those types of options fitting more people, I suspect insurance would soon come to an end - or be fairly rare - or improve.

[umsami]

Here's hoping for consierge medicine to take off! Shared wards at the hospital? MRSA and flu patients rooming with post op patients,with breathing issues? Yeah, no.

Do you have any idea what concierge medicine is? It's popular where I live.  You pay thousands of dollars per year, for the privilege of being seen in a timely manner.  The local concierge pediatrician wants $5000/year.  It does not mean that this fee is in exclusion of other regular charges…it's in addition to.  With an internist, it basically means that the physician coordinates your care with other specialists.  

 

As for MRSA and flu patients rooming with patients with breathing issues, that does not happen in countries who use wards… to even imply such a thing is an insult to medical and public health professionals in those countries, who by the way, have far healthier populations than our own.  Let's not forget that our healthcare system is 37th in the world, not number one.   Nor does it using it for some situations imply that it would be used for all.   Sigh.

[Murphy101]

I've paid thousands in addition to or prior to being able to use a dr or pay the dr fees too. Only difference is I paid them to an insurance company instead.

 

Maybe you missed it. Her reference to MRSA patients rooming in with post OP patients was a direct reference to someone describing the care her parents received in a Canadian hospital vs not having that experience in a Michigan hospital. So yes, it does happen at least once in Canada.

 

Tho I'm in complete agreement that is awful and not the way it should be anywhere.

[creekland]

Do you have any idea what concierge medicine is? It's popular where I live.  You pay thousands of dollars per year, for the privilege of being seen in a timely manner.  The local concierge pediatrician wants $5000/year.  It does not mean that this fee is in exclusion of other regular charges…it's in addition to.  With an internist, it basically means that the physician coordinates your care with other specialists.  

 

As for MRSA and flu patients rooming with patients with breathing issues, that does not happen in countries who use wards… to even imply such a thing is an insult to medical and public health professionals in those countries, who by the way, have far healthier populations than our own.  Let's not forget that our healthcare system is 37th in the world, not number one.   Nor does it using it for some situations imply that it would be used for all.   Sigh.

 

If we opted to go with insurance, based upon an ACA calculator, we'd be paying $9480/year even if we use absolutely nothing.  Then we'd have to go with certain providers and pay 30% OOP on most things until we reached $12,700/year (in addition to the $9480 above).  This year we'd have maxed it out.

 

With our health share (non-profit) we pay $4840/year even if we use absolutely nothing.  Then every covered expense (granted, some aren't) over $300 is covered at 100%.

 

The latter is not insurance and doesn't work for everyone because these groups are still fairly exclusionary (fits us, but not all).  If more groups were to form, I really do think it would be a better system for the country.

 

I do NOT encourage anyone to go without something.  Big ticket items do happen.  I work in our local public school and I see them occur with both students and teachers - essentially all ages.  It's a lottery that can easily bankrupt or severely disrupt a family's finances and who needs that stress on top of whatever the illness/accident is!  One can say there's always charity, and to some extent that's true, but that doesn't help our overall health care system and rarely is ideal.  It should be rarely used.

 

With regards to the US being #37 - is that for actual healthcare that is provided by doctors and hospitals (what is actually done in their care)?  If so, that would surprise me considering all I've heard from both domestic and international acquaintances (some of whom are in the medical field).  My guess is the ranking is the overall deal - including the fiasco caused by the expense and "rules" of insurance.

 

I guess, putting it in other words, if someone were wealthy and choosing literally any hospital/doctor in the world, would they tend to choose those in the US or elsewhere?  Would we be #37 on that list?  I doubt it.

 

[Mama Geek]

Medical tourism is happening for those without insurance and who can afford to go out of country for treatment.  We have friends that are in the know enough that if something serious happened to one of us that would be a real option.  Dh said just the other day he came across an article with a website that you can actually get bids from all over the world for medical procedures.  I had never even thought that something like that was out there but it is an interesting idea.

[creekland]

Medical tourism is happening for those without insurance and who can afford to go out of country for treatment.  We have friends that are in the know enough that if something serious happened to one of us that would be a real option.  Dh said just the other day he came across an article with a website that you can actually get bids from all over the world for medical procedures.  I had never even thought that something like that was out there but it is an interesting idea.

 

This is what we'd be doing if we had no coverage... and I expect to see the world with some of the basic follow up things I'll be needing in the future - not due to lack of coverage, but due to my love of travel.

 

I did seriously consider it for my "main deal" now, but in the end, opted for the well-known instead since it's a pretty major thing and relatives in the field severely cautioned against it (for my stuff).  There would have been no difference in cost to us (travel expenses would have been reimbursed).  Had it been more minor or we had to pay for it all ourselves... it'd still be on the table for consideration.

 

[umsami]

The #37 is by the WHO. http://www.who.int/whr/2000/media_centre/press_release/en/

 

And yes, you have to take into account the entire system.  If the system only works for the rich, or those who are employed, that's an issue.  My husband sees people who lose their sight permanently, because they couldn't afford to keep their diabetes in-check, or see an endocrinologist, or an ophthalmologist until it was too late.  It's not an easy conversation to have with a person that they will never ever regain sight in that eye..or both eyes.  Plus, by the time one's vision is affected, it usually means they have kidney issues and other issues as well.  

 

And as many of you mention, even with health insurance, out of pocket costs are so extreme that it impairs care.  We need universal health coverage…covered by a VAT, payroll tax, or something similar.  Let the private insurance companies offer additional plans, kind of like the Medigap plans, but while the ACA is better than what we had (in it covers birth control, preventative care, nixes pre-existing conditions, got rid of limits on coverage, limits the amount of liability, and allowed young people to stay on their parent's plans)…..it's still not where it needs to be.

 

We suck with regards to premature births as well.  We lead the developed world, which is not someplace you want to be.  That would also take into account that even poor pregnant Moms are usually eligible for Medicaid.  http://www.newsweek.com/us-leads-industrialized-world-premature-births-2917

 

The US is a great place for care to be if you have money or great insurance.  Absolutely.  But for covering its entire population…and providing good preventative care…it's not.   Some of the drugs my husband injects monthly into a patient's eye run $2000/injection.  The same drug is sold under a different name for $50.  There have been a few studies that show equivalency in effectiveness.  Yet, technically, he's not supposed to use the cheaper drug because it isn't packaged for individual injections.  That's insane.   

 

Our medical system needs major overhaul… but it's never going to happen.  Too many lobbyists. 

[creekland]

 If the system only works for the rich, or those who are employed, that's an issue.

 

...

 

Our medical system needs major overhaul… but it's never going to happen.  Too many lobbyists. 

 

:iagree:   I'd like to see our terrific healthcare available to all who need it rather than see care lowered.  And I agree that only a major overhaul of some sort would actually do it, but the likelihood of that happening is poor due to the lobbyists.

 

In the meantime, if people could pull together and copy things that are working (like health share groups) even improving on them with experience, it would help some folks here and now rather than simply giving up and saying nothing can be done.

 

(I'll even agree that the premise of ACA is better than what we had, but I'll also admit to breathing a sigh of relief when health share groups were granted a legal exemption as I, personally, was not going to be happy with having to "trade down" for more money.  There is NOTHING that will ever make me want to hop on the "insurance" bandwagon again.  Too many $$ heading to all the wrong people.)

 

[Aelwydd]

Why do you believe this is a trend?

Why do you feel it could get worse?

I feel it's only going to get worse because 1), we can't seem to to separate our ideations of for-profit capitalism from basic survivalism, thereby creating a system at large that thrives off a sick and dying population; 2), we put faith in the free market system like it's a magic talisman that can save us from the hyenas that basically feed off all of us: conglomerate medical groups, pharmaceuticals, insurance companies, medical supply, and even certain food industries; 3) unrealistic expectations of the ability of a government crippled by its unholy marriage to the financial industry to correctly gage its first duty to its citizens and successfully implement truly universal healthcare; and 4), citizens ability to correctly identify the aforementioned culprits and step outside of a delineated political landscape long enough to work together against Big Goviness (government + business) and realize neither political party is capable of saving us.

 

Until we change the above, we will only continue to decline.

[Carrie-txmama2six]

 

 

We've also noticed that the doctors are billing faster, and requiring payment sooner. Twice in the last week, we were told to pay our balance or future appointments would be cancelled, whether we had received the bill yet or not.

 

Sigh.

This is probsbly due to electronic billing. The claims are now paid in about two weeks when they used to take a acouple of months.

[NASDAQ]

One does have to get a laugh out of some of those questions...

 

"What's your sexual orientation?  Are you sexually active?"

 

My first instinct was to respond, "You have my chart, you see that I'm married with three biological kids.  GUESS!"  

Ooooh, I can't miss an opportunity to share my very favourite medical history question.

 

At the hospital with my infant daughter: "are you and the baby's father related in any way other than by marriage?"

[Jean in Newcastle]

Ooooh, I can't miss an opportunity to share my very favourite medical history question.

 

At the hospital with my infant daughter: "are you and the baby's father related in any way other than by marriage?"

But some people could answer "yes"  and I don't mean incest but cousins and other familial relationships.  

[Excelsior! Academy]

DH is a physician and he always offers the Medicare rates to self-pay patients.  If your doctor doesn't and you're self-pay, ask.  

 

(Not all will… back when I was pregnant with DS3, we didn't have health insurance. Nobody would see me and I was high risk.  High Risk OB wanted $2000 cash per appointment.  Normal OB wanted a check for $5k before they'd see me.  Luckily, my normal endocrinologist told me he'd work with me via email to manage my gestational diabetes.  I also found a direct-entry midwife who was willing to take me for prenatal care.)

 

As for wards vs. private rooms… that used to be the norm in the US…but things started to change in the late 70s/early 80s.  It's far more economical to care for multiple patients in a ward, vs. having private rooms.  I'd take wards vs. private rooms any day with national health insurance vs. having to worry about co-pays, co-insurance, bankruptcy, pre-existing conditions (thankfully no longer an issue), etc.

 

 

I would not want a ward style and I don't think it has to be either that or the POC system we have.

 

If for no other reason than I can't comprehend how any aspect of HIPPA can be followed with a stranger/another patient 3 feet away. Several times during my stay quite a bit of private information was being discussed. My address, ssn, sexual activity, abuse (they always ask those questions. Is your husband abusing you? Are you sexually active/could you be pregnant?)

 

 

Ah but that is completely luck of the draw. And recovery is not the same as a hospital room. Recovery is usually a very brief time, less than 2 hours. Most recovery rooms are curtain divided ward style here. You aren't spending a week there.

 

I am not sure how it is now, but when my oldest dd was born ('97) I had to share a room for recovery.  Because of this they limited visiting hours for the dads, and would take the babies to the nursery.  There was no other option.  I did not care for it one bit for the reasons listed and a whole lot more. 

 

[LizzyBee]

This drives me batty and is exactly why I hate when people get all excited about the "consumer driven health plans" (AKA health savings accounts paired with insanely high deductible plans that don't cover pretty much anything).  There is no such thing in my experience.

 

I have an HSA with a high deductible plan, and it's the best insurance I've ever had.  Our family deductible is $7k, then the insurance company pays 100%.  We meet the deductible in the first month because of the cost of my medicine, then we know everything is covered the rest of the year.  That first month is stressful, but at least we have a year to save up. I get the money deducted from my paycheck, so it's pre-tax and it goes straight into the HSA so I'm not tempted to spend the money elsewhere.  Chances are that if we had an 80/20 plan, we'd pay much more than $7k/year.  OTOH, if I had a $7k deductible and then 80/20 after that, I wouldn't be happy with that plan! 

[NASDAQ]

But some people could answer "yes"  and I don't mean incest but cousins and other familial relationships.  

 

Yes, some people could say yes. And apparently some people do say yes. But It's still  double take of a question, especially since it takes one a minute to parse it out.

[Haiku]

Ooooh, I can't miss an opportunity to share my very favourite medical history question.

 

At the hospital with my infant daughter: "are you and the baby's father related in any way other than by marriage?"

 

Two of my kids are black, and I am white. When I was at a new doctor with my son, who was about 5 at the time, and had my oldest with me, who was about 13 at the time, the nurse came into the room, looked at us, and said, "Now, which one of you is the mom?"

[creekland]

Two of my kids are black, and I am white. When I was at a new doctor with my son, who was about 5 at the time, and had my oldest with me, who was about 13 at the time, the nurse came into the room, looked at us, and said, "Now, which one of you is the mom?"

 

Ok... I was about to mention that we've had 13 year olds with babies at school (rare, but happens), but then I re-read and saw your son was 5... so... :svengo:

 

Did your daughter happen to look older than her age - just for the benefit of the doubt?

 

[Haiku]

Ok... I was about to mention that we've had 13 year olds with babies at school (rare, but happens), but then I re-read and saw your son was 5... so... :svengo:

 

Did your daughter happen to look older than her age - just for the benefit of the doubt?

 

 

No, at the time she actually looked younger than her age. She'd been adopted only about a year prior, and she still had a very little-girl hairdo and wore no make-up.

[G5052]

 

And as many of you mention, even with health insurance, out of pocket costs are so extreme that it impairs care. 

 

This is why I've always worked and homeschooled. The out-of-pocket would have sent us down the tubes long, long ago, or we would have had to stop treatment. At times we've considered that, believe me. And then I get a lot of flack for that in our conservative circles, but healthy, whole people truly have no idea how the bills can mount up. We finally got word yesterday that a very large bill is thankfully going to be mostly covered, but we still owe thousands. Thankfully the day before that, a former boss contacted me, letting me know that her major grant was renewed, and that she wants to contract with me for more work in 2014. So it works out for us in the end, but it isn't easy. And not every family has a secondary income-earner who can bridge the gap. 

[Murphy101]

I am not sure how it is now, but when my oldest dd was born ('97) I had to share a room for recovery.  Because of this they limited visiting hours for the dads, and would take the babies to the nursery.  There was no other option.  I did not care for it one bit for the reasons listed and a whole lot more.

 

My kids were born in 95, 96, 98, 99, 01, 02, 04, 06, 09 (home), and 11.

 

I've never shared a room for any part of any of the deliveries or the maternity stay afterwards. My husband stayed the entire time and overnight with all except 1 of them.

 

But care can vary WIDELY in different places, even in the same hospital sometimes.