Why not change to laws to require all doctors to accept ACA+what they charge?

[ludin]

Not exactly.



Cash is wonderful if the private sector is ready to pay for the training of its own professionals.

again you don't understand what I am talking about I have attempted to explain it but you don't seem interested.
a cash system has nothing to do with training doctors.

a cash system takes insurance companies which end up costing you 60-80% more for your medical care.

I already posted the link that shows the break down so calling it wrong is not correct. it is very correct.
posted by an established news organization.

not going to get into a tit for tat I posted the info from a reliable source. that is all I need to do.
it is not wrong it is correct.

you still have yet to address the reason that a full cash medical system which I have posted at least 3 links showing that it is cheaper than insurance is bad.
in fact you called it a utopia which I clearly disproved.

 

[VanceMack]

it seems that you are a doctor or in the medical field. is it not cheaper for you to operate in a cash system instead of having to deal with government agencies and insurance companies. about how much off the top of your head does it cost you to file and administer all of the paper work just to get paid?

from what I have heard and seen it is about 60-80%.

I'm in the clinical (psychological) field. Administrative costs are greater for medical providers...but personally I cant see a large volume of providers of any type surviving in a cash only setting. I know providers that collect co-pays and hire private contractors to bill insurance companies and pay them percentages rather than salaries. I suppose with a large enough cash pay client base you could be profitable.

For us...its not the cost of filing so much as it is the carrying costs. Insurance companies pay...you just have to know the routine. A lot of times it is about PR as much as it is anything else. Can you call and talk to someone on the other end of the line and create a relationship where they are invested in helping you. Really...a good office administrator that knows the game is worth their weight in gold.

 

[sangha]

This is not correct. the residency program is about 12 million per year. of that medicare only pay 3m. not even the majority of the program.
the rest of the program is paid by clinical revenue, grants and other support.

How residency programs are funded | UTSanDiego.com

you act like it pays it all and it doesn't. you then act like people are wrong and they are not. while I was not correct in that it had nothing to do with it isn't the huge amount that you think it is.
in fact it only covers about 1/4 of the program. other money covers the other 3/4ths.

yet this still doesn't address any of the points that I made so please continue to ignore how cash is a better cheaper more affordable payment of healthcare than insurance.

The article is short on math. It says it costs $12 billion to train residents, and that $6.5 billion comes from Medicare. 6.5 is clearly more than 50% of 12.

And the article mentions three sources of funds for the training of residents. The first two come from Medicare (note how both mention the 1996 caps, which were caps on the Medicare program). The last one makes up a very small portion of the total ($250 million out of $12 billion, which is about 2% of the total)

So you do have a point - not *all* of the money to train residents comes from Medicare.....just 98% of it

 

[ludin]

I'm in the clinical (psychological) field. Administrative costs are greater for medical providers...but personally I cant see a large volume of providers of any type surviving in a cash only setting. I know providers that collect co-pays and hire private contractors to bill insurance companies and pay them percentages rather than salaries. I suppose with a large enough cash pay client base you could be profitable.

For us...its not the cost of filing so much as it is the carrying costs. Insurance companies pay...you just have to know the routine. A lot of times it is about PR as much as it is anything else. Can you call and talk to someone on the other end of the line and create a relationship where they are invested in helping you. Really...a good office administrator that knows the game is worth their weight in gold.

There are a few doctors out there that are switching to a direct pay subscription type system.

They basically charge a flat monthly fee and offer full services with discounts to other services like labs.
so for an average adult they would charge 50 dollars a month. no co-pays or other fee's. if you need labs like blood work. insurance charges around 90. doctors are getting a cash price of 15 dollars.

Right you have to carry the cost then you have to pay the staff to keep on top of what has been paid and not paid. that is why doctors that are offering direct pay have lowered their costs by 60-80% as they don't have to pay people to fill out insurance billing or re-billing or anything else.

 

[sangha]

There are a few doctors out there that are switching to a direct pay subscription type system.

They basically charge a flat monthly fee and offer full services with discounts to other services like labs.
so for an average adult they would charge 50 dollars a month. no co-pays or other fee's. if you need labs like blood work. insurance charges around 90. doctors are getting a cash price of 15 dollars.

Right you have to carry the cost then you have to pay the staff to keep on top of what has been paid and not paid. that is why doctors that are offering direct pay have lowered their costs by 60-80% as they don't have to pay people to fill out insurance billing or re-billing or anything else.

Concierge care generally does not cover everything. It is not "full service". They only cover the procedures they are able to perform.

So if you're healthy and you want your check-ups, diagnostic tests, and basic outpatient procedures covered, concierge care will cover it. But if one of those diagnostic tests uncovers cancer, you're not covered for that unless you happen to have subscribed to a concierge medical provider that happens to also be a cancer center.

 

[Samhain]

Concierge care generally does not cover everything. It is not "full service". They only cover the procedures they are able to perform.

So if you're healthy and you want your check-ups, diagnostic tests, and basic outpatient procedures covered, concierge care will cover it. But if one of those diagnostic tests uncovers cancer, you're not covered for that unless you happen to have subscribed to a concierge medical provider that happens to also be a cancer center.

Sounds the correct solution would be to blend concierge care & catastrophic insurance, rather than an insurance covers everything model.

 

[sangha]

Sounds the correct solution would be to blend concierge care & catastrophic insurance, rather than an insurance covers everything model.

ACA allows people to bundle concierge care with a wraparound catastrophic policy.

Pros and Cons of Concierge Medicine - WSJ.com

Also fueling the trend is a little-known clause tucked into the health-care law that allows direct primary-care to count as ACA-compliant insurance, as long as it is bundled with a "wraparound" catastrophic medical policy to cover emergencies.

 

[ludin]

Sounds the correct solution would be to blend concierge care & catastrophic insurance, rather than an insurance covers everything model.

call your local hospital. say you have cash and are checking on the price of a CT scan is if you pay in cash no insurance. if you mention insurance they will have to quote you the insurance rate.

on average depending on the hospital it is around 200-400 dollars for a CT scan. if you use insurance the price is 2k-4k.

there is no down side only an upside and people save a ton of money. hospitals and doctors improve care and costs go down.

 

[sangha]

call your local hospital. say you have cash and are checking on the price of a CT scan is if you pay in cash no insurance. if you mention insurance they will have to quote you the insurance rate.

on average depending on the hospital it is around 200-400 dollars for a CT scan. if you use insurance the price is 2k-4k.

there is no down side only an upside and people save a ton of money. hospitals and doctors improve care and costs go down.

Hospitals charge people with no insurance more than they charge people with insurance

Hospitals: Is the Price Right? - CBS News

Promise Of Price Cut On Hospital Bills For Uninsured Under ‘Obamacare’ In Limbo « CBS DC

 

[wbcoleman]

My observation is that the right obsessively criticizes any program that helps poor people because it rewards bad behavior and promotes dependency on govt

Why should YOU support schemes which reward bad behavior and promote dependency on government? Wouldn't you agree that a welfare program which avoids or, at least, minimizes bad incentives is preferable to those which don't?

 

[wbcoleman]

washunut, take a look at the first quote in this post, and then tell me again that I've mistated the right's opposition to the govt providing health care to the poor.

There isn't a huge constituency on the right for abolishing safety net spending. Cutting it back, sure, but that's where the disincentive concerns emerge.

 

[wbcoleman]

There is a difference between a doctor and a resident. a resident cannot legally treat someone. only a doctor can do that. a resident is required to run all of their diagnosis through the doctor first and the doctor has to order the treatment.

without the government supplementing the residency program or even paying for it there would be no doctors for the future because the hospital isn't going to employ someone that doesn't make it money.

doctors are people that have completed the needed residency program and passed.
so we don't have a single payer system.

The residency program isn't the issue, and real doctors aren't going to work for peanuts. that is why the worlds best doctors come here to the US because in their own country they only make so much money and that is it regardless if they see 1 patient or 100.

Residents are doctors and they are able to obtain individual licenses to practice while residents. In general, they cannot obtain board certification until they complete residency.

 

[sangha]

My sense is that your last statement is incorrect. To question ACA is not to question whether or not the poor should get insurance, rather what is the best way to do it.

Hey, washunut - It looks like we've got another poster who believes what you say no one believes:

Why should YOU support schemes which reward bad behavior and promote dependency on government? Wouldn't you agree that a welfare program which avoids or, at least, minimizes bad incentives is preferable to those which don't?

 

[ludin]

Residents are doctors and they are able to obtain individual licenses to practice while residents. In general, they cannot obtain board certification until they complete residency.

I know this but a cash system has nothing to do with residence or how they are trained. it isn't that confusing. i don't understand why people keep harping on resident training it has nothing to do with what we are talking about.

 

[sangha]

I know this but a cash system has nothing to do with residence or how they are trained. it isn't that confusing. i don't understand why people keep harping on resident training it has nothing to do with what we are talking about.

Before this year, anyone could have refused to purchase insurance and paid cash, but the overwhelming majority chose not to take your advice. Do you know why?

Because your advice sucks!

Even now, after the individual mandate has kicked in, people are allowed to subscribe to a concierge provider (as long as they also buy catastrophic insurance too) and they're not doing that either. Do you know why?

Because they know that the cash system you promote sucks!

 

[274ina]

we do regulate, with Gov force what people charge for services.

They are called Police, FBI, Firemen, Librarian, prosecutors, etc.

No "fee for service" allowed. They get salary and thats it.

Time for Dr's to join them.

 

[Samhain]

Before this year, anyone could have refused to purchase insurance and paid cash, but the overwhelming majority chose not to take your advice. Do you know why?

Because your advice sucks!

Even now, after the individual mandate has kicked in, people are allowed to subscribe to a concierge provider (as long as they also buy catastrophic insurance too) and they're not doing that either. Do you know why?

Because they know that the cash system you promote sucks!

Cash-only family practices have tripled in the last 6 years. Clearly somebody is doing it.

 

[sangha]

Cash-only family practices have tripled in the last 6 years. Clearly somebody is doing it.

When something comprises such a small portion of the market, it doesn't take much to show a large percentage growth.

For example, the Duggar family has grown quite a bit in the last 6 years also, but they're still a very, very, small portion of the population.

 

[Samhain]

When something comprises such a small portion of the market, it doesn't take much to show a large percentage growth.

For example, the Duggar family has grown quite a bit in the last 6 years also, but they're still a very, very, small portion of the population.

For sure. I think they represent 8-9% of family practices. It will be interesting to see if the growth continues or tapers off.

 

[fedupwithgov]

Normally I would not believe in government pricing BUT we have a problem in emergency room treatment. In the past year, my wife and I both had emergency room treatment and the charges were as expected except for two doctors who refused to take the payment offered by the insurance company. The hospital accepted the payments. But these two doctors want c. $800 for 5 minutes or so of apparent work and refused to take the $400 or so offered and turned things over to their collection agency. When you are in an emergency, you can't check on the doctor's membership in a plan or whatever-you take what you can get. If the hospital accepts the plans pay, one would think that any doctor with attending permission would as well. There is no recourse to the bill. I guess that next time I will refuse a doctor if he/she won't agree to my plans coverage. Non emergency situations are different.

Again, want to say I have many many years of health care administration experience and my husband is a physician/surgeon. So, regarding these two doctors, if you insurance approved $400.00 as the allowed/covered charge), they probably paid only X % of the charge, say 80-90% based on your contract/policy and you would owe the remaining 20-10%
If these physicians are providers on your policy that is all you owe. If not, pay them the 20% or 10% and tell them to "go fish". You are right, if these emergency physicians didn't accept your insurance, you should have been notified prior to them treating you, and, I guarantee you that the norm is that emergency room physicians should accept insurance as the hospital does. That is normally how it works. I would pay them your copay and then make sure you dispute the charges claimed by the collection company. If you need help please let me know. I will help you.

 

[sneakosview]

I don't think that position is PC.

 

[leoborn]

You got that right. The Government would be fixing prices, something private companies are legally not allowed to do!

Good point!

 

[sneakosview]

I think you are confused. You have a lot better chance that a huge government denying coverage as a function of socially managing their public to suit their own idea of good public policy. If its felt that this would reel in the wealthy then that's delusional..

 

[fedupwithgov]

Thank You for your post. Seems you understood my point.

 

[fedupwithgov]

Normally I would not believe in government pricing BUT we have a problem in emergency room treatment. In the past year, my wife and I both had emergency room treatment and the charges were as expected except for two doctors who refused to take the payment offered by the insurance company. The hospital accepted the payments. But these two doctors want c. $800 for 5 minutes or so of apparent work and refused to take the $400 or so offered and turned things over to their collection agency. When you are in an emergency, you can't check on the doctor's membership in a plan or whatever-you take what you can get. If the hospital accepts the plans pay, one would think that any doctor with attending permission would as well. There is no recourse to the bill. I guess that next time I will refuse a doctor if he/she won't agree to my plans coverage. Non emergency situations are different.

My husband is a doctor(not emergency room physician) and I have worked for over 38 years in health care admin. and I totally agree with you regarding ER care. You are correct that most hospitals will work with you regarding their charges but when it comes ER physicians, Radiologists, and the like who are not employees of the Hospital you have no idea what the fees will be. That is unacceptable in my opinion. So should you ask every individual that attempt to give you some form of treatment what their fee will be? That is ridiculous in my opinion. So here is my position based on my experience. The Hospital will always work with you and provide a reasonable monthly payment and if the physicians that send you a separate bill refuse to, just send them $10.00 a month to show your good faith and if you believe they have charged you too much for their service, indicate so in writing with you first $10.00 payment. And, know this, I have not seen many courts that rule against a patient(debtor) that is sending a payment, no matter what amount, monthly. And, most physicians will not file a lawsuit. They may send you to collection. If they do, respond to the Collection Notice, in writing within 30 days of receipt and advise you cannot afford the amount charged and you were not informed of the charge prior to the care being given. This is probably true. However, if you were informed of the charge and signed an agreement to pay then you advise them that based on your income you can only pay X a month. This should suffice to offset a court action.