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(Bangor Daily News)   Maine doctor stops taking all forms of insurance and drops his prices as much as 50%. "If more doctors were able to do this, that would be real health care reform," he said. "That's when we'd see the cost of medicine truly go down"   (bangordailynews.com) divider line 186
    More: Obvious, Maine, healthcare reform, nurse practitioner  
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10644 clicks; posted to Main » on 28 May 2013 at 10:32 AM (46 weeks ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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2013-05-28 05:47:47 AM
Indeed, a significant portion of a PCP's services (and his costs) is handling insurance companies on behalf of patients.  Perhaps some geek will make that function as superfluous as travel agents or H&R Block.

DIY insurance claims can't be any scarier than doing your own taxes, can it?   Yeah, I know, most people do taxes just once a year. But still...
 
2013-05-28 06:31:44 AM
He's a GP. The vast majority of large medical expenses are for specialists, surgical or diagnostic procedures, and prescriptions. So his patients would still have to carry insurance.
 
2013-05-28 06:56:45 AM
Most docs n dentists will do this if you ask. They like cash and like cutting office costs as much as anyone.
 
2013-05-28 07:12:57 AM
If I have insurance, I won't visit a doctor who doesn't accept it.  Nice going on cutting charges by 50%, but the problem isn't insurance companies.  It's hospitals.
 
2013-05-28 07:22:32 AM
I will have to do some digging but I think this practice is illegal under Obamacare.
 
2013-05-28 07:40:58 AM
Cutting out bureaucracy to reduce the cost of health care? The devil you say!
 
vpb [TotalFark]
2013-05-28 08:20:52 AM
No surprise.  Doctors jack up prices so they can offer the discounts that insurance companies demand.

I suspect he is just charging the public what he would charge the insurance companies.
 
2013-05-28 08:37:23 AM

vpb: No surprise.  Doctors jack up prices so they can offer the discounts that insurance companies demand.

I suspect he is just charging the public what he would charge the insurance companies.


Actually, he can charge the insurance company whatever he wants. He can write $5,000 to pull a splinter out, but depending on the code he uses the reimbursement is already set. I think you meant to say he's charging the public what the insurance company reimburses.
 
2013-05-28 09:34:41 AM
What a Maine doctor may look like:

www.tabletmag.com
 
2013-05-28 09:48:27 AM

BarkingUnicorn: Indeed, a significant portion of a PCP's services (and his costs) is handling insurance companies on behalf of patients.  Perhaps some geek will make that function as superfluous as travel agents or H&R Block.

DIY insurance claims can't be any scarier than doing your own taxes, can it?   Yeah, I know, most people do taxes just once a year. But still...


The problem is each insurance company has their own forms and their own codes and there are thousands of companies. If the government mandated they all use the same forms and codes it would help but that will never happen because of "My god, socialism!".
 
2013-05-28 09:54:21 AM
A GP who works in family practice can get away with this.

The next time you need 5 MRIs, a CT scan, and a couple of EKGs, prior to seeing your neurologist in consult with your neurosurgeon and a radiologist to decide if you should have laser scalpel radiation therapy or just have a good old fashioned craniotomy, allow me to assure you: this. won't. work.
 
2013-05-28 10:04:28 AM
If any doctor could actually tell you the cost of a procedure up front it would be a miracle.  They don't even know what a regular check-up is charged at.  Hell, it might be different amounts depending on which insurance is being billed.  The whole thing is a scam!!!

Except my doctor.  He's cool.  Like my senator is awesome, but Congress is evil.
 
2013-05-28 10:12:06 AM
Is there anything stopping doctors from doing this? Pretty sure they can. And yes, medicine can be cheap if you have no problems. Let's see how well this system works if you find out you need surgery.
 
2013-05-28 10:20:13 AM
here's one way to get around it:

get a high deductible insurance plan with an HSA.  Put the money saved on health insurance premiums in the HSA.  Make sure the high deductible plan covers everything or almost everything over a certain amount (say over $2500 or $5000) in the rare event you have some very expensive malady.  Go to doctors like this for regular checkups and pay for it from money in your HSA.  Use the high-deductible plan if you need a surgery or get cancer or something.

I have over $5000 sitting in my HSA investment account right now.
 
2013-05-28 10:29:32 AM

SlothB77: I have over $5000 sitting in my HSA investment account right now.


Good for you. And for disciplined folks like yourself, that's a workable solution.

But for a vast an diverse and increasingly economically and socially unequal population of 310,000,000, that's an unworkable solution. Especially when large numbers of people are living paycheck to paycheck, rents are off the charts, and even people with degrees are having a biatch of a time finding a job that pays more than minimum wage. Asking them to save $5000 in the face of so many other immediate financial demands is simply unrealistic.
 
2013-05-28 10:34:15 AM
so a doctors visit and some blood work is now only like 800 bucks? poor people must be lining up out the door on the account it's so cheap.
 
2013-05-28 10:35:30 AM
So he's admitting he's been overcharging his patients and the insurance companies?

Well, at least he decided to start being honest.
 
2013-05-28 10:37:13 AM
This is a great idea. Now, everyone go out and get yourself a job that pays enough to allow you to save a lot of money (I think they hand those out down at the unemployment office) and put it in a health savings account, and whatever you do, do NOT get critically sick or injured until you've saved up for it for a decade or two. Problem solved!

If you fail to follow these instructions, please go die in the gutter and decrease the surplus population. Thanks!
 
2013-05-28 10:38:19 AM

midigod: So he's admitting he's been overcharging his patients and the insurance companies?

Well, at least he decided to start being honest.


What do you mean "overcharging"? It's a market. He's charging what the market will bear.
 
2013-05-28 10:39:10 AM

midigod: So he's admitting he's been overcharging his patients and the insurance companies?

Well, at least he decided to start being honest.


No, he's admitting that a significant part of his office staffing costs was dealing with insurance BS.  SInce he's not doing that anymore he doesn't have to pay for office staff.
 
2013-05-28 10:39:10 AM
I know a few docs who do this and have for years. Works out well for all involved. One of them even has a 'free' day each week.

Insurance craziness is also another reason why good docs are setting up international 'vacation' clinics for major surgical and dental. Works well if you have the funds or can finance. Obviously it's still expensive, but when contemplating 300k worth of procedures and inpatient stays, 50k financed like a car sounds downright reasonable.
 
2013-05-28 10:39:39 AM
Since he no longer takes any government programs, that means he doesn't have to worry about serving poor old or poor disabled people.
 
2013-05-28 10:39:58 AM
As long as he'll take chickens, pigs, zuccini, "services" etc as payment, I think we're good.
 
2013-05-28 10:40:45 AM
You know what else would save time and money in dealing with medical insurance? Single-payer.
 
2013-05-28 10:41:56 AM

Dejah: If I have insurance, I won't visit a doctor who doesn't accept it.  Nice going on cutting charges by 50%, but the problem isn't insurance companies.  It's hospitals.


Insurance companies are no small part of the problem. They add a lot of overhead with stupid shiat but also force stupid pricing. If you've ever looked over the stuff they send you, you'll see something like "Visit cost: $200 Negotiated Discount: $90." What they are saying is your doctor charged them $200, but they only paid out $90. Now clearly, if what you had done cost $200, that wouldn't be sustainable. What goes on is doctors have to inflate their prices to get the insurance companies to pay what they actually need. The problem is that the doctors then have to charge the full amount to cash patients. If they don't, the insurance companies will come after them and pay them even less.

This then creates a nasty feedback loop for those without insurance: The rates on things, particularly hospital visits, are too high to pay. So they skip on the bills. The practices can't just do work for free, so that cost gets rolled in to the cost everyone else pays, which further ups the price, makes less people able to pay, and so on.
 
2013-05-28 10:42:19 AM

flucto: I will have to do some digging but I think this practice is illegal under Obamacare.


Let us know what you find out. I for one would be *shocked* (no sarcasm) if that is true.

Obamacare is focused on reducing costs by regulating the health insurance industry, not regulating doctors.
 
2013-05-28 10:42:40 AM

Lord Dimwit: You know what else would save time and money in dealing with medical insurance? Single-payer.


I agree with you.  But, your name with that comment could draw some interesting results.
 
2013-05-28 10:42:49 AM
My old doctor did this. She charged a flat fee of $100 for each visit, but she would take as long as necessary with each patient to deal with whatever they needed taken care of. Follow up visits, if within a week or so, she waived the fee. Lab work was still processed through insurance though since it was just her and her receptionist (who doubled as the 'take your BP and temp' nurse). She's the one that detected my prostate cancer before it spread, and if it wasn't that she practices 20+ miles from my house I'd still keep her as my GP.
 
2013-05-28 10:48:36 AM

midigod: So he's admitting he's been overcharging his patients and the insurance companies?

Well, at least he decided to start being honest.


Charges are set by the insurance companies. They have a rate they pay, and a rate they go against (the "normal" charge) that they set contractually with their clients (the providers). That way, when you see your statement, you see completely fictitious numbers showing how much money you "saved" versus what the "actual cost" would have been.
 
2013-05-28 10:49:13 AM

Nonrepeating Rotating Binary: As long as he'll take chickens, pigs, zuccini, "services" etc as payment, I think we're good.


My maternal grandfather who was a country doctor accepted chickens, cows and produce for payment. We have his old handwritten receipts.

My other grandfather was also a GP and until he retired in 1987, charged $5 for an office visit. He would rant about how insurance was ruining the system back then.

We usually pay cash day-of for office visits for doctors and dentists aside from the yearly/semiannual checkups insurance covers. It's cheaper and easier for everyone involved. The insurance is for hospitals and expensive tests.
 
2013-05-28 10:49:28 AM

Zasteva: flucto: I will have to do some digging but I think this practice is illegal under Obamacare.

Let us know what you find out. I for one would be *shocked* (no sarcasm) if that is true.

Obamacare is focused on reducing costs by regulating the health insurance industry, not regulating doctors.


Truly? I could've sworn that programs like PQRI, ACO and PCMH were all designed to regulate provider care by constraining reimbursement to community outcome norms.
 
2013-05-28 10:49:45 AM
He's gonna be glad he missed out on the Macaw Codes
And the attacking turtle codes
And shake his head in wonder at the burning water ski codes

Missing Out On The Fun

SFW unless you're employed by the DNC
 
2013-05-28 10:50:20 AM
There is an older family doctor that I know of in my city that refuses to do paperwork for insurance. You simply pay a $1,500 annual payment, and all visits, procedures and expenses for his office for the entire family are covered for the year. He has more business than he knows what to do with and has been doing this for decades. He says this program covers his main expenses and he has already made most of his money in his career earlier, so he is not too concerned about the rising costs to do business. He no longer takes new patients, so I think he will probably be retiring soon.
 
2013-05-28 10:54:06 AM
If more doctors would do this, we wouldn't need healthcare reform.
 
2013-05-28 10:56:11 AM
Only dropped his prices %50?  Wow, he took one look at that %350 insurance mark-up and said, "I'm keeping me some of that"
 
2013-05-28 10:59:49 AM

Zasteva: flucto: I will have to do some digging but I think this practice is illegal under Obamacare.

Let us know what you find out. I for one would be *shocked* (no sarcasm) if that is true.

Obamacare is focused on reducing costs by regulating the health insurance industry, not regulating doctors.


This. Doctors do NOT have to accept insurance. Many won't accept medicaid or medicare. A lot of doctors do what this one is doing and have been for years.
 
2013-05-28 11:01:17 AM

Bendal: My old doctor did this. She charged a flat fee of $100 for each visit, but she would take as long as necessary with each patient to deal with whatever they needed taken care of. Follow up visits, if within a week or so, she waived the fee. Lab work was still processed through insurance though since it was just her and her receptionist (who doubled as the 'take your BP and temp' nurse). She's the one that detected my prostate cancer before it spread, and if it wasn't that she practices 20+ miles from my house I'd still keep her as my GP.


How do I know you don't live in a semi-rural area.....

/ Where "It will only take a hour to drive there" is a perfectly valid comeback to someone complaining about distance.
// I'll travel 20 miles for supper once a week if I really like the place.
/// And I live in a city of over 50k people
//// It really boils down to culturally what "far" is
 
2013-05-28 11:04:58 AM

scanman61: midigod: So he's admitting he's been overcharging his patients and the insurance companies?

Well, at least he decided to start being honest.

No, he's admitting that a significant part of his office staffing costs was dealing with insurance BS.  SInce he's not doing that anymore he doesn't have to pay for office staff.


but muh jobs
 
2013-05-28 11:10:35 AM
IIRC, the Time magazine article about ChargeMaster prices showed that the usual markup is >>2x. If the doctor reduces his prices by 50%, he's still charging well above what insurance will pay.

I certainly have no problem with him making a living, but please don't pretend that this guy is a philanthropist. The concept of charging more to a smaller patient population is hardly something new (see "concierge medicine").
 
2013-05-28 11:12:59 AM

Dejah: If I have insurance, I won't visit a doctor who doesn't accept it.  Nice going on cutting charges by 50%, but the problem isn't insurance companies.  It's hospitals.


The problem is he system(insurers are probably more to blame than any other group though). The biggest thing this guy did was post his prices online. One of the biggest problems with the healthcare system in the US is that nobody really knows what care costs at various care providers. The other big problem being that what insurance pays for care is pretty much unrelated to the costs.
 
2013-05-28 11:16:30 AM

Dinki: He's a GP. The vast majority of large medical expenses are for specialists, surgical or diagnostic procedures, and prescriptions. So his patients would still have to carry insurance.


Agreed.

He's not actually cutting prices in half, either.  He's setting them to a bit less than what he would actually collect from the insurance.

sycraft: Insurance companies are no small part of the problem. They add a lot of overhead with stupid shiat but also force stupid pricing. If you've ever looked over the stuff they send you, you'll see something like "Visit cost: $200 Negotiated Discount: $90." What they are saying is your doctor charged them $200, but they only paid out $90. Now clearly, if what you had done cost $200, that wouldn't be sustainable. What goes on is doctors have to inflate their prices to get the insurance companies to pay what they actually need. The problem is that the doctors then have to charge the full amount to cash patients. If they don't, the insurance companies will come after them and pay them even less.


Actually, no.  What the insurance pays has nothing to do with what the doctor bills.  The doctor bills high to ensure he's never leaving $ on the table.  The doc can charge less for cash so long as it is at least as much as the insurance would have paid.
 
2013-05-28 11:18:19 AM

Dinki: He's a GP. The vast majority of large medical expenses are for specialists, surgical or diagnostic procedures, and prescriptions. So his patients would still have to carry insurance.


Patients of his that have insurance simply file claims for his services themselves and so the patient gets reimbursed by the insurance company for what they paid the doctor.  You didn't know that was possible, did you?  Used to be the way insurance was done a long time ago.  This whole doctor's office doing it themselves bit was only started recently actually, but probably still before you were born.
 
2013-05-28 11:22:48 AM

Z1P2: Dinki: He's a GP. The vast majority of large medical expenses are for specialists, surgical or diagnostic procedures, and prescriptions. So his patients would still have to carry insurance.

Patients of his that have insurance simply file claims for his services themselves and so the patient gets reimbursed by the insurance company for what they paid the doctor.  You didn't know that was possible, did you?  Used to be the way insurance was done a long time ago.  This whole doctor's office doing it themselves bit was only started recently actually, but probably still before you were born.


I do that for out of network counseling costs for my kids.  If nothing else, it counts toward the deductible.  But with my kids' issues, I'm not the average medical spender.  We spend a lot on medical.  Over $12K on the premiums, plus $5K on the deductible, then more on drugs, then some on out of network costs.
 
2013-05-28 11:27:48 AM
First world problems

graphics8.nytimes.com
 
2013-05-28 11:29:46 AM

Dejah: If I have insurance, I won't visit a doctor who doesn't accept it.  Nice going on cutting charges by 50%, but the problem isn't insurance companies.  It's hospitals.


And lawyers.
 
2013-05-28 11:30:12 AM

scanman61: midigod: So he's admitting he's been overcharging his patients and the insurance companies?

Well, at least he decided to start being honest.

No, he's admitting that a significant part of his office staffing costs was dealing with insurance BS.  SInce he's not doing that anymore he doesn't have to pay for office staff.


And a couple more people lose a decent paycheck (and possibly health insurance as well). That's OK, they can stock shelves part-time in Walmart.
 
2013-05-28 11:31:52 AM
I_C_Weener:  Like my senator is awesome, but Congress is evil.
-=-
Ah. Your Senator must be Al Franken. You lucky bastard.
-------------
I wonder if he'll take chickens for payment. (I didn't look at his price sheet.)
 
2013-05-28 11:35:24 AM

SlothB77: here's one way to get around it:

get a high deductible insurance plan with an HSA.  Put the money saved on health insurance premiums in the HSA.  Make sure the high deductible plan covers everything or almost everything over a certain amount (say over $2500 or $5000) in the rare event you have some very expensive malady.  Go to doctors like this for regular checkups and pay for it from money in your HSA.  Use the high-deductible plan if you need a surgery or get cancer or something.

I have over $5000 sitting in my HSA investment account right now.


That is really the best way of doing it.

I have a 5k deductible and I pay 50% for the next 15k. After that the insurance company pays 100%. So I owe 12.5K on catastrophic bills over 20K. I can handle that, its really for disaster - cancer, etc.  Pay for my on dental, etc and get better prices because I pay cash.

HSA's and catastrophic insurance system would work really well for medicare and  veterans, if they'd try it.

I would like to see a system similar to that of Switzerland to replace Medicaid. Allow insurance policies to be sold over state lines, then the gov;t simply buys the cheapest policy they can get and hands them the insurance card. The end. Little gov't involvement and a small bureaucracy. Would save a lot of money and provide better care with less waste.
 
2013-05-28 11:35:35 AM

SlothB77: here's one way to get around it:

get a high deductible insurance plan with an HSA.  Put the money saved on health insurance premiums in the HSA.  Make sure the high deductible plan covers everything or almost everything over a certain amount (say over $2500 or $5000) in the rare event you have some very expensive malady.  Go to doctors like this for regular checkups and pay for it from money in your HSA.  Use the high-deductible plan if you need a surgery or get cancer or something.

I have over $5000 sitting in my HSA investment account right now.


That's what we have. I don't mind submitting forms for re-embursement and I'm saving money. We did not use the money we put into a traditional plan, but we still have the back up high deductible plan for major medical issues. I wish this Dr was in WI.
 
2013-05-28 11:36:34 AM

CptnSpldng: scanman61: midigod: So he's admitting he's been overcharging his patients and the insurance companies?

Well, at least he decided to start being honest.

No, he's admitting that a significant part of his office staffing costs was dealing with insurance BS.  SInce he's not doing that anymore he doesn't have to pay for office staff.

And a couple more people lose a decent paycheck (and possibly health insurance as well). That's OK, they can stock shelves part-time in Walmart.


What is with all the Wal-Mart love today? Even they don't hire just anybody, you know.
They need to make sure their underlings don't have curiosity, a willingness to report anything awry, or any incentive to look up from their feet. Hence the 250 question quiz with repeating questions, about morality, ethics, and behaviors.

\Why, yes, I'm bitter about Wal-Mart not hiring me after graduation, with my B.S. in Mathematics, when I attempted to make ends meet; why do you ask?
 
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