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

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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

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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

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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

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Medical bill negotiators in the spotlight on ABC News

The other night Michelle Katz was on ABC News describing how a family that had been hit with a $50,000 bill for what seems to have been a normal c-section birth was able to use a medical bill negotiator to dramatically reduce their bill. Here’s the segment, about 2 minutes and 45 seconds long:




The family was able to reduce the bill at first by about $12,000 simply by pointing out to hospital that the national average for a c-section is only about one-fourth what they were charged ($12,397 according to Healthcare Blue Book).

After getting this discount through their own efforts, they then turned to CoPatient, a firm that specializes in reducing medical bills both by finding errors and by negotiating for additional discounts. In this particular case, apparently the hospital billed the family for extra care supposedly incurred because the child was born sick. Of course, he hadn’t been, but this was a $17,000 mistake by the hospital! Continue reading

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Health sharing ministry members refute critics

Last week I wrote about the fine article in the Washington Post featuring people who had decided to opt-out of Obamacare, with a focus on those who had joined health sharing ministries. I also noted that many of the comments on the article revealed a great deal of confusion, ignorance, and even hostility to the whole idea of individuals choosing to voluntarily share medical bills amongst themselves.

Here’s one of the more lucid, less offensive (but still almost completely wrong) comments:

…if you actually go read [Christian Healthcare Ministries’] site, even the “Gold” level of protection is WORSE THAN the ACA-defined “Bronze” level, for anything excepting a person who has very little healthcare needs. 
 
CHM has [lousy] catastrophic coverage (even with their Brothers’ Keeper’s add-on). Given the immense costs of any chronic disease or accident, you’ll burn through their coverage almost instantly. A single fairly-serious car accident will bankrupt you quickly even with CHM.  
 
And, of course, ongoing drug costs (if you’re in “maintenance”, which most chronic conditions are) are going to NOT be covered.  
 
Lastly, you pay all bills up front, then seek reimbursement from CHM, with a 2-3 month lag time AFTER you’ve submitted the paperwork. 
 
Sounds like a real winner to me. The $150/unit cost isn’t a good deal either – with subsidies, most families of 4 will get better coverage under the ACA policies. I.e. family of 4, $60k income, you get a nice “enhanced Silver” package for $400/month, which is less than the CHM’s $450/month bill and provides FAR superior coverage. 

To just run through the biggest mistakes here:

  1. Christian Health Ministries’ ‘Gold’ level plan has a ‘personal responsibility’ amount of $500, compared to most ‘bronze’ level insurance plans with a deductible in the $5,000 – $6,000 range. Continue reading
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Washington Post features Americans opting out of Obamacare

Nearly two and a half months ago, I posted here that a reporter had contacted me and was looking for people to interview who had chosen to opt out of Obamacare. Several dozen of you responded, and I was able to pass along your information for her to include in her article.

The article finally ran last week in the Washington Post  (her editor had bumped it until after the end of Obamacare’s open-enrollment period, hence why it’s only now coming out), and I’m pleased to say I think the reporter did a good and fair job explaining what some Americans are doing.

The article focuses mostly on health care sharing ministries, and doesn’t really address some of the other coverage options, such as critical illness policies. It also neglects the actual provider community that caters to self-pay patients, such cash-only doctors, telemedicine companies like Connect2Docs* and 24/7DocRx*, medical tourism, and the many other options that self-pay patients have.

That’s not the reporter’s fault, of course – had she tried to cover all of this, she would have wound up writing a book, not a news article (and fortunately, someone has already written a book on how to save money in health care as a self-pay patient!). Here’s the first few paragraphs of the article:

Susan Tucker is one of millions of Americans who dislike the health law and want nothing to do with it. But the 54-year-old Venice, Fla., homemaker took her opposition a step further: She opted out.

Tucker dropped the private health plan she had carried for more than a decade and joined Christian Healthcare Ministries, a faith-based nonprofit in which members pool their money to pay for one another’s medical needs — and promise to adhere to biblical values, such as attending church and abstaining from sex outside marriage.

“When all this came up with the ACA, I just realized I don’t want to be a part of any of this,” said Tucker, who views the Affordable Care Act as the government meddling in her personal health care. The Christian Healthcare program is not as comprehensive as insurance — she has to pay for her preventive care, for example — but the monthly payment of $150 can’t be beat, she said.

Tucker is part of a small but growing group of Americans whose opposition to the Affordable Care Act is spurring them to seek out alternatives, choosing once-fringe methods to pay for their medical care in an effort to skirt the many requirements the law imposes on the private health insurance market.

In addition to the focus on health care sharing ministries, the article briefly touches on direct primary care practices, critical illness policies, and short-term health insurance.

The article quotes several other people on the benefits and potential downside of these alternatives, including myself and two professors, Timothy Jost of Washington & Lee University’s law school and Sabrina Corlette with Georgetown University’s Center on Health Insurance Reforms. Both Jost and Corlette are generally skeptical of these options (I’ve read their work before, suffice it to say they’re both pretty smart but have trouble seeing value in anything aside from the conventional system of bureaucratic medicine).

More interesting than the article itself might be the comments, most of which are uniformly hostile to the idea of people charting a path independent of Obamacare and bureaucratic medicine. I and a few others have offered our own comments to try to rebut the misunderstanding, misinformation, and ignorance on display, or clarify certain points – hopefully anybody reading through will get a better sense of these alternatives. If you feel like it, go ahead and leave a comment yourself on your experience as a self-pay patient!

In the next week I plan to provide several stories of individuals who have opted out of Obamacare and bureaucratic medicine, choosing instead to join a ministry, buy an alternative type of insurance, join a direct care practice, or otherwise become a self-pay patient. If you have a story you’d like to share, please let me know!

Posted in Affordable Care Act, Health Sharing Ministries | Tagged , , , , | 2 Comments

OkCopay brings prices, deals to self-pay patients

Options for self-pay patients continue to grow, and today I wanted to briefly describe one that that could be a great resource for anybody who is paying directly for non-primary, non-urgent health care, whether they’re uninsured, have a high-deductible plan, or even some of those who have more comprehensive insurance.

I’d actually seen this company’s web site several months ago, in what looked to be a ‘beta’ version, meaning that it looked like it had launched without really being able at that time to provide much in the way of services to most people. Not that the product or concept wasn’t good, it just had a very limited range of services, at least in my opinion.

That’s changed. The site, OkCopay, now serves as a platform for people looking for prices on a variety of healthcare services and is in markets across the country.

The site’s focus is primarily on what many consider non-primary and non-urgent care, such as vision and dental care, lab and radiology services, and acupuncture.

Here’s how the Minneapolis/St. Paul Business Journal described OkCopay when they began offering services in the Twin Cities region:

Startup that lets people comparison shop for health care enters Twin Cities market

OkCopay Inc., a Chicago startup that lets consumers comparison shop for medical procedures online, entered the Twin Cities market this week.

The company, founded by J. Touré McCluskey, targets people who don’t have insurance and will have to cover the full cost of medical care. It also focuses on consumers shopping for pricey elective procedures — such as Lasik eye surgery — that aren’t typically covered by insurance. Continue reading

Posted in Cash-Only Doctors, Dental Care, Labs & Imaging, Price Transparency | Tagged , , , , | 10 Comments

Telemedicine breaks through on ABC News

One of the interesting things I’ve been able to watch since I wrote my book The Self-Pay Patient: Affordable Healthcare Choices in the Age of Obamacare and launched this blog has been growing interest by the media in alternatives to the third-party payer system in favor of direct payment for medical care. I take this as a sign that there is growing interest in the country regarding ways that individuals can take back control of their health care from bureaucratic medicine, and save money while getting better access to care at the same time.

The most recent installment is a recent story on ABC News, featuring one of my favorite self-pay advocates Michelle Katz. The story is about telemedicine, a topic I’ve covered here several times before. Here are some key excerpts from the story.

Save Money, Time by Bringing the Doctor to You With Telemedicine

With three growing boys, the Alspaughs of Dayton, Ohio, say their home away from home is unfortunately often the doctor’s office.

“We really do have a stack of medical bills and it overwhelms us,” said Rachel Alspaugh.

…it costs the family $90 a visit. The price goes up to $100 each time mom or dad goes.

“We’re just wondering, ‘Is there a better way?’” Philip Alspaugh asked.

According to health care consumer advocate Michelle Katz, there is: telemedicine, a brand-new, high-tech medical service.

For $40 to $50 a use — about half the cost of the average doctor’s visit — doctors perform virtual medical exams either online or over the telephone. They even write prescriptions.. Continue reading

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How to safely buy prescription drugs online

Last week I shared my thoughts on why self-pay patients shouldn’t be buying prescription drugs from overseas. I thought I’d follow up with a related and somewhat overlapping topic, buying prescription drugs online. As with just about any other product, buying prescription drugs online can produce significant savings.

There are a number of legitimate sites online that allow people to order their medicines online, but there are also a lot of sites that are not. One convenient tool I found for determining whether an online pharmacy is legit or not is LegitScript.com. The founder of the site, John Horton, explains here what they do and why they do it:

A Message from LegitScript Founder and President, John Horton

I believe that online pharmacies represent a lot of promise. Standing at the intersection of technology and health care, safe online pharmacies are not only convenient, but they can also help keep costs down.

The problem is, only 2% – 3% of all Internet pharmacies meet LegitScript’s standards for safety and legality – standards that are endorsed by the National Association of Boards of Pharmacy. By contrast, well over 90% of Internet pharmacies are outright illegal, selling prescription drugs without a valid prescription; offering unregulated and potentially unsafe pharmaceuticals; and/or lacking required pharmacy licenses. The rogue Internet pharmacy market is a multi-billion dollar market, and these shady websites’ mission isn’t to help others – but to turn a profit even if it means putting people and pets at risk. Continue reading

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