More Self-Pay Practices – June 2015

I’ve had several doctor’s offices and other medical providers who cater to self-pay patients reach out to me in recent weeks, wanting me to pass along their information. Finding a cash-only or at least cash-friendly doctor is probably the biggest challenge for those of us operating outside the third-party payer system, so I’m always happy to pass along information when I get it (even though I may not be terribly timely). Here are a couple that have contacted me recently, I’ll have more in the coming days and weeks (hopefully).

Associated Urologists of Orange County

Primary care physicians who cater to self-pay patients are generally easier to find, so I’m always pleased to see specialists as well. Associated Urologists of Orange County is one such practice, located in Santa Ana, California. They do accept insurance, but their web site says “We welcome all patients, including Self Pay patients.” They offer a price list for self-pay patients, and according to the page they offer cash prices comparable to what PPO insurance companies pay. I checked out a few of the procedures they had listed and this appears to be the case. A vasectomy, for example, is listed for $800, while according to Healthcare Bluebook in the Orange County area a typical insurer would pay $850. A pelvic ultrasound at AUOC lists for $125, close to the $116 price that Healthcare Bluebook shows.

An initial visit for new patients is $150 while follow-up visits are $75 for self-pay patients, which compares favorably to what I’d guess would be the closest “standardized” visit type, a Level II visit to see a doctor ($161 and $95, respectively).

Associated Urologists of Orange County is located at 1801 N Broadway in Santa Ana, and can be reached at (714) 639 -1915 or by an online form available at http://ocurology.com/contact-us/.

Dr. Tom Horiagon

Self-pay patients in the Denver area ought to know about Dr. Tom Horiagon of Littleton, Colorado. He lays out his vision and practice on the home page of his practice:

…Ambulatory care is now an out-of-pocket expense due to high deductibles, narrow networks, and long wait times to be seen in network. Moreover, as hospitals have purchased physician practices, the fees for ambulatory care have skyrocketed in Denver. Hospital master charge lists are not transparent for the most part and indefensible price variations emerge in the absence of constant scrutiny. These price variations can be as much as tenfold for identical services in the Denver metropolitan market.

To make medical care realistically priced, administrative costs, labor costs, and rent need to be as cheap as possible. A 2 room practice like I have can repair wounds, treat simple eye injuries, treat a huge variety of musculoskeletal injuries, and manage the majority of chronic medical conditions with episodic or scheduled visits. Everything is priced by the amount of time I personally spend treating someone ($50/15 minutes). EKG’s, complete pulmonary tests, sleep apnea evaluations, simple urinalysis are all available at the office. High-quality imaging services are available in the same building and the price for patients who pay cash is a small fraction of the cost applied when insurance is used. A network of other providers who have superior quality and cash prices for patients who do not wish to use insurance is used preferentially for referrals.

$50 for a 15 minute visit with a doctor of his experience and expertise (his bio shows board certifications in internal medicine and pulmonary disease, and he received his medical degree in 1981, giving him 30+ years of experience) is a bargain. Again looking at Healthcare Bluebook, an established patient visit to a doctor for 15 minutes runs about $140 dollars in the Denver area. And judging from the introduction on his homepage, it’s clear that Dr. Horiagon is fully on board with the self-pay idea!

Dr. Horiagon’s office is at 26 W. Dry Creek Circle, Suite 640 in Littleton and he can be reached at 720-306-8280 or chestmedicine@gmail.com.

 

 

Posted in Cash-Only Doctors | 3 Comments

Insured but not letting the doctor know?

I’ve been incredibly negligent in posting here the past several months, hopefully getting down to one job will allow me to post here more frequently (and yes, I’ve said things like that before).

Today I wanted to address something I’ve gotten several e-mails on over the past few weeks. Early last year I put up a post titled “Insured patients can save money by pretending to be uninsured.” The gist of the article was that the negotiated rates paid by insurers to doctors are sometimes more than the cash price the same doctor might charge someone who is uninsured. In those circumstances, for people who are going to be paying the full bill because it’s under their deductible, it’s better to hide the fact that you have insurance and just pay the cash price.

The question I’ve gotten a couple of times recently has to do with the legality of doing this, and what might happen if the doctor finds out you are insured. The answer to the first one is easy – it’s completely legal to not use the insurance you have, or at least I’ve never heard of an insurance policy requiring that their policyholders use them for all treatment.

The second one can be a little tricky. A couple of people have told me that they’ve tried to get the cash price after they have given their insurance information, only to be told they have to charge them the negotiated rate. Unfortunately, this is true, even though the patient will be paying the full price, whatever that may be. Once you tell a doctor’s office you are insured, they are contractually obligated to charge you the rate they agreed to with the insurer.

Someone else described the following scenario: they’ve been getting the cash price by not telling the doctor they are insured, what happens if they find out they’re insured? Will the doctor go back and have to re-price all the past bills? Two thoughts.

One, it depends on what exactly the doctor finds out the patient is insured. If they only find out that now, as of this particular visit the patient is insured, they’re likely going to assume it’s new coverage and not ask about whether past visits could have been covered under the insurance policy as well, so this shouldn’t be a problem.

If, on the other hand, the doctor discovers the policy was in effect during previous treatments, there might be a problem, and I just don’t know what might happen. Some doctors might opt for a “water under the bridge” attitude and not worry about it (there’s not much financial incentive for them to pursue the higher charge, as the marginal increase in revenue is likely to be gobbled up with the bureaucratic hassle of going back and dealing with it), while others may insist on going back. It probably depends on the doctor and how devoted they are to the third-party payment system (if they were offering good cash prices to begin with, the answer is probably “not very”).

I’d be interested in hearing any experiences anybody has had that relate, shoot me your thoughts at selfpaypatient [at] gmail [dot] com.

Posted in Cash-Only Doctors, High-deductible health insurance | 21 Comments

Cash-only Neuro-Ear Doctor in Louisiana

If you’re a self-pay patient in Louisiana and need a neuro-otologist (that’s a doctor who treats neurological disorders of the ear – I had to look it up too), I’ve got good news for you. Dr. Gerard J. Gianoli has ditched third-party payment, and gone cash only. The Wall Street Journal carried an op-ed by Dr. Gianoli today:

Saying Goodbye to Third-Party Medical Payments

The Affordable Care Act is raising costs, restricting patient choice and doctor freedom, and putting bureaucrats in the treatment room. It isn’t good—but it’s here to stay, largely intact, at least until a Republican president can work with a Republican-controlled Congress.

But that doesn’t mean nothing can be done. The onus is now on physicians to innovate and improve patient outcomes within the restrictive confines of an ObamaCare world…

If what many providers advocate is true—that doctors, not bureaucrats or politicians, know what’s best for patients—physicians must begin offering solutions. This requires thinking like entrepreneurs and innovators, not lab coats awaiting orders from outside parties on how to deliver medical care… Continue reading

Posted in Cash-Only Doctors | Tagged , | 8 Comments

Kiplinger’s reports on self-pay health care

Last night I read an article in Kiplinger’s reporting on the growing trend of people who are opting out of third-party medicine and simply paying directly for their care. Kiplinger’s, for those of you unfamiliar with the publication, bills itself as a source of personal finance and investment information, and they provide a pretty good overview of self-pay healthcare.

Pay Cash for Your Health Care

In an era of higher health insurance deductibles, rising out-of-pocket costs, shrinking provider networks and fewer choices in health care, more people are taking matters into their own hands. Instead of using their health insurance for all of their care, they’re going off the grid and paying cash so that they can see the doctors they choose or get the drugs they prefer. Some are paying a fee to their primary care physician in exchange for longer office visits and 24/7 access.

Going off the grid doesn’t mean ditching your health insurance altogether. You’ll still need insurance for big-ticket medical care. But it usually makes sense to get a high-deductible policy to save on premiums. Payments you make in cash may count toward your deductible, and if you contribute to a health savings account or a flexible spending account, you can usually use that money tax-free to cover your out-of-pocket costs for medical expenses, even if your insurer doesn’t count them toward the deductible. The payoff: more control over your care, which may cost less than you’d pay with your health insurance policy…

One quibble, of course, would be that you don’t necessarily need health insurance for big ticket medical care – plenty of self-pay patients do fine without it and are able to afford what would otherwise be too expensive simply by shopping around and considering all of their options, including medical tourism. And of course there are alternatives to conventional health insurance too, such as critical illness policies and health care sharing ministries.

The article covers concierge care and direct primary care, as well as describing how the story of Jeff McElroy and his experience at the Surgery Center of Oklahoma:

Jeff McElroy’s 8-year-old daughter, Caroline, needed surgery to remove a mass in her ear. McElroy had recently changed jobs, and the McElroys’ first choice for the procedure, the Surgery Center of Oklahoma, in Oklahoma City, wasn’t covered in his new insurer’s network. McElroy asked the surgery center how much it would cost if he paid cash to have the surgery done there. The answer: just $1,700.

His policy would have covered the surgery at a local hospital for $7,600, but because McElroy’s policy had a $6,400 deductible, he would have had to pay most of the bill out of pocket. So he chose the surgery center and paid cash. “It was the same surgeon and the same surgery,” says McElroy. The surgery center submitted the expense to his insurer to count toward his deductible. He also used money from a health savings account to pay the bill.

McElroy, who is a certified financial planner, thought about switching to a lower-deductible policy during open enrollment for 2015 coverage but changed his mind after he did the math: He could save $150 a month in premiums with the high-deductible policy, make the most of the growing number of stand-alone facilities and providers in Oklahoma City that offer cash discounts, and contribute up to $6,650 to a health savings account to pay the bills with tax-free money.

McElroy’s story is something I expect to be replicated many times in the coming years, as high-deductible health insurance spreads and more people realize the ‘negotiated’ rate they’re being asked to pay, often billed as a ‘discount,’ far exceeds what they’ll pay if they just go to a cash-only or cash-friendly provider or facility.

Getting a publication like Kiplinger’s to promote the benefits of self-pay medicine is significant, I think, and hopefully will help more providers of health care services to realize there is a growing market filled with patients who don’t want to invite a third party into the doctor-patient relationship and instead just want to pay directly for their health care just like they pay for other important goods and services.

Posted in High-deductible health insurance, Price Transparency | Tagged , | 2 Comments

Altrua Qualifies for Obamacare Exemption

It’s been so long since I posted here I’m sure a few of you wondered if I’d been hit by a bus, kidnapped by the insurance companies, or just lost interest. Fortunately the answer to all of these is ‘no,’ but I have been swamped with my work that pays, at least that pays in ways that fill my bank account and allows me and my family to eat!

I’ve got a bunch of things that have been sitting in my in-box (of course), and I’m planning on beginning to work my way through them over the next few weeks with a number of fairly short post.

I thought I’d start by sharing what is probably the biggest news, that Altrua Healthshare, one of the five health care sharing ministries I’m aware of, recently received a letter from the Centers for Medicare and Medicaid Services confirming Atrua members are exempt from the tax Obamacare levies on many uninsured people (I’d blogged about Atrua’s merging with Blessed Assurance Bulletin, which is what allowed them to qualify, here: Altrua qualifies for Obamacare exemption, plus more on CMF Curo).

Here’s a link to Altrua’s recent press release announcing the good news: Altrua Gains Recognition as a Health Care Sharing Ministry

This is great news, of course – there was some question early on whether or not Altrua might qualify but I’m pleased to see that Altrua members, who have done the responsible thing and arranged to take care of potential major medical expenses outside of the conventional third-party payer health insurance system, won’t be penalized.

I haven’t heard from the other four ministries: Christian Care Ministry (better known as Medishare, and with a sweet new web site, by the way!); Christian Healthcare Ministries; Samaritan Ministries; and Liberty HealthShare. There’s really not much doubt the first three qualify, but there is some question about Liberty although they seem pretty confident they’ll qualify, and I hope they do. I’ve got a message in to the head of Liberty and will share it with you when I get it.

Posted in Affordable Care Act, Health Sharing Ministries | Tagged , , , , , | 17 Comments

4 quick tips on prescription drug savings

I was on the David Madeira Show this morning, talking about alternatives to conventional health insurance. David is a member of Samaritan Ministries, one of the five major health sharing ministries that bring together people who want to share medical bills outside of conventional insurance, so of course we got to talking about sharing ministries (I’ll be posting David’s experience with Samaritan soon, it’s a great story that proves wrong those who say sharing ministries don’t work for high-cost medical needs).

Anyways, in the course of our conversation, David mentioned the post I wrote on Altrua merging with Blessed Assurance Bulletin, meaning that Altrua members would be eligible for the exemption from having to pay Obamacare’s tax on the uninsured. David referenced it as, and I’m paraphrasing here, “the most recent post on The Self-Pay Patient site, dated October 15…”

Yeah. It’s been a while. I’m happy to be so busy with work that actually pays, but still.

So, I’m going to have to try to be better about posting here, but in order to do that it probably means a lot less of me writing stuff, and a lot more of me cutting-and-pasting from other interesting things I find that I think will be helpful for self-pay patients while not violating any copyright laws.

Like the article below, on prescription drug savings. I’ve covered some of these things here before of course, but one that I haven’t was the bit about re-evaluating your medicines periodically. I know from personal experience (not mine, but family members – I’ve probably had less than a dozen prescriptions in my entire life, thankfully) that it’s easy to allow inertia to take over in terms of medicines, and just assume that since you’ve been taking a particular drug for months or years that you need to keep taking it. 

Unfortunately I think a lot of doctors also don’t think much about reviewing medicines, and just keep renewing the same one over and over. Continue reading

Posted in Prescription Drugs | Tagged , , , , | 8 Comments

Altrua qualifies for Obamacare exemption, plus more on CMF Curo

Two important updates on health care sharing ministries that I want to share with all of you.

I’ve mentioned a few times in the past that Altrua HealthShare, a ministry based out of Texas, may not be eligible for the exemption granted under by the Affordable Care Act (more popularly known as Obamacare), which only allowed members of ministries existing since 1999 to be exempt from the tax on being uninsured. Because Altrua appeared to have begun operation in 2000, it looked like members wouldn’t get the same exemption as members of the other ministries (a shame, in my humble opinion).

So I was thrilled this morning to receive an e-mail from the Executive Director of Altrua HealthShare letting me know that they have recently merged with what was, if memory serves correct, one of the original health sharing ministries, Blessed Assurance Bulletin. This means members of Altrua will have the same exemption as members of other sharing ministries.

With his permission, I’ve posted his e-mail to me below.

I read your latest Self-Pay Patient article on Health Care Sharing Ministries dated October 3, 2014. In order that your readers may be better informed regarding Altrua, we thought it best to send you an update directly. 

We are pleased to let you know that Altrua HealthShare and Altrua Ministries, both established in March of 2000, has merged with Blessed Assurance Bulletin earlier this year.  You may recall your own mention of Blessed Assurance Bulletin in an article you wrote back in 2005 (see http://news.heartland.org/newspaper-article/2005/09/01/medical-sharing-societies-offer-affordable-alternative-insurance).  Blessed Assurance Bulletin began assisting its members in sharing healthcare needs among its members back in the mid-90s, forming a Texas non-profit corporation in 1997, has continuously shared needs from that time all the way through the merger. 

Altrua has submitted its Substantiation Letter to the HHS for recognition and qualification as a HCSM. Although we have not yet received a letter of formal recognition, we remain confident that recognition is forthcoming.  The arbitrary December 31, 1999 date, chosen by the drafters of that particular section of the Affordable Care Act, is no longer an issue.

 Please feel free to contact me with any questions you may have.  Please know that I appreciate what you do in supporting all HCSMs.  It is refreshing to hear a voice that celebrates an alternative to typical insurance and allows our biblical beliefs to be viewed by others as we care for one another’s needs through our medical cost sharing ministry.

 Yours in good health,

Randall L. Sluder

Executive Director

Altrua HealthShare/Altrua Ministries

Terrific news!

The other update has to do with my earlier post about Christ Medicus Foundation Curo, a health care sharing ministry option aimed at Catholics. CMF Curo is part of Samaritan Ministries, and the partnership helps to resolve the same issue as the one facing Altrua above, that members of ministries that haven’t been in existence since 1999 aren’t exempt from the tax on being uninsured.

The post prompted a number of comments, raising several issues and questions. A few days after I put up my post, I received a message from David Wilson, Founder and CEO of CMF Curo that a great job of addressing many of the questions and comments that were raised, and with his permission I’m posting his response here.

Sean, thank you for your coverage and discussion on CMF CURO. In specific response to your dialogue above, we are confident in the status of the very specific provision in the law (26 U.S.C. 5000A (d)(2)(B)) that clearly exempts health care sharing ministries from the individual mandate. In fact, we are working to continue to promote expansion of these provisions in both the House and the Senate.

Sean, your answer in reference to solvency can be expanded further. CMF CURO and Samaritan are unique in that the sharing of medical needs is strictly direct from one member to another, (CMF CURO and Samaritan never “pool” the money). Meaning the “solvency” of the ministry is really the solvency of the 37,000 households of our membership. As Sean notes, the financial record over the past 20 years has been impeccable, outstanding. Member-to-member Christian charity and community is truly powerful and beautiful.

Raymond, in reference to your practice, I congratulate you on moving to a direct care practice model. This is clearly a great, positive, movement for the future of primary care – providing to your patients the time and passion to assure best quality care. Direct care practices are a great compliment to CMF CURO and health care sharing ministries. Assuming that you are a primary care physician, I recommend that you continue to charge your “annual membership fee” as you have it structured. For your Christian patients, CMF CURO – SMI offers them the opportunity to actively practice their faith through Christ-centered health care sharing. It also, of course, provides them the ability to share their medical needs and expenses (outside of your practice) for specialist and facility care. Under CMF CURO, your patients can attend the doctor of their choice – you. They pay directly for your services and share expenses outside of your services for professional and facility expenses, all together for much less than the cost of traditional insurance – getting all the benefits of both your care and the Christian health sharing ministry.

In relationship to your question on payment amount and network, again it is important to note that our members select their physician and facilities of care, without restriction.

The CMF CURO price for services, what we call the “love your neighbor price” (LYNP), is calculated at 125% of Medicare. Lastly, the CMF CURO debit card makes health care sharing easier for the patient and the physician. The card is both a membership and health care debit card, and it can only be used to pay health care providers.

I hope this is helpful to you both.

Please contact us through our website at CMFCURO.com for any additional questions and we will work to respond promptly.

Peace and Joy in The Lord.

David E. Wilson, Founder of CMF CURO

The ‘Raymond’ referenced in the letter, by the way, is Dr. Raymond Kordonowy, a direct primary care physician in Fort Meyers, Florida, whom I profiled back in July.

All in all, it appears that health sharing ministries are well positioned to be an alternative for people who are looking for alternatives to high-priced conventional health insurance or want to escape from bureaucratic medicine!

Posted in Affordable Care Act, Health Sharing Ministries | Tagged , , | 1 Comment

A new(ish) health care sharing ministry for Catholics!

***UPDATE BELOW***

I’ve been touting health care sharing ministries for quite some time, pretty much since I launched The Self-Pay Patient blog back in August 2013.

The concept is pretty simple – individuals and families voluntarily agree to pay one another’s medical bills, facilitated by a well-organized central office that matches the donations of members with the medical bills submitted by other members. It isn’t insurance, but in some ways it serves the same function, giving people the peace of mind knowing that if they suffer an injury or illness and can’t pay the bill out-of-pocket, they’ll have financial support from their fellow ministry members.

Among the many benefits of membership in a sharing ministry (I’m a member of one, and am quite happy about it) is that they are typically far less expensive than health insurance, even though they can provide protection from large medical bills that is roughly comparable to that offered by conventional health insurance. In my case, I pay roughly one quarter what I would if I were on my wife’s plan from her employer. Continue reading

Posted in Affordable Care Act, Health Sharing Ministries | Tagged , , , , , | 16 Comments

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 , , | 10 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 , | 25 Comments