Welcome to The Self-Pay Patient!

Today is the launch of TheSelfPayPatient.com, a blog intended to be a resource for Americans who find themselves having to pay for needed medical care out of their own pocket, often called ‘self-pay patients.’

This blog is an outgrowth of a book I’m currently writing, intended to be a guide for the tens of millions of Americans who, even after implementation of the Affordable Care Act (a.k.a. ‘Obamacare’), will still be either uninsured, have high-deductible health insurance, or find that their insurance doesn’t cover certain medical treatments, and will find themselves as self-pay patients. 

To cite just one estimate, the Congressional Budget Office expects that even after Obamacare is implemented 30 million Americans will remain without health insurance. Many will be uninsured because they can’t afford insurance, or don’t see value in the plans available to them, or prefer to wait until they are sick or injured to buy insurance. In some cases, people will chose to remain uninsured because they object to being pulled into the third-party payment system that intrudes between doctor and patient. 

Tens of millions more are likely to find that the only plans available or affordable to them through their employer or an Obamacare exchange are those with high deductibles. Under Obamacare deductibles of up to $6,350 are permitted and are likely to be quite common, exposing patients to significant out-of-pocket expenses for medical treatment before their insurance pays any benefits.

One problem that many uninsured people and those with high deductibles have in being efficient buyers of health care services is that for the most part, medical treatment in America is just not very friendly to people who pay directly for their own health care. The third-party payment system, in which insurers or government programs pay for most care has distorted the marketplace for health care so badly that it can be very difficult (not to mention extremely frustrating) for a patient to find out in advance what a visit to the doctor will cost, or how much a specific procedure will cost.

As bad as that is, for the uninsured there is an even bigger problem created by the third-party payment system – the prices for health care that they are charged are typically much higher than those charged to insurance companies and government programs, often three or four times or even ten times more. Several months back Steven Brill wrote an excellent article in Time about insane hospital prices, including the case of a 64-year old uninsured woman in Connecticut that was charged nearly $21,000 after a visit to the emergency room with chest pains that turned out to be heartburn. A third-party payer such as Medicare would have paid a few thousand dollars at most.

The situation isn’t quite as bad for those with high deductible insurance, because are able to get the ‘discounts’ that the uninsured typically don’t get. But it can still be maddeningly impossible to find out what a visit to the doctor or a treatment will cost, because few health care providers even know themselves what their payments from insurers and government programs are.

Fortunately, there are options available to self-pay patients. Lots of options, in fact. These range from health care sharing ministries that can serve as a highly effective substitute for the ‘comprehensive’ health insurance that Obamacare seeks to get most Americans into, to cash-only doctors who are often much less expensive than doctors that accept insurance, to hospitals in the U.S. and around the world that are able to provide surgical services at a fraction of the cost of what other U.S. hospitals charge self-pay patients, plus numerous other health care providers that treat self-pay patients fairly.

These options form the cornerstone of an alternative to the two choices that many people think they have under Obamacare, and indeed even before that law was passed – either purchase an expensive ‘comprehensive’ health insurance policy that may or may not provide much value to them and that traps them in the bureaucratic medical system, or go completely uninsured and have limited access to health care and potentially face financial ruin and severe health consequences if they they get diagnosed with a significant illness or are seriously injured. As this blog intends to demonstrate, there is an option between these two extremes.

The Self-Pay Patient takes no position on whether people are better off obtaining ‘comprehensive’ health insurance under Obamacare or opting out and instead embracing some of the options that will be described here. Each person will have to make that choice for themselves, based on their own health, financial situation, values, preferences, and other reasons. But there is a general consensus that even as Obamacare is implemented tens of millions of Americans are going to remain or become self-pay patients in the years ahead. The Self-Pay Patient hopes that more than a few of them will realize that they still have affordable options for the health care many of them are bound to need, and that this blog can play a part in helping them to get that care

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2 Responses to Welcome to The Self-Pay Patient!

  1. Withheld says:

    Thank you for establishing this blog. I am a “self-pay” patient and have been since I figured out the “health care insurance” racket many years ago. I was a public employee and got excellent benefits through PacificCare that cost me all of $27 a month. When I quit public service my COBRA payments jumped to $384 per month, and that was back in 1995. After my COBRA ran out I had no insurance at all due to pre-existing conditions like Type II diabetes and other minor issues that I treat with diet, exercise and medication. Last time I checked, in 1998, a private policy would have cost me more than $1200 per month just for one unmarried person with no children. I could not possibly afford this so I decided to take charge of my own health and health care.

    Ever since I have paid for my own health care, and I’ve been moderately successful in negotiating good rates because I’m willing (and able for now) to pay cold, hard cash for service.

    In one case I suffered a kidney stone attack that required a visit to the ER. They did a CAT scan but when I got the bill it was for TWO CAT scans, one for the “upper abdomen” and one for the “lower abdomen/pelvis.” I reviewed the scan, which was actually one continuous scan, and objected to the $6000 bill for “windowing” the scan into two different films when a simple shift of the film window on printout by less than two inches up (for the LA/P shot) would have covered everything they needed to see in one image.

    I talked to the billing department when I got the bill and used the words “fraud”, “medical ethics board” and “consumer protection department” liberally and they not only took off the bogus $3000 charge, they reduced the entire bill to 45% of its original amount because I slapped greenbacks down on the desk.

    My concern now is Obamacare. I categorically and absolutely REFUSE to buy mandatory “insurance,” and I also refuse to allow the IRS to manage or even have access to my health records, so I’m using a private clinic and I’m paying cash at a carefully negotiated rate for my annual physical and medication renewal prescriptions. I get my blood work done at an anonymous testing facility and hand-carry the results to the clinic. I have asked them to code my files, which were on paper till recently, with an alias and I REFUSED to give them either my SSN or my home address. They agreed to do this.

    But now I worry that Obamacare will require them to report my medical records to the IRS, and worse I’m very worried that they will not be permitted to treat me “anonymously” for cash.

    Do you have any information on what the requirement is for physicians to report? Can a “concierge doctor” opt-out of the system and keep medical records on paper and private or not?

    I really need to know so I can figure out how to continue to take responsibility for my own health care without allowing federal bureaucrats and spies to access my private medical information.

    • seandparnell says:

      Thanks for the great comments!

      My understanding is that if you are concerned about privacy and electronic medical records (EMR), then a cash-only doctor is probably your best option. Many concierge doctors (but not all!)still accept insurance or participate in government programs like Medicare, and my understanding is that the drive to push doctors into using EMRs is piggy-backing on government programs. You’ll want to ask each doctor whether or not they use EMRs and who has access to them, but generally speaking cash-only docs are not participating in any government program that would require them to give medical records to any government agency.

      A good source for finding cash-only doctors who will respect your privacy and keep your medical records confidential is the Association of American Physicians and Surgeons, who keep a list of members who are cash-only or cash-friendly, and generally do everything they can to minimize government and insurance involvement. You can find the list here: https://aaps.wufoo.com/reports/m5p6z0/

      Thanks again for your great comments!

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