More doctors abandoning insurance system, going ‘cash-only’

Being a self-pay patient, either uninsured or with a high deductible health insurance policy, can be a challenge on many levels. For most people who only need to be able to find a doctor to take care of routine primary care, the first challenge is just finding a physician who will treat them fairly and offer real prices to self-pay patients.

The good news is, it appears to be getting easier to meet that first challenge.

The media reports more and more frequently about the growing number of doctors abandoning health insurance and simply asking their patients to pay cash for their healthcare, just like any other professional. Not too long ago CNN ran the following story:

Cash-only doctors abandon the insurance system

Fed up with declining payments and rising red tape, a small but growing number of doctors is opting out of the insurance system completely. They’re expecting patients to pony up with cash. 

Some doctors who have gone that route love it, saying they can spend more time with and provide higher-quality care to their patients. Health advocates are skeptical, worrying that only the wealthy will benefit from this system.

In Wichita, Kan., 32-year old family physician Doug Nunamaker switched to a cash-only basis in 2010 after taking insurance for five years. (“Cash-only” is a loose description. Nunamaker accepts payment by debit or credit card too.)

Under the traditional health insurance system, a large staff was required just to navigate all the paperwork, he said. That resulted in high overhead, forcing doctors like Nunamaker to take on more patients to cover costs. Plus, the amount insurance companies were willing to pay for procedures was declining, leading to a vicious cycle.

“The paperwork, the hassles, it just got to be overwhelming,” Nunamaker said. “We knew that we had to find a better way to practice.”

So Nunamaker and his partner set up a membership-based practice called Atlas M.D. — a nod to free-market champion Ayn Rand’s book Atlas Shrugged. Under the membership plan — also known as “concierge” medicine — each patient pays a flat monthly fee to have unlimited access to the doctors and any service they can provide in the office, such as EKGs or stitches.

The fee varies depending on age. For kids, it’s $10 a month. For adults up to age 44, it’s $50 a month. Senior citizens pay $100.

The office has negotiated deals for services outside the office. By cutting out the middleman, Nunamaker said he can get a cholesterol test done for $3, versus the $90 the lab company he works with once billed to insurance carriers. An MRI can be had for $400, compared to a typical billed rate of $2,000 or more…

The story goes on to note the growth in the number of doctors moving towards cash-only medicine:

It’s believed that only a small number of doctors have switched to a cash-only model. The American Academy of Family Physicians said about 4% of respondents to a 2012 survey reported taking only cash, up from 3% in 2010. A Medscape survey found 6% of physicians in the cash-only business in 2013, up from 4% in 2012.

While the numbers are small compared to the overall number of doctors, the growth does represent thousands of new options for self-pay patients. A recent survey of state licensing boards found that there are about 850,000 doctors in the U.S. with active licenses, so a 1% increase in the number embracing cash-only medicine means about 8,500 additional options for patients who pay out of pocket for their healthcare.

The Medscape survey suggests that around 50,000 doctors across the country are practicing cash-only medicine (6 percent of 850,000). That seems a bit high to me, but there’s little doubt that more doctors are choosing this option, and self-pay patients are likely to be the main beneficiaries. There are several links on the Self-Pay Healthcare Market page that can be used to find these doctors, and eventually it’s my hope to be able to provide a full listing here on this site.

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One Response to More doctors abandoning insurance system, going ‘cash-only’

  1. Dave says:

    …and with physicians yet to understand the complexity and the consequences of the ACA, I am surmising the number of “insurance/medicaid/medicare refused” offices will see significant growth…

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