April notes from the Self-Pay Patient

It’s been a bit since I last posted – last Friday, in fact. I’d hoped to do more this week, but had to go to Oregon to visit my father, who was in the hospital. He’s reasonably well now, but of course that took priority over getting out a new blog post.

There’s a few items I thought I’d catch people up on a few items that have been gathering dust in my in-box or otherwise have come to my attention that aren’t necessarily worth a full blog post but that may be helpful information for people to know.

Stand-alone indemnity plans get strong support

Last month I mentioned that the Department of Health and Human Services (HHS) was considering prohibiting people from purchasing stand-alone indemnity products, such as critical illness or fixed-benefit policies, if they didn’t have an Obamacare health insurance plan. This could be devastating to many self-pay patients who can’t afford the rich benefits package or high premiums of an Obamacare plan, but would like to be protected from unexpected major medical costs.

In what I take to be an encouraging sign, the National Association of Insurance Commissioners (NAIC) has submitted comments to HHS opposing this move. NAIC is probably as influential an organization as there is when it comes to insurance regulation, and is no foe of Obamacare, making them a highly credible and visible opponent of this proposed regulation. 

You can read the NAIC comments here, the relevant part is on pages 3 and 4. Here’s their recommendation:

The NAIC recommends that the requirement that fixed indemnity plans be supplemental be removed from the regulation and that federal and state regulators, along with consumer and carrier representatives, should work together to develop a definition that will protect consumers and also retain coverage options. In the meantime, we agree that all fixed indemnity plans must include a clear notice that the coverage is not minimum essential coverage and does not satisfy the individual mandate.

Hopefully NAIC’s recommendation will be enough to persuade HHS to not adopt this proposed regulation, which would deny self-pay patients one of the key tools that can help them to fund needed health care.

Another cash-friendly surgical center in California

Earlier this month I was happy to write about the Ocean Surgery Center, a surgical facility located in California that had begun offering real prices for self-pay patients. Randy Cox of Pricing Healthcare was kind enough to let me know about another California surgical center that has begun offering cash prices for self-pay patients, Orthopedic Surgery Center of Orange County.

I only briefly reviewed the prices given, but they seem to be in line with what you’d think a self-pay patient ought to be paying. For example, a total hip replacement has an all-inclusive price of $20,250, which compares to Healthcare Blue Book’s average cost in the Los Angeles area of about $26,000.

The facility only provides orthopedic surgery services, and therefore doesn’t have the broader range of services that you might have at Ocean Surgery Center or the Surgery Center of Oklahoma. But for anyone needing orthopedic surgical services in California or the West in general, it’s nice to see another option!

Book review of The Self-Pay Patient

One of the things that book authors are constantly looking for is positive reviews of your book. I’m no different. I’ve been thrilled to have 25 reviews of my book so far on Amazon, all of them either 4-star or 5-star. My favorite one starts “I usually only give fives to Shakespeare and Dickens. But this book will save you hundreds or thousands of dollars and give you a sense of control over your healthcare budget, so close enough…”

I also wanted to share with you all the latest review of my book, this one on Big Al’s Books & Pal’s, which got 4 out of 5 stars from Big Al. Here’s a few excerpts:

…By way of disclaimer and to expose any potential bias I might have on this subject, although the author largely keeps politics out of the discussion, ferreting out which direction he leans (left or right) is easy to figure out and happens to be the opposite from my own leanings. I’m also employed in the health insurance arena…

… I wouldn’t have been surprised to discover I had significant and far reaching issues with much of this book. It turns out I don’t … [H]is expertise on where things stand right now and how people can work within the current framework to find what works best for them is excellent. I found The Self-Pay Patient to be almost entirely free of ideology unless the author’s dislike for bureaucratic medicine falls in that category. His approach of having each individual look at their specific situation to determine what works best for them with examples is well done, laying out the considerations and his logic clearly. (Some of his examples even advise that working largely within the current system is the best choice)

I was also impressed that the author was upfront about the major problem of opting out of the current system (not having access to negotiated network discounts) and provides some strategies to deal with this…

Big Al does quibble with my recommendation that people who are self-pay and without conventional insurance might want to consider getting covered through Obamacare if they get diagnosed with a major illness or are seriously injured. Fair enough, although think I’ve explained in the past why that shouldn’t be troubling. If not, I think I know what one of my next blog posts will ned to be!

Anyways, thanks to Big Al for giving me such a great review!

I say something nice about hospitals

One of the takeaways that people may have from my book and particularly this blog is that I’m not a fan of hospitals. That’s not true, but it’s easy to see why someone might believe that – criticizing the ‘chargemaster’ billing practices of hospitals is something of a staple here at The Self-Pay Patient blog!

But, as I hope I’ve said before, when you need a hospital, you need a hospital. And the care can be excellent, particularly when you have complex medical needs. That was exactly the case with my father earlier this week – at 73 years old, a mild heart attack (so mild the EMT’s apparently didn’t even recognize that he’d had one) isn’t just a mild heart attack, it’s often only one condition or issue that needs to be dealt with simultaneously. The heart attack was basically caused by low iron in his blood, and subsequently caused fluid to build up in his lungs (it takes about 5 minutes to explain the whole thing, which I’ll spare you). And of course there were other complications as well.

So, a full-service hospital like Legacy Good Samaritan Medical Center in Portland, Oregon was exactly where someone like my father needed to be to receive the care he needed. So while I generally recommend that people avoid hospitals if at all possible, it’s important to recognize that it isn’t always possible, and the more complex your health status and treatment needs the more likely it is that you should be going to a hospital and not an urgent-care clinic, specialty or surgical hospital, or some other alternative to full-service hospitals.

The Self-Pay Patient price going up in May

I mentioned a while back that I had lowered the price of The Self-Pay Patient book from $9.95 for the paperback and $7.95 for the digital version, knocking $1 off of each price. This was largely in response to my discovering that I had unwittingly enabled a print-on-demand service that allowed other vendors to undercut my price. I’ve resolved the issue, and plan to raise the price of the book back to $9.95/paperback and $7.95/digital on or about May 1.

So, if you haven’t bought your copy yet, you might want to do so in the next few days

This entry was posted in Critical Illness, Accident, & Fixed Benefit Insurance, Hospitals, Price Transparency, Surgery and tagged , , , , . Bookmark the permalink.

2 Responses to April notes from the Self-Pay Patient

  1. Betty McGinty says:

    Hello. My husband and I are seriously considering entering into the self-pay patient arena.
    I don’t have your book yet, but am about to order it. However, I was concerned with the statement you made in this article concerning Big Al’s difference of opinion about your recommendation for self pay patients w/0 conventional insurance maybe getting coverage through Obama-care if the are diagnosed w/a major illness or a serious injury. That makes me feel uneasy about entering into this if that’s true. Your reply would help a lot in presenting this to my husband while I wait for the book to arrive. Thank you, Betty McGinty

    • sean@impactpolicymanagement.com says:

      Thanks for your question. What I basically said in the book was that if being a self-pay patient didn’t work out for a person, Obamacare can be a fallback. I’m not a fan of the idea that people should have no coverage, and describe in the book several alternative types of coverage that people can consider, like short-term insurance and membership in a health care sharing ministries. I think these will work for most people, but I’m not blind to the fact that people’s needs and conditions change, and it may not be a perfect long-term fit for everyone.

      So, for most people with unconventional coverage, getting a major illness or injury should not pose a problem financially. For the handful that it might, Obamacare serves as a ‘safety net.’

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