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:

Doctor as renegade — accepts cash, checks, eggs or pie, not insurance

Osakis, Minn. — Dr. Susan Rutten Wasson sits on the corner of a bed in the cramped bedroom of Alice Johnson, a 91-year-old Osakis resident everyone calls “Grandma Alice.” She’s examining Johnson’s arm, which is swollen, she’s determined, because of a tight sleeve cuff.

Also in the room are Alice’s daughter, Ione, and granddaughter, Anne, who lives downstairs in the farmhouse Johnson has occupied for decades. A Rottweiler mix as big as a Shetland licks the face of 18-month-old Sarah, Rutten Wasson’s daughter, who sits on the doctor’s lap.

It’s more a scene from the days of frontier medicine than from the modern health care system. And that’s because Rutten Wasson, 42, is a throwback to a time before HMOs, electronic health records and hospitals with fountains in their lobbies. She sees patients the same day they call if she’s not booked up, spends at least a half-hour per visit — compared to the more typical 15 minutes — and usually charges only $50 for a consultation. She takes cash or check, but no insurance — and sometimes accepts gratuities of a dozen fresh eggs or a pie…

In an era of high overhead, ever more byzantine regulations and payment models, cuts to Medicaid and Medicare benefits, and large medical systems swallowing independent practices, Rutten Wasson relishes her straight-forward manner of practicing. Since many federal health care reforms — such as those requiring electronic medical records — are tied to Medicare, they tend not to apply to her…

Not surprisingly, Dr. Wasson was driven to practice as a cash-only doctor in large part by her experience working for a large medical facility where the cost of care was driven up by administrative overhead and also the common practice of charging the uninsured a higher price for treatment:

What bothered Rutten Wasson most, though, was that she couldn’t give a break to patients without insurance. “It’s hideously unfair that uninsured people are given a bill for $375 and are expected to pay the whole thing, while the insurance company pays between 60 and 75 percent. It’s not right. People without insurance are subsidizing people who have it…”

Her clientele are people who can’t or won’t go elsewhere: people with no insurance or high deductibles, people looking for second opinions, Amish people and Latinos. Rutten Wasson, who speaks “medical Spanish” with ease, serves immigrants working in the area’s dairies and meat packing plants. Other patients come from as far away as Bemidji and the Twin Cities, she says…

If you live in the general area of Osakis, Minnesota, and are looking for a primary care physician that caters to self-pay patients, Dr. Wasson seems like a pretty good option! Her office is located at 200 W Nokomis St in Osakis, and her phone number is (320) 859-2366.

Dr. Don Gehrig, St. Paul, Minnesota

The AAPS event I attended was in Minneapolis, Minnesota, so there were more than a few doctors from that area whom I met. In addition to Dr. Wasson, I was able to listen to Dr. Don Gehrig, a specialist in internal medicine. He’s relatively new to cash-only, dropping Medicare and Medicaid as well as other insurers starting in 2012. He gave an excellent presentation to attendees describing his practice, which I’ve inserted below:


He’s discussing the benefits for doctors of adopting cash-only and cash-friendly practices, and his audience is fellow doctors, so the video may not be relevant to everyone (although I think understanding why doctors embrace these sorts of practices is important for self-pay patients too). But if you’re in the Minneapolis area and looking for a cash-only internist, Dr. Gehrig may be worth checking out. His office is at 393 Dunlap St N Suite 834 in St. Paul, Minnesota, and his phone number is (651) 644-5610.

 Dr. Lawrence Huntoon, Derby, New York

Another speaker at the AAPS event was Dr. Lawrence Huntoon of Derby, New York, which is in the Buffalo region. Dr. Huntoon is a neurologist. His practice is called Private Neurology, and he typically treats patients with headaches, lower back and neck pain, Parkinson’s and Alzheimer’s, seizures and epilepsy, and other serious conditions affecting the brain and nervous systems.

His web site describes his practice this way:

Private Neurology is a third-party-free practice. That means that I do not allow any insurance or government bureaucrat to interfere in your medical care. Physicians, not HMO or government bureaucrats, should be the ones practicing medicine. I also believe patients are smart enough to make their own medical decisions, with the advice of their physician, and Private Neurology puts patients back in charge of their own medical care. I work directly for patients, not for government or HMO bureaucrats (bureaucrats who often work against the best interest of the patient). I practice medicine not bureaucracy.

Because I am free of the coercion, restrictions and health care rationing imposed by Medicare, Medicaid, HMOs and other third parties, I am able to provide a totally objective assessment of your condition and can recommend a treatment designed to meet your individual needs.

Private Neurology also believes in protecting patient privacy in accordance with the Oath of Hippocrates. Since I am a non-covered entity under HIPAA, your medical records are safe from the increased risk of disclosure under HIPAA law.

Like nearly all cash-only practices, Dr. Huntoon’s rates are very simple. An initial consult is $100, and each follow-up visit is $40. There are a few additional fees for specific diagnostic tests, and house calls are 150% of the standard fee, so $150 for a first visit and $60 for subsequent visits. I believe I mentioned in the past that my wife suffers from severe migraines and she’s seen neurologists for treatment in the past, so I’ve seen just how expensive neurologists can be. Dr. Huntoon’s rates a bargain, plain and simple, and I’d bet just about every migraine sufferer in the country would weep for joy if they found a neurologist who made house calls like Dr. Huntoon.

Dr. Huntoon’s practice is located at Chapel Park Villa, Suite 6, 7008 Erie Rd. (Route 5) in Derby, New York and his office phone number is (716) 627-7759.

Dr. Lawrence Robbins, Northbrook, Illinois

I had nearly forgotten until I wrote about Dr. Huntoon above and mentioned the fact that my wife has seen neurologists to help deal with her migraines, but the first neurologist she saw who was ever helpful (I’m using her words here) was, in fact, a cash-only doctor by the name of Dr. Lawrence Robbins who practices in Northbrook, Illinois, part of the greater Chicago area.

The idea of a doctor who didn’t accept insurance was a bit shocking to my wife at first – wait a minute, isn’t this what I have insurance for? – but her migraines were so severe that she was willing to try just about anything, even some crazy neurologist who wouldn’t take her insurance. It helped that he was highly recommended by another migraine sufferer.

Suffice it to say that Dr. Robbins proved just why he was so highly recommended. His practice is called Robbins Headache Clinic, and although it’s been several years since she’s seen him (we moved away from the Chicago area in 2007) she still speaks very highly of him and the fact that he didn’t have to check with the insurance company to see what treatments they would or would not cover.

Dr. Robbins’ site doesn’t talk much about being cash-only, unlike most doctors who have adopted this type of practice. The only place this is mentioned is on the site’s section for Your First Visit, where it explains their rates and billing policy:

During your first session, the doctor will talk with you about your symptoms and discuss a treatment plan. There are many new, safe, and effective ways of treating headache patients. Initially, you will spend about 60-90 minutes at our office. Before your first visit, please complete our intake forms and bring them in with you. You can download the forms from the “New Patients” section of our website.

The initial visit usually costs approximately $280. Return visits are $110 to $140. PAYMENT IS REQUESTED AT THE TIME OF SERVICE. Checks, Visa, MasterCard and Discover are accepted. We do not directly bill any insurance. You may submit our bill to your insurance company for reimbursement.

$280 for an initial visit and $110 to $140 for follow-up visits is definitely on the high end of cash-only medicine, although for a highly-regarded specialist it doesn’t seem quite so much. And as just about any serious migraine sufferer will tell you, they’d gladly pay just about anything to effectively treat them, and Dr. Robbins certainly was a bargain for my wife and I. If you live in the Chicago area and are looking for a cash-only headache specialist, I highly recommend Dr. Robbins. His office is located at 60 Revere Drive, Suite 330 in Northbrook, Illinois, and his phone is (847) 480-9399

To be continued…

I have several more cash-only practices around the country that I’ll be writing up in the  next several days. In the meantime, if you’re aware of a cash-only or cash-friendly practice you’d like me to feature on The Self-Pay Patient blog, please let me know about them my e-mailing me at: selfpaypatient [at] gmail [dot] com and I’ll include them in future posts!

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4 Responses to More cash-only and cash-friendly doctor’s offices, Part I

  1. Pingback: More cash-only and cash-friendly doctor’s offices, Part I | Free Market Medical Association

  2. Good afternoon,
    It is always encouraging to hear of others who are forging backwards into the time before insurance and government payers invaded the privacy of a physician-patient visit. Healthcare is an area where we need more of this going backwards in order to move forward out of our health crisis.
    Hopefully, in a few months, you’ll be able to blog about Sanctuary Medical Care and Consulting having arrived in Nashville (early 2015 launch). I’m working hard to bring simple house calls and direct primary care medicine to Nashville’s families.

    Eric Potter MD
    Sanctuary Medical Care and Consulting
    Wholistic healthcare for the glory of God. (Col.3:23)

  3. Jerome Bigge says:

    Deregulation of health care will lower health care costs by a considerable amount. My blog “muskegonlibertarian.wordpress.com” goes into details as to how this could be done. Repeal of prescription laws is the first step towards “medical freedom” as it eliminates the legal monopoly doctors now enjoy over access to medical drugs.

    Replacement of health insurance by “Medical Savings Accounts” using pretax income allows people to make their own decisions over health care. Additionally, given the 20% minimum overhead of insurance companies, those with medical savings accounts are already 20% better off and also have the choice of making their own decisions about treatment instead of doctors and insurance companies. Additionally Medical Savings Accounts should offer the right to invest the money where it will receive interest. Currently a return of 5% is not that difficult to obtain with stock and bond index funds, making Health Savings Accounts a personal account that will continue to grow until needed, further reducing the need for health insurance for most people except for perhaps a “major med” policy with a large deductible.

  4. Regardless of ObamaCare, “Self-Pay” Primary Care Practice Models Will Thrive!

    Even before ObamaCare, as a direct result of diminishing reimbursements and rising overhead costs, many Primary Care Physicians (PCPs) retired early, abandoned their practice or joined primary care groups to share overhead. Some refused to accept government or private insurance, opting to change their insurance-based practice to a “direct-pay” business model (self-pay). Currently in the USA, direct-pay accounts for 4%-6% of primary care medical practices – and growing. Even In England, where they have socialized medicine for several decades, it is growing at 5% per year.

    Stressed Primary Care Physicians

    Today PCPs typically get paid about 20% – 25% of their billed amount, while shouldering labor-intensive collections effort. Thus, by not accepting any form of health insurance, we eliminate unnecessary employees, which allows for a lower overhead, which in turn allows us to charge only $75 per visit.

    More Patients and Less Primary Care Physicians = Long wait-times for appointments

    ObamaCare will add 32 MM patients to the insurance rolls; and, by the government’s own admission, they expect a shortage of 52,000 PCPs by 2020. Even with the full implementation, they also predict that over 30 MM people will remain uninsured (you read correctly)! This will lead to congestion: in Massachusetts, with its mini-ObamaCare, the wait time to see a PCP is about two months; and, if patient care in Veterans Hospitals is any indication of things to come, long wait-times to be seen by a physician will be the norm.

    Gaming the System: Small Penalties vs High Premiums vs Lifestyle

    Small penalties for not having health insurance will likely lead to people who will game our healthcare system, resulting in higher premiums for those who comply, e.g., a thirty year-old earning $30,000 per year will pay about $300 per month. At that age there is very little thought given to illness or accidents. So, knowing that – by law – hospitals must treat uninsured patients, it might be a good gamble to lease a new BMW instead of paying for mandatory health insurance.

    A new congressional report estimates more than 25 million Americans without health insurance will not be made to pay a penalty in 2016 due to an exploding number of ObamaCare exemptions – serving as another loophole for not buying health insurance.

    Growing Premiums with Deductibles of $5,000 to $9,000

    Many insured patients with mandatory high deductibles may shop around for low prices, even if they have to pay out-of-pocket. Then, there are the middle-middle and some upper-middle class who cannot afford their monthly insurance premium, which can only continue to rise. The poor will receive free healthcare via Medicaid, and the lower-middle class will receive subsidies.

    Fraud —> Higher Premiums —> More Uninsured Middle-Middle Class

    By the Government’s own admission: although the IRS will play a key roll in ObamaCare, there is no system in places to monitor income requirements for subsidies, they will rely on the honor system. This will lead to fraud and higher premiums from insurance companies. The poor will not be affected but many in the middle-middle class may not be able to afford higher premiums; and, they will also seek out affordable “Self-Pay” PCP and diagnostics proposed herein.

    Questionable Legality of Federal Subsidies

    Two US judicial panels recently issued conflicting rulings over the federal government’s ability to offer subsidies to 5 of the 8 million consumers who signed up for insurance this year. This will most likely require Supreme Court intervention; and, depending on their decision, many who now qualify for government subsidies will be unable to afford health insurance.

    Small Employers Wanting to Give Workers Some Coverage

    Small employers with less than 50 employees will be looking to offer their employees some form of primary care health coverage. A recent book by Ezekiel Emanuel, one of the architects of ObamaCare admitted that only 20% of employer-based health insurance will exist within 10 years. This is not surprising considering that employers with over 50 employees will only be fined $2,000 per year per employee for whom they do not provide health insurance. Thus, anywhere from 50MM to 80MM employees will be shunted to the health insurance exchanges. This is an excellent market for memberships.

    Flying Under the Radar

    In as much as young, uninsured workers will still require an occasional visit to a PCPs; and, since our Direct-Pay model is not required to report to private or government insurance companies, the government will not be able to identify them – until they are forced to enter the governments’ healthcare data base, e.g., hospitalization or a hospital emergency room. These, mostly young individuals are an obvious pool of potential patients to Direct-Pay models.

    Privacy of Medical Records

    Being that SelfPayMD will not accept any form of private or government insurance, we are not required to upload our patients’ medical records to the government’s data-hub. Thus, our patients’ medical records and personal information are safe from government scrutiny and possible hackers.

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