More cash-only and cash-friendly doctor’s offices, Part II

Yesterday I wrote about four cash-only and cash-friendly doctor’s offices. Without further introduction, here’s four more that self-pay patients should know about.

Dr. Kathleen Brown, Coos Bay, Oregon

As a native Oregonian, I’m always pleased to run into someone else from the rain-drenched state. I was fortunate enough to do so at a recent meeting of the Association of American Physicians & Surgeons (AAPS), Dr. Kathleen Brown of Coos Bay, Oregon. She’s a dermatologist who in 2011 decided she’d had it with bureaucratic medicine and instead set up her own cash-only practice on the Oregon Coast. Here’s how The Lund Report, an Oregon-specific site focused on health care, reported on her switch:

Coos Bay Dermatologist Strikes Out on Her Own, Abandons Billing Codes

December 15, 2011 – In July, Dr. Kathleen Brown decided to leave the Coos Bay clinic where she’d been practicing since 1997 and open her own dermatology practice. [Brown] …decided to eschew the use of CPT codes, a set of medical billing codes required by the American Medical Association for reimbursement by insurers.

Processing patients according to the codes was eating up too much time, she said. Instead, she switched to a time-based model that bills patients in five-minute increments, using a tiered pricing structure that adjusts the costs based on what type of procedure is needed. Prices are listed on her website. Although patients pay out of pocket, the price is still lower than it might be if they billed insurers themselves.

Brown sees a mix of insured and uninsured patients, and she now sees herself as working for the patient — not insurance companies and not the government. “I think something pretty much everyone agrees on is that the way we pay for healthcare is broken,” she said.

The pricing for Dr. Brown’s dermatological practice is pretty straightforward. For example, a ‘Level 1’ visit lasting 15 minutes and addressing fairly simple or routine issues would cost $69. A more complex ‘Level 2’ visit lasting 20 minutes, which might include a biopsy or removal of a skin cancer that doesn’t require stitches, would cost $112. A ‘Level 3’ visit, which typically requires sutures or sterile technique (I’m not sure what exactly that means, I’m just taking it off her website) and lasting 30 minutes would cost $198.

Those prices may seem a little steep to some self-pay patients, but I think it’s worth keeping in mind that Dr. Brown is a specialist, which almost always costs more than primary care. And Dr. Brown’s price is a bargain compared to what someone with insurance and a high deductible might otherwise pay. According to Healthcare Blue Book,  removal of a malignant skin lesion (which I’m guessing is comparable to a ‘Level 3’ visit), is $845 in the Coos Bay region. That’s for an hour-long procedure, which on Dr. Brown’s price sheet would come to $396, less than half what insurers pay.

If you’re anywhere along the Oregon Coast or within an easy drive of Coos Bay, as a self-pay patient I hope you’ll be filing Dr. Brown’s contact info away for future reference. Her office is located at 620 Commercial Avenue in Coos Bay, right next to the Bay Area Hospital, and her phone number is (541) 267-0347.

Southdale Internal Medicine, Edina, Minnesota

Yesterday’s post included a couple of doctors from Minnesota, and I’ve got another one to report on today. Southdale Internal Medicine is located in Edina, Minnesota, just outside of Minneapolis. It’s a five-physician primary care practice. Dr. Merlin Brown, one of the five, spoke at the AAPS conference which is how I learned of his practice (and to the best of my knowledge, he’s not related to Dr. Brown of Coos Bay).

Southdale Internal Medicine has two basic types of visits listed on their fee schedule, ‘Focused’ which cost $80 and usually last around 15 minutes, and ‘Complex’ which last around 30 minutes and cost $120. The very helpfully include a list of conditions that typically are classified as either Focused or Complex.

On the Focused list are things like bladder infection, cough or bronchitis, ear wax removal, mono, strep throat, minor burns, stitch or staple removal, and shingles. On the list of Complex issues are conditions such as chest and abdominal pain, depression, and management of chronic conditions.

They also offer a package for enhanced access and additional services. For an additional $300 per year a patient can have the ‘Enhanced Primary Care’ package, which includes access to your doctor through phone, text message, and e-mail, as well as same-day priority scheduling and other benefits. Each visit to the doctor’s office is still charged according to the regular fee schedule. Without this package, patients pay $40 for a phone consultation.

For $118 a month for the first patient and $68 for each family member thereafter, patients can get the ‘Total Health’ package which more closely resembles a direct primary care practice. These types of practices typically allow unlimited visits for a fixed monthly membership fee (they’re different from concierge medicine in that they typically cost much less and concierge medicine frequently exists alongside insurance, while direct primary care operates without any insurance company involvement).

In the case of Southdale Internal Medicine, the Total Health package provides unlimited visits, access to your doctor through phone, text message, and e-mail, all necessary lab tests, same-day priority scheduling for appointments, and a chest x-ray.

The blending of a traditional fee-for-service cash-only practice with a direct primary care practice isn’t something I’ve seen before, but I think it offers the best of both worlds. For patients who rarely see doctors and don’t expect to need much medical care, joining a direct primary care practice usually isn’t a good value. Likewise, patients who do regularly see doctors can rack up big medical bills even if they’re visiting cash-only doctors that charge less than conventional doctor’s offices. By offering both fee-for-service and a direct primary care option, Southdale Internal Medicine may just have found the model that more and more cash-only doctors will adopt in the future!

One final note about Southdale Internal Medicine – unlike most cash-only practices, they do accept Medicare patients and are able to bill Medicare.

Anyone looking for an affordable primary care physician in the Minneapolis area that caters to self-pay patients would be well served to check out Southdale Internal Medicine, which is located at 6545 France Avenue South, Suite 510, in Edina, Minnesota. They can also be reached by phone at (952) 927-7079.

Dr. Mary Eldridge, Kenosha, Wisconsin

Dr. Mary Eldridge and her practice, Lipid Specialists, are located in the southeast corner of Wisconsin, about 60 miles north of Chicago and 40 miles south of Milwaukee. Dr. Eldridge is a specialist who focuses on ‘cardiovascular disease, high blood pressure, prediabetes, and diabetes prevention, diagnosis, and management.’

Dr. Eldridge describes her practice and fees as follows:

Lipid Specialists, S.C. is a “cash or charge” practice in which the patient is not controlled by insurance companies. Without the red tape, saving your life can be the primary focus. This is a practice where your concerns are heard and the concerns you should have are addressed. In an era when the health care system is failing to provide personalized prevention and management of diabetes and cardiovascular disease, it is time to take back control of your life, and Mary Eldridge, M.D., wants to help you. She will provide you with access to the recommended testing and treatments that you need and deserve…

Appointments are scheduled in half-hour increments, with one hour (two half-hour segments) costing $100. The price varies depending on how long each appointments will require. Payments for your appointment must be made when you arrive at the office in the form of cash, debit or credit card. Patients are given a receipt. The receipt cannot be submitted to an insurance company but you may be eligible for reimbursement upon submission of the receipt by your flexible spending account (FSA).

$50 for half an hour with a doctor. I suspect there are people with conventional ‘comprehensive’ insurance who would do just about anything short of murder for that much time with a doctor focused on them and their medical needs, especially in the era of 7 minute visits for a $35 co-pay!

Self-pay patients in southeast Wisconsin and northeast Illinois struggling with high cholesterol, obesity, heart disease, diabetes, or any of the other conditions treated by Dr. Eldridge now have a cash-only option available to them. Dr. Eldridge is located at 1400 75th Street, Suite 5 in Kenosha, Wisconsin, and can be reached at (262) 656-1911.

Dr. Maribel Aviles, Orlando, Florida

A new cash-only practice opened just this week in Orlando Florida. Started by Dr. Maribel Aviles, Innova Medical Care is a direct primary care practice. This means that patients pay a monthly fee and are able to see Dr. Maribel whenever they need to.

Dr. Maribel explains her practice this way:

A  Direct Primary Care practice (or DPC) is a model where the physician gives care directly to you without insurance intermediaries or the ‘middleman’.   In this setting, the physician does not accept nor contracts with insurance companies. Patients are served for a recurring low  monthly fee for most of their outpatient routine and preventive medical care in a more personable way. Therefore, we can lower overhead by not having to deal with regulations and requirements from health insurance companies, and as a result lowering medical cost!

Many times patients get scared about this. But don’t, for most of our patients actually save money as a DPC member. In addition to savings benefits, you get the most personable, all- about- you, type of medical care, where you do not feel rushed, ignored nor disrespected.

The pricing structure for patients at Innova Medical Care is, as usually, very straightforward. There’s an initial enrollment fee of $75, although for families that’s capped at $200. Monthly fees vary by age, starting at $25 for teens, $40 for those 20 to 40 years old, and $50 for those between 41 and 64. Patients who are 65 or older can also be members of Innova Medical Care, for $60 a month. The maximum a family would pay in monthly fees is $150.

As is standard at direct care practices, patients get unlimited visits, access to their doctor by phone and e-mail, a number of tests are included, appointments are typically same-day, and the doctor does make house calls.

Another feature of Innova Medical Care is that they also offer fee-for-service prices for walk-in patients who aren’t members. Here too the pricing is very simple – $100 for a first visit, $75 for subsequent visits. One nice thing about these charges for walk-in patients is that if they then decide to become a member, the charges will be applied to their monthly membership fees.

Finally, Innova Medical Center does include a focus on patients with fibromyalgia, a condition that causes severe and debilitating pain throughout the musculoskeletal system and other serious problems including fatigue and memory problems. They’re a great option for any self-pay patient in the Orland area, but especially for anyone suffering from fibromyalgia.

Dr. Maribel and Innova Medical Center are located at 2822 South Alafaya Trail, Suite 160 in Orlando, Florida and can be reached at (407) 394-1336.

To be continued… (again)

I’ve got at least one more post to do with more doctors catering to self-pay patients, hopefully this week or early next! Again, if you know of any more that I haven’t covered here before, or if you have an update or want to share you r experience at a cash-only doctor, drop me an e-mail at selfpaypatient [at] gmail [dot] com.

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One Response to More cash-only and cash-friendly doctor’s offices, Part II

  1. Jerome Bigge says:

    It should be noted that in some countries, the patient pays the doctor, then submits the bill to their insurance company which pays a fixed benefit for that service. I believe this is the way it is done in France. Patient pays doctor at time and point of service, gets a bill for services rendered, turns the bill over their insurance company (non-profit) which then pays the individual back minus a deductible. So doctor doesn’t need a billing service, or determine what the patient’s insurance is. They simply provide the service. The patient gets the major portion of the bill back as a payment from the insurance company. At one time this sort of thing was commonplace here in the US too.

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