Cash-only Neuro-Ear Doctor in Louisiana

If you’re a self-pay patient in Louisiana and need a neuro-otologist (that’s a doctor who treats neurological disorders of the ear – I had to look it up too), I’ve got good news for you. Dr. Gerard J. Gianoli has ditched third-party payment, and gone cash only. The Wall Street Journal carried an op-ed by Dr. Gianoli today:

Saying Goodbye to Third-Party Medical Payments

The Affordable Care Act is raising costs, restricting patient choice and doctor freedom, and putting bureaucrats in the treatment room. It isn’t good—but it’s here to stay, largely intact, at least until a Republican president can work with a Republican-controlled Congress.

But that doesn’t mean nothing can be done. The onus is now on physicians to innovate and improve patient outcomes within the restrictive confines of an ObamaCare world…

If what many providers advocate is true—that doctors, not bureaucrats or politicians, know what’s best for patients—physicians must begin offering solutions. This requires thinking like entrepreneurs and innovators, not lab coats awaiting orders from outside parties on how to deliver medical care…

In 2005, well before ObamaCare, my practice in Louisiana transitioned to one such alternative: Third-party-free. Rather than deal with the hassle of private insurers or government health-insurance providers like Medicare, physicians in our practice work for patients—and no one else. When patients have a problem, they come in for treatment, pay with cash, and are out the door hassle-free. No copays. No insurers. No government…

These alternative practice models also come with enormous cost-savings potential for physicians and patients. When insurance billing isn’t involved, physicians can save an average of 40% in overhead administrative expenses, according to reporting in this newspaper, and these savings are passed down to patients in lower fees…

The whole article is great, but the Wall Street Journal does require a subscription to read it, I think.

The important takeaway is that doctors continue to bail out of third-party payment, and it’s not just primary care physicians that willing to give self-pay patients a real price that is less than what even insurers pay.

Dr. Gianoli is located in Covington, Louisiana, which is just north of New Orleans. Here’s the web site for his practice: Ear & Balance Institute.

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11 Responses to Cash-only Neuro-Ear Doctor in Louisiana

  1. Elaine says:

    Hurray!! Hope more doctors do the same thing!

  2. Congratulations to all Americans. The providers that appreciate the benefit of Doctors freeing themselves to take better care of patients, will see the benefit today. Dr. Gianoli’s patients will see it first. Many will argue against Dr. Gianoli’s decision till the evidence of benefit to ALL is beyond refute. Even then, there will be some denying that any change is good.

  3. judy ritchie says:

    My daughter had surgery on her thyroid gland a few years ago, she is 51 years old and has no insurance. Her husband has VA insurance as he is older than she is. But she has NO insurance now and is at a loss for a solution to her medical needs. What can she do???

    • says:

      Well, health care sharing ministries can be a good alternative to conventional health insurance. It all depends of course on what her needs are, and whether the thyroid condition persists or has led to other complications, or if she has other medical issues. It’s entirely possible that her best bet is to get insurance through the Obamacare exchanges, can’t really say without knowing more (and even then it’s unlikely I could say, everybody has to make their own choice as to what suits them best).

  4. Erica miller says:

    Dr Gates is a fantastic physician that accept patients without insurance. He really listens to the concerns of patients and his prices are affordable.

  5. Ron says:

    Does anyone out there know of a primary care doctor in Portland, Or sympathetic to our cause? I’ve been trying to find one for years without success, it’s so frustrating. Doctors squawk about insurance but don’t come up with an alternative for self pay. When I bring the subject up they claim to be interested but don’t do anything about it. I’m talking about GP’s. Specialists, however, seem to get it and offer discounts for self pay. At least that has been my experience. But those, GP’s/ PCP’s arrrgghhh!

  6. Paul Mullen says:

    The insurance companies are a big part of the problem with American medicine.

    So too though is the insurance-fed overuse of repetitive diagnostic tests and unnecessary procedures: because treatment is nearly-free to the patients, doctors get paid per procedure, and because lawyers are hovering to file malpractice suits if they miss anything, doctors will always perform a procedure if they feel it might be needed. Millions of hysterectomies that could be avoided. Double the number of colonoscopies than are really justified. and so on. Sick patients are given procedures that are unlikely to help much, and subject them to a lot of pain, all because the doctors are afraid of being second-guessed by a lawyer.

    This is all possible only because most patients have employer provided insurance or Medicare/Medicaid, and so do not pay (or even know) the costs of the treatment proposed for them. Doctors will almost never talk about costs.

    The solution is for patients to be given knowledge about the costs and benefits of possible treatments but that is very complicated. We don’t have an organization like Britain’s National Institute of Clinical Excellence, which looks at evidence on the effectiveness of each procedure versus the cost and pain caused. Instead recommendations are made by Medical Associations comprised of doctors whose incomes depend on performing as many procedures as possible.

    It is very difficult to even find out the total cost of a hospital visit or out-patient procedure. My cardiologist performed some tests, which found nothing wrong, but it was possible that there might be an issue not covered by those tests. So he suggested that “just to be on the safe side” I should go for a five hour long diagnostic test conducted by the hospital’s Department of Nuclear Medicine. Suspicious that perhaps I might not need that test, and worried since my insurance plan had a fairly high deductible, which I had not yet met, I called the hospital and asked the price of that procedure. The cardiologists office could not tell me, so I asked billing. First I had to reasearch the CPT code for the procedure (found it thanks to the internet). Even so, all that billing could tell me is that the hospital’s list price was $2,200 but the price I would be charged depended on my insurance company. So I asked what the agreed rate for my insurance plan was. He could not tell me: all he knew was that actual reimbursements received from insurance plans varied between $350 and $800. My insurance company could not tell me! Despite the fact that I was going to be asked to pay up to $1000 out of my pocket, no one could give me a price in advance!

    The first thing to notice is that cash patients are typically given a price that is between three and ten times higher than the insurance companies pay. You can join an association (such as Liberty Health) to get discounted rates but you will find it almost impossible to know in advance how much they will save you. For lab tests I love, who will arrange lab tests, with the same big lab testing companies your doctor uses, for as little as 1/10th of the price an uninsured person would be asked to pay.
    Unfortunately our healthcare system has become dominated by insurance (both private and government run). Employer bought insurance covers half the US population, Medicare, Medicaid, VA or other government plans another 35%. So the potential demand for doctors who refuse to take either is going to be pretty limited.
    Finally there is the problem that at any time we could be diagnosed with cancer, or some other very expensive to treat illness, or have a severe accident, and end up with a $150,000 or more in medical bills. We all need some kind of “stop-loss” insurance – a guarantee to cover medical costs in excess of 10 to 15% of our family income.

    Before more doctors can start giving discounts to cash customers we need a completely new system where everyone gets a tax-free Health Savings Account, to pay for their own medical costs, plus some kind of insurance to cover medical costs more than 10% or so of their income. All hospitals and doctors should have to post prices by law, and give estimates in advance. And all should have to offer a discount for cash payment at time of treatment which must be at least as much as they give the insurance companies.

    With patients in control, we will soon start to reduce the high cost and poor results of the US Health Care industry.

  7. cheryl hayes says:

    outrageous premiums and deductions are making life maxium difficult for the family i know. how can they begin to be on self pay instead of insurance.

    • Sean Parnell says:

      Easiest thing is to just do a little research, and find out how to best become a self-pay patient. Sharing ministries, cash-only doctors, critical illness plans, Minute Clinics – there’s no shortage of options!

  8. Paul wrote,

    “All hospitals and doctors should have to post prices by law, and give estimates in advance. And all should have to offer a discount for cash payment at time of treatment which must be at least as much as they give the insurance companies.”

    I emphatically disagree with your proposal because it means having government forcing medical care providers–ultimately at gunpoint and the threat of murder (yes, that’s what enforces any law)–to post their prices and offer discounts. This is a flagrant violation of private property rights and the right of freedom of contract and association of all parties to the transaction.

    Restaurants and many other types of businesses routinely–voluntarily–post their prices since they understand that doing so makes logical sense from a marketing and competitive standpoint. Medical care providers can do the same. If a doctor or hospital should (foolishly) refuse to disclose the price before treatment is provided, the patient can refuse to do business there and seek competitors who disclose fees before service is rendered.

    As for cash discounts, this must be at the medical care provider’s discretion as to whether or not to offer one, for it is the provider’s time and labor–his/her private property–that the patient is obtaining; therefore, government has no rightful business mandating discounts, just as it has no business dictating what a provider charges for services rendered.

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