Do doctors reject patients that offer to pay out of pocket?

[John VN]

What happens if you don’t have the money?

Find another Dr.

 

[Marrila]

Find another Dr.

Was the money you owed your copay or was it the entire Dr fee?

 

[tink2424]

Places you can go for care without insurance, and pay out of pocket: urgent care, retail clinics, ER and concierge practices.

Most providers are employees. Admittedly, there are a few group practices that still exist, these are groups that have a lot of leverage to do so....typically expensive specialties (like neurosurg). These groups contract with hospital systems for "privileges" to practice within the hospital system facilities and they rent their offices from the hospital as well. But, your average primary care provider is more likely to be an employee of the hospital physician group. These average Joes have no say in how patients are billed.

Only a tiny percentage of what you and your insurance company pays goes into the pocket of the doctor who is seeing you. Seriously, take a look at your local non-profit hospital network, you can see how much the administrators are paid. Another thing to take notice of is their capital expenditure. You see hospital CEOs crying out that their income is down, but this is in comparison to their expenditures....they are still spending billions of dollars (collectively) on new infrastructure and the costs to reorganize constantly.

Health care was not as expensive when it was simple. Over the years, it's become BIG business. While there are well paid providers, it's the administrative staff who make the BIG bucks. On the backs of the nurses, techs, environmental services, cafeteria workers, etc, etc, etc.

^^THIS^^

As an interesting aside I was without insurance a few years ago due to an administrative error and my co-pay for my cardiologist was $50 per visit. When I didn't have insurance I paid for my visits in cash and it was only $60 so not much more than I was already paying and the full $60 went to the Dr. at that point. I think most doctors would be very happy with going cash only as it cuts down on the overhead and gives them more freedom to spend as much time with their patients as is needed.

Without going to nationalized healthcare there is a LOT that could be done to make the system work a lot better but it will be hard to implement since there is so much big business involved which means lots of lobbyists...

 

[John VN]

Was the money you owed your copay or was it the entire Dr fee?

Entire fee.

 

[Marrila]

Entire fee.

And then you had the option to file on insurance for reimbursement, is that right?

 

[John VN]

And then you had the option to file on insurance for reimbursement, is that right?

Back in 2015, DW's insurance would not cover Dr's fee for the procedure.

 

[sasywtch]

I always think of retiree healthcare benefits are something that is common in public sector jobs, and rare in the private sector. Most jobs with the State of California, you are vested in low or no cost health benefits for life if you work in the job for at least 5 years. A lot of people I worked with in their mid to late 50's get a state job just for that benefit.
I worked for 9 different corporate owners in 42 years and none offered retiree benefits, and one REQUIRED current employees to go on Medicare when they reached 65.

Unless something has changed in 7 years, you were vested at 10 years and fully vested at 20. As I worked over 20, Cal Pers pays all of my monthly insurance. For the 10 year people, Cal Pers would pay 50% of their monthly cost. While I was working, it was $200 a month so guessing if I had only worked 10 years, I would pay $100 out of my retirement check. Still not bad. When I turned 65, Cal Pers did everything for me. I just received the new senior advantage card in the mail. I see no difference in what I pay when I go to the doctor or medication. The money social security takes out of my ss check for the medi-care, Cal pers gives me that money back on my retirement check so still paying zero. I am fortunate.

 

[mousefan73]

And also requiring every American to have insurance or have to pay a penalty goes against how this country was founded.

here we go again, another social issue using the " founding fathers" arguement. I am pretty sure when the constitution or whatever was written back in the 1700s, NOBODY had medical care, died probaby around 50 and medicine was herbal tea and leeches.

Like car insurance everybody has a responsiblility to be covered. Same with healthcare as in the end we all pay. A healthy 30 year old who thinks why should I be forced to pay, might not realize he/she is a walking time bomb or will get hit by a car the next day.

Liberty or freedom is kind of out the window when others have to foot the bill

 

[Karin1984]

here we go again, another social issue using the " founding fathers" arguement. I am pretty sure when the constitution or whatever was written back in the 1700s, NOBODY had medical care, died probaby around 50 and medicine was herbal tea and leeches.

Like car insurance everybody has a responsiblility to be covered. Same with healthcare as in the end we all pay. A healthy 30 year old who thinks why should I be forced to pay, might not realize he/she is a walking time bomb or will get hit by a car the next day.

Your post made me curious about the history of health insurance. With us in the Netherlands, the first form of health insurance started around 1780s and was specifically aimed at the poor, so they weren't reliable on the church etc. to help them.

And before that, guilds probably already had some form of health insurance to help out their co-workers.

But yeah, it is a terrible argument, "because document from year 0 didn't mention it, I do not have to think about how the world might have changed'. Plus, things might be able to improve when you approach it a different way.

 

[tink2424]

here we go again, another social issue using the " founding fathers" arguement. I am pretty sure when the constitution or whatever was written back in the 1700s, NOBODY had medical care, died probaby around 50 and medicine was herbal tea and leeches.

Like car insurance everybody has a responsiblility to be covered. Same with healthcare as in the end we all pay. A healthy 30 year old who thinks why should I be forced to pay, might not realize he/she is a walking time bomb or will get hit by a car the next day.

Liberty or freedom is kind of out the window when others have to foot the bill

Overall I don't have in issue with insurance what I have an issue with is government mandated insurance. Yes, our country was founded on LIMITED government and we have become so bloated and totalitarian and socialist it is ridiculous.

Also, your examples make no sense. Car insurance?? The only apples to apples comparison would be if everyone was required to have car insurance regardless if they had a car or not. Then that would be apples to apples. Right now you are only required to have car insurance if you actually own a car.

 

[ronandannette]

here we go again, another social issue using the " founding fathers" arguement. I am pretty sure when the constitution or whatever was written back in the 1700s, NOBODY had medical care, died probaby around 50 and medicine was herbal tea and leeches.

Like car insurance everybody has a responsiblility to be covered. Same with healthcare as in the end we all pay. A healthy 30 year old who thinks why should I be forced to pay, might not realize he/she is a walking time bomb or will get hit by a car the next day.

Liberty or freedom is kind of out the window when others have to foot the bill

What type of system is in place in Germany? We regularly contrast the American system with Canadian public health care and sometimes with Britain’s NHS, but I know little of how things are organized elsewhere.

 

[Starport Seven-Five]

And yes, I agree about insurance. I was reading an article someone has written that maybe medical insurance should be for catastrophic events only (ie; hospitalizations, cancer, etc) and that your general PCP would be on you to cover as well as basic labs, prescriptions, testing, etc. The article also advocated for prices to be transparent and that is could maybe benefit the consumer more. I actually would advocate for this route as to me it seem that it is the best option for the most amount of people.

This is what I would advocate for as well which is why I wasn't upset by the taxes on "Cadillac plans" in the ACA. The only unfortunate part is most employers pocketed the savings going away from the better plans instead of giving the money to their employees... but that's capitalism I guess.

^^THIS^^

As an interesting aside I was without insurance a few years ago due to an administrative error and my co-pay for my cardiologist was $50 per visit. When I didn't have insurance I paid for my visits in cash and it was only $60 so not much more than I was already paying and the full $60 went to the Dr. at that point. I think most doctors would be very happy with going cash only as it cuts down on the overhead and gives them more freedom to spend as much time with their patients as is needed.

Without going to nationalized healthcare there is a LOT that could be done to make the system work a lot better but it will be hard to implement since there is so much big business involved which means lots of lobbyists...

We can do both a nationalized system with streamlining though and get the best of both worlds. There is no benefit to end patients from having Blue Cross Blue Shield increasing the cost of our healthcare by shuffling papers.

here we go again, another social issue using the " founding fathers" arguement. I am pretty sure when the constitution or whatever was written back in the 1700s, NOBODY had medical care, died probaby around 50 and medicine was herbal tea and leeches.

Would African American's only get 3/5ths of a leech if they had written healthcare in? What about women?

The "founding fathers" argument is always a non-starter as they were living an flawed times and gave us the tools to amend the documents. To quote Jefferson:

I am not an advocate for frequent changes in laws and Constitutions. But laws and institutions must go hand in hand with the progress of the human mind. As that becomes more developed, more enlightened, as new discoveries are made, new truths discovered and manners and opinions change, with the change of circumstances, institutions must advance also to keep pace with the times. We might as well require a man to wear still the coat which fitted him when a boy as civilized society to remain ever under the regimen of their barbarous ancestors.

 

[tvguy]

Unless something has changed in 7 years, you were vested at 10 years and fully vested at 20. As I worked over 20, Cal Pers pays all of my monthly insurance. For the 10 year people, Cal Pers would pay 50% of their monthly cost. While I was working, it was $200 a month so guessing if I had only worked 10 years, I would pay $100 out of my retirement check. Still not bad. When I turned 65, Cal Pers did everything for me. I just received the new senior advantage card in the mail. I see no difference in what I pay when I go to the doctor or medication. The money social security takes out of my ss check for the medi-care, Cal pers gives me that money back on my retirement check so still paying zero. I am fortunate.

Depends on which state agency you work for and what benefits were negotiated in their union contract. OES for example, you have completely free health insurance for life after only a 5 year vesting period.

 

[tink2424]

We can do both a nationalized system with streamlining though and get the best of both worlds. There is no benefit to end patients from having Blue Cross Blue Shield increasing the cost of our healthcare by shuffling papers.

I strongly disagree with a nationalized system. It is very easy for it to go very wrong and it really stifles innovation. There are many problems with that system that would make our situation worse, not better. There is a reason that anyone with money comes here for medical care when they have a serious situation.

Would African American's only get 3/5ths of a leech if they had written healthcare in? What about women?

The "founding fathers" argument is always a non-starter as they were living an flawed times and gave us the tools to amend the documents. To quote Jefferson:

I agree government policies need to adapt and change. I am just not for government being involved in everything. To me it should be limited and allow the marketplace to function as it should.

 

[Starport Seven-Five]

I strongly disagree with a nationalized system. It is very easy for it to go very wrong and it really stifles innovation. There are many problems with that system that would make our situation worse, not better. There is a reason that anyone with money comes here for medical care when they have a serious situation.

The rest of the world spends less with better results. They have a far better healthcare systems as a whole, even with their flaws.


Now, does the US have some specialties that we lead the world in? Sure, and it's great that a small portion of the country gets to experience that. We need to do what is best for the entire country though and this ain't it.

I agree government policies need to adapt and change. I am just not for government being involved in everything. To me it should be limited and allow the marketplace to function as it should.

You and I fundamentally disagree here as I don't think there should be a "marketplace" for basic human needs like this. Profit motive has no place in our healthcare system and the people who price gouge in this arena are some of the most shameful people on earth.

Disclaimer: This is a bit of a sensitive subject to me right now as our household has accumulated close to 200k in medical bills (before insurance pays their part) in the last couple months. It is absolutely amazing what a few weeks in a hospital costs thanks to our disaster of a medical system.

 

[tink2424]

The rest of the world spends less with better results. They have a far better healthcare systems as a whole, even with their flaws.
View attachment 787744

Now, does the US have some specialties that we lead the world in? Sure, and it's great that a small portion of the country gets to experience that. We need to do what is best for the entire country though and this ain't it.

So this graph is about life expectancy and health expenditure which doesn't really equate to quality of life and how good is your care. So not sure what this is supposed to be proving.

We agree that our system is broken and needs to be fixed. We just don't agree on the way to fix it.

You and I fundamentally disagree here as I don't think there should be a "marketplace" for basic human needs like this. Profit motive has no place in our healthcare system and the people who price gouge in this arena are some of the most shameful people on earth.

Disclaimer: This is a bit of a sensitive subject to me right now as our household has accumulated close to 200k in medical bills (before insurance pays their part) in the last couple months. It is absolutely amazing what a few weeks in a hospital costs thanks to our disaster of a medical system.

First - I'm sorry to hear about your medical debt. As I mentioned before I have been uninsured before and currently my sister is uninsured so I know a little about what you are going through. I hope you that your household is healthy again and is able to get some/all of the debt settled soon.

Now, we do fundamentally disagree. My largest issue comes down to the ability of the government to manage healthcare. A private company will maximize profits and to do that they need to meet the needs of the market. Insurance and government insurance plans have allowed these private companies to make a lot of money without being subjected to the marketplace. That is one of the items that would need to be fixed to make healthcare work for everyone and get pricing down to where it really should be.

I believe this way in part based on some of the quotes from economist Milton Friedman below:

1) You can spend your own money on yourself. ​

If you spend your own money on yourself, you’re very careful on what you spend it on. You make sure you get the most for your dollar.

2) You can spend your own money on someone else.​

When you spend your own money on someone else, you’re careful on not spending too much. You don’t worry as much about the gifts you buy for other people as the things you buy for yourself.

3) You can spend somebody else’s money on yourself.​

You’re careful to get good things for the money. But you’re not very worried about getting the best bang for your buck. You’re happier to spend more of somebody else’s money within reason.

4) You can spend somebody else’s money on somebody else.​

You become a “distributor of welfare funds.” You’re interested in making your own life as good as you can. But you’re not going to be anywhere near as careful as spending this money on other people.

He also said:

"What most people really object to when they object to a free market is that it is so hard for them to shape it to their own will. The market gives people what the people want instead of what other people think they ought to want. At the bottom of many criticisms of the market economy is really lack of belief in freedom itself."

"Nobody spends somebody else's money as carefully as he spends his own. Nobody uses somebody else's resources as carefully as he uses his own. So if you want efficiency and effectiveness, if you want knowledge to be properly utilized, you have to do it through the means of private property."

 

[mousefan73]

What type of system is in place in Germany? We regularly contrast the American system with Canadian public health care and sometimes with Britain’s NHS, but I know little of how things are organized elsewhere.

In the simplest way to say it. We have a public system where if one works a job that is taxable (basically everything over 500 a month) healthcare is automatically deducted as a "social tax". 14% split between employee and employer. there is a cap where i am at so I pay 385 a month. since I make more than the cap I can option out into "private" which in my case will be more ( you only save money if you lock in male, young, no preconditions) and might save money if above hte threshold, but warning as you age your premiums go up.

with this insurance bascially all is covered. come co-pays ( just got my retinaA prescription and have to pay 5 euros). Just got physiotheraphie 6x and have to pay 26.. Hospital stays regardless of what or how long ( might be cap) are 10 euros a day.. but there is no deductible! coverage starts right away.
Since my DH works he also pays the same.. Had I been a hausewife. I could be insurance under him in a family plan but I believe his monthly cost doesnt change. There is no per head cost, but purely income based. ( I hate this, lower my share and have per head imo). Kids are the same, no additional costs.

If one doesnt work, welfare etc.. they are covered by the govern. there are also student plans but most fall under their parents until 27 I believe.

in a nutshell as a family we pay about 700 a month (DH + my salary deductions). All in. kids included. no deductables etc.. no surprises. yes maybe we could pay less under an employer plan back in the states, but there is a peace of mind the idea of prespriction costs, or care financially is 100% covered. We can also deduct about half of what we pay a year in monthly premiums on our income taxes.

Benefit of private vs public:
1. If young and healthy and you make VERY good money you could save under the 385 a month cap. but not much and as you age most policies are dynamic
2. As you buy your own policy you can add in extras... 1. head Dr treats you in the hosptial, not some staff 2. privte room vs shared room ( though I have paid OOP for private room as cash you can "upgrade" if on public)
3. "vanity" treatment are covered. homoepathie etc...
4. Some Drs only take private

but the difference is not so great. If you have cardiac surgery or cancer the treatment is the same.

 

[mousefan73]

I always think of retiree healthcare benefits are something that is common in public sector jobs, and rare in the private sector. Most jobs with the State of California, you are vested in low or no cost health benefits for life if you work in the job for at least 5 years. A lot of people I worked with in their mid to late 50's get a state job just for that benefit.
I worked for 9 different corporate owners in 42 years and none offered retiree benefits, and one REQUIRED current employees to go on Medicare when they reached 65.

my dad had one as a UAW employee at Caterpillar, per contract they and their spouses got "free" healtcare as a retiree, before medicare kicked in. Cat then pulled this. I believe there was a major lawsuit.. Dont recall the outcome ( my dad has since passed anyways, but I remember the discussion). but many union jobs has insurance included for retirees.

 

[Karin1984]

@ronandannette
In the Netherlands nextdoor to Germany, part is paid through taxes as well. Next to that every adult has to have basic health insurance which is around 120 euro ($130) a month. If you live temporarily abroad or you are in prison, you are exempted.

All your basic care, GP, hospital, some physical therapy etc is included. You can get additional insurance for dental, but also glasses/contacts, alternative medical care, additional physical therapy. Or pay out of pocket.

There is an 'own risk'-part of max 385 euro a year on care. This is excluding GP and hospital care. That is always covered. But it can be on prescribed medication for example.

The hospital bills are paid for only if it's a necessary procedure, not cosmetic. If you need a nosejob because you have difficulty breathing, it can be covered. If it is because you do not like the shape of your nose, you have to pay for it yourself.

Children under 18 do not pay for basic care and dental care.

It is common for (larger) companies to have a deal with a health insurance company so you can get a little discount on the 120 euro. My current company is even better, paying everyone 100 euro on top of salary to go towards health insurance.

Of course, the system is not perfect, but it works for the majority of the people.

 

[ronandannette]

Thank you @mousefan73 and @Karin1984 . Very informative...and very unlike Canadian public health care.