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smartgirl3778 said:   This is true. I have read something about this. It is really cheaper if you will pay cash than insurance for Prescriptions.

I don't use my insurance to pay for prescriptions at WalMart. The cash price is cheaper than my copay!

surfcaster said:   If I could pay cash and get the same discounts my insurance company gets i would save $$$ with only a high deductible insurance plan, but no one will give you their rates. For blood work my insurance co discount for labs is 1/11th the billed amount. I've heard people without insurance brag about getting lab to discount 75%. They are still paying too much - and these are the people that need the breaks the most. On physical therapy I think my insurance co gets a 75% discount on their rate. I have heard the therary office work out deals for people without insurance by giving them 25% discount for cash. Considering they are paying cash you would think they could get the same rate the insurance cc gets.

With Labs the cash discount your negotiate before you get the test will be much higher than the cash discount after the fact. Unfortunately you can only take advantage of this if you can plan ahead, so cannot be used for unexpected medical conditions.

Cigna (HDHP) told me that I could ask for the cash price, and then file myself to apply it towards my deductible. Haven't tried it yet, though.

cr3s said:   I didn't know they can make money on a $250 CT scan. Must be overcapacity. Some administrator must have had the hairbrain idea of buying that awesome 64 slice CT scanner and now it's just sitting around collecting dust.

Here's fact: Some large publicly traded hospital chains offer cash discount to uninsured patients. The issue is that even w/ the cash discount, the indigent person would still pay more than the insurance company. Example:

Listed Price: 1000
Uninsured/Cash Discount: 40%
Insurance Discount: Usually 60%.
Medicare Discount: 75%
----------------------------------------

Medicare Rate is considered cost + ~2-5 percent. Of course, 'cost' is a game played by all providers.

Cash payments is usually good for simple office visits and labs. For complicated items, it's not so good.


Cost of l33t superduper fast CT Scanner: $OMG
Federal Healthcare Awesome Act / Stimulus / Whatever Rebate: -k*OMG
Net Cost: $x AR

CTs for $250 = OMG * (depreciation factor)
However, $250 * (num scans in a months) >> $x

Profit!

This will be a big case of YMMV. My wife had jaw surgery this year. At first the insurance said they were not going to cover it. We decided to go ahead and pay with cash. The hospital said it would be some big amount but since we would not be doing insurance they would knock off ~50-70% and if we paid in full right away they would take off another 10%.

Long story short the insurance said the week before that they would cover it. We told the hospital and they reran the numbers and we got a refund from them since the insurance cost was cheaper than cash/no insurance.

daugenet said:   ... Long story short the insurance said the week before that they would cover it. We told the hospital and they reran the numbers and we got a refund from them since the insurance cost was cheaper than cash/no insurance.
You found out that your deductible + co-pay under the insurance was much lower than your out of pocket costs. That isn't quite the point being discussed here.

daugenet said:   ... At first the insurance said they were not going to cover it. We decided to go ahead and pay with cash. The hospital said it would be some big amount but since we would not be doing insurance they would knock off ~50-70% and if we paid in full right away they would take off another 10%.
That is the point being made here. The hospital didn't give you a discount. The "discounted price" is what they are happy to receive but they will happily bill an inflated amount to your insurance company because they can get away with it.

aadam101 said:   smartgirl3778 said:   This is true. I have read something about this. It is really cheaper if you will pay cash than insurance for Prescriptions.

I don't use my insurance to pay for prescriptions at WalMart. The cash price is cheaper than my copay!


Yeah, I remember I got a prescription about four years ago and went to fill it and there was a problem with my insurance (Was switching to a new policy on Jan 15th, old one was supposed to be active until that date, but the benefit system was rejecting me on Jan 5th). The pharmacist couldn't figure out how to get it to bill. After about half an hour on the phone with my provider, I had the bright idea to ask what the cash price was.

$12. I paid it because it wasn't worth my time to clear up the problem.

BradisBrad said:   I like this idea for lower-cost things like bloodwork, CT scans, routine checkups.. But the reason I carry insurance is for the unexpected events like when I get hit by a bus or fall out of a helicopter.

What you do is contrary to what you said. If you are only worried about falling out of chopter or getting hit by a bass, you should have catastrophic insurance with a very high deductible. I am not talking about a run of the mill $5K high deductible plan. I am talking about a whopper deductible, $25K, catastrophic plan.

Much as I hate to point it out, why does someone want to be a doctor or chiropractor, when he gets paid $35 or $50 for an office visit?
Costs to run the office, and pay the outrageous insurance doctors pay, have to eat up that income pretty damn quick.
It's one thing to spew against corporate greed at Best Buy, but to cut short the guy or gal who I want to have MY best interest at heart, seems more than a tad shortsighted & foolish.

Appelski said:   Much as I hate to point it out, why does someone want to be a doctor or chiropractor, when he gets paid $35 or $50 for an office visit?
Costs to run the office, and pay the outrageous insurance doctors pay, have to eat up that income pretty damn quick.
It's one thing to spew against corporate greed at Best Buy, but to cut short the guy or gal who I want to have MY best interest at heart, seems more than a tad shortsighted & foolish.

I pay around that much for a visit to a clinic where I am examined by a RN. It usually takes no more than 5 minutes to reach a diagnosis and provide a prescription. Add another 10 minutes for simple measurements (temperature, blood pressure, weight) and review of the chart for a total of about 15 minutes. That works out to $140 to $200 per hour. Not a bad wage rate, even with all the overhead.

oopsz said:   aadam101 said:   smartgirl3778 said:   This is true. I have read something about this. It is really cheaper if you will pay cash than insurance for Prescriptions.

I don't use my insurance to pay for prescriptions at WalMart. The cash price is cheaper than my copay!


Yeah, I remember I got a prescription about four years ago and went to fill it and there was a problem with my insurance (Was switching to a new policy on Jan 15th, old one was supposed to be active until that date, but the benefit system was rejecting me on Jan 5th). The pharmacist couldn't figure out how to get it to bill. After about half an hour on the phone with my provider, I had the bright idea to ask what the cash price was.

$12. I paid it because it wasn't worth my time to clear up the problem.


It's also more convenient at WalMart. They will allow me to get a 90 day supply. My insurance company will only pay for q 30 day supply. This is what happens when consumers do not get to choose their own health insurance. Let insurance companies compete in the consumer market and watch how fast things change!

I have a supplemental insurance plan that pays set benefits regardless of what the primary insurer pays. After the deductible I frequently make a profit. I've made as much as $3000-$4000 above costs in a year (including the premium).

Argyll said:   I have a supplemental insurance plan that pays set benefits regardless of what the primary insurer pays. After the deductible I frequently make a profit. I've made as much as $3000-$4000 above costs in a year (including the premium).

Ok, I gotta know... How do you pull this off?

In the last 25 months I have been fighting cancer and my out of pocket has been under $500 for everything... Insurance has paid out over $300k

If I could roll my visits into money legally that would help pay the bills while I am out of work.

The factor here is fear, which takes us to the insurance companies, faith only belongs to those who believe in it.

Alcibiades said:   cr3s said:   I didn't know they can make money on a $250 CT scanThey should not count on actually getting that over the phone quote when you show up. The labor, lights, electricity, etc to perform a CT scan Costs more than $250

the $250 is probably w/o contrast.

Appelski said:   Much as I hate to point it out, why does someone want to be a doctor or chiropractor, when he gets paid $35 or $50 for an office visit?
Costs to run the office, and pay the outrageous insurance doctors pay, have to eat up that income pretty damn quick.
It's one thing to spew against corporate greed at Best Buy, but to cut short the guy or gal who I want to have MY best interest at heart, seems more than a tad shortsighted & foolish.


Most primary care doctors see about 12-14 patients per hour. Do the math.

DarthEnol said:   I've been doing this for years.

My approach: "Hello, Dr. 'X', I have no insurance and will be paying for this myself. I can pay you either cash or credit card, which method do you prefer and which method saves me the most?"

I typically pay cash, as the Doctors don't have to pay any CC processing fees, which saves me even more. I do get receipts of alll services rendered, for both personal and tax purposes.


Do you have a plan B for major/emergency medical expenses?

AFSOC said:   Argyll said:   I have a supplemental insurance plan that pays set benefits regardless of what the primary insurer pays. After the deductible I frequently make a profit. I've made as much as $3000-$4000 above costs in a year (including the premium).

Ok, I gotta know... How do you pull this off?

In the last 25 months I have been fighting cancer and my out of pocket has been under $500 for everything... Insurance has paid out over $300k

If I could roll my visits into money legally that would help pay the bills while I am out of work.


The plan I have is no longer offered to new members. However, there are many types of supplemental insurance plans, including some disease-specific, like cancer. It can be a little tricky as there are a lot of things they don't pay for and some odd quirks.

I got quite lucky. One of the reasons they stopped offering this plan is that a lot of people were confused and thought it was regular health insurance, only later to find there were limits and a lot of things for which there were no benefits. However, it easily covers my primary deductible and more because it offered benefits for a number of procedures I went through.

tolamapS said:   BradisBrad said:   I like this idea for lower-cost things like bloodwork, CT scans, routine checkups.. But the reason I carry insurance is for the unexpected events like when I get hit by a bus or fall out of a helicopter.

What you do is contrary to what you said. If you are only worried about falling out of chopter or getting hit by a bass, you should have catastrophic insurance with a very high deductible. I am not talking about a run of the mill $5K high deductible plan. I am talking about a whopper deductible, $25K, catastrophic plan.


Does 25K deductible even exist (as a stand alone health insurance policy)?

cr3s said:   Appelski said:   Much as I hate to point it out, why does someone want to be a doctor or chiropractor, when he gets paid $35 or $50 for an office visit?
Costs to run the office, and pay the outrageous insurance doctors pay, have to eat up that income pretty damn quick.
It's one thing to spew against corporate greed at Best Buy, but to cut short the guy or gal who I want to have MY best interest at heart, seems more than a tad shortsighted & foolish.


Most primary care doctors see about 12-14 patients per hour. Do the math.


My math says that is 4 to 5 minutes spent per patient. no way

sueruns said:   cr3s said:   Appelski said:   Much as I hate to point it out, why does someone want to be a doctor or chiropractor, when he gets paid $35 or $50 for an office visit?
Costs to run the office, and pay the outrageous insurance doctors pay, have to eat up that income pretty damn quick.
It's one thing to spew against corporate greed at Best Buy, but to cut short the guy or gal who I want to have MY best interest at heart, seems more than a tad shortsighted & foolish.


Most primary care doctors see about 12-14 patients per hour. Do the math.


My math says that is 4 to 5 minutes spent per patient. no way


And MY experience is that a Doctor's visit takes a minimum of 15 minutes, usually more.
I prefer to go to a doctor who knows me,
and who can & *will* take more than 30 seconds to scan my chart/history,
and is not so stressed that he misses the diagnosis.
Again, the financial math, $50 x 4 = $200/hr $100 x 4 = $400/hr
$200k/yr insurance = $100/hr
less: Receptionist/Nurse/Administrator
less: Mortgage/Rent + Utilities + Phone, Car, etc.
less: Continuing Education
less: Amortizing education cost (4 yrs Med school, 2 yrs Intern, 2-4 yrs more for Specialty)
etc
etc
etc

We were thinking of going the high deductible route.

My daughter had appendecitis like symptons so we took her to the ER. Long story short, after a full day in the ER, it turned out to be a virus that memics appendicitis and she was fine. Anyway, we got the bill about two weeks later and it was over $6k. The insurance only had to pay $479 and I had to pay my $100 deductible.

What a crock. Without insurance or if I had the high deductible plan, I would have been responsible for the $6k+

traderneal said:   Anyway, we got the bill about two weeks later and it was over $6k. The insurance only had to pay $479 and I had to pay my $100 deductible. What a crock. Without insurance or if I had the high deductible plan, I would have been responsible for the $6k+Did you ever ask what the cash price was?

cr3s said:   Appelski said:   Much as I hate to point it out, why does someone want to be a doctor or chiropractor, when he gets paid $35 or $50 for an office visit?
Costs to run the office, and pay the outrageous insurance doctors pay, have to eat up that income pretty damn quick.
It's one thing to spew against corporate greed at Best Buy, but to cut short the guy or gal who I want to have MY best interest at heart, seems more than a tad shortsighted & foolish.


Most primary care doctors see about 12-14 patients per hour. Do the math.


Most primary care doctors spend about 12-14 minutes per patient just filling out paperwork!

aadam101 said:   smartgirl3778 said:   This is true. I have read something about this. It is really cheaper if you will pay cash than insurance for Prescriptions.

I don't use my insurance to pay for prescriptions at WalMart. The cash price is cheaper than my copay!
While it is possible to have that, you may want to double check on that. With most large health carriers, you pay the lower of the cash price or the co-pay for your prescriptions. This way you'll never be disadvantaged by using your health policy.

On a related note, as others have correctly pointed out above, with a few exceptions insurance negotiated pricing will almost always be a lot less than the cash price. Exceptions often have to do with indigent care situations or medical settlements whereby the provider perceives the patient as being judgment proof and would rather collect something than nothing.

You also have to remember that with more complex procedures, the pricing issue often has to do with bundling. In essence, insurance companies often negotiate bundled pricing on various aspects of care, so that being told that procedure X will cost you $100 if you pay cash or $125 if you use insurance can be very misleading. That's because while the statement can be correct, with insurance bundling when procedure X is combined with procedure Y, insurance companies may not pay anything for procedure X, as they will consider their reimbursement for Y to be reimbursement for both. This can be true not just for complex surgical procedures but even for office visits that involve labs.

BrodyInsurance said:   smartgirl3778 said:   This is true. I have read something about this. It is really cheaper if you will pay cash than insurance for Prescriptions.

I can tell you that this is not true in the state of MD.


Maryland has a hospital rate setting agency, so for most things healthcare, it's "weird" when comparing to other States.

The whole subject bothers me. In the state of MD, it is illegal to charge somebody more money based upon the type of insurance that they have or whether they have insurance. Yet, they do charge everybody more. How do they get away with it? Everything has a "fake" sticker price to it and then they charge some people less.

As an example, how does it make any sense that if my son needs speech services, the agency will happily accept $24 if I have Blue Cross, but if I'm going to pay cash, they need $75?

I must add a caveat to all of my insurance posts concerning health insurance. Although I am licensed and I do make money from it (others do the work for me), I have virtually no more knowledge than anybody else. My health insurance posts are all written from the perspective of a lay person.

BrodyInsurance said:   The whole subject bothers me. In the state of MD, it is illegal to charge somebody more money based upon the type of insurance that they have or whether they have insurance. Yet, they do charge everybody more. How do they get away with it? Everything has a "fake" sticker price to it and then they charge some people less.

As an example, how does it make any sense that if my son needs speech services, the agency will happily accept $24 if I have Blue Cross, but if I'm going to pay cash, they need $75?

I must add a caveat to all of my insurance posts concerning health insurance. Although I am licensed and I do make money from it (others do the work for me), I have virtually no more knowledge than anybody else. My health insurance posts are all written from the perspective of a lay person.


Key word is HOSPITAL. MD Rate setting rules don't apply to physician offices, though I do believe there is some similar program for pharmacy.

http://www.hscrc.state.md.us/aboutHSCRC.cfm

larrymoencurly said:   samko said:   The point is not that you pay less of a premium with a high-deductible plan, but rather that people without any insurance at all who pay cash for their procedures pay less than those with insurance, regardless of deductible.Other hospitals charge cash patients more, not less, than insurance-covered patients, sometimes as much as 300% more.

This has been my experience as well. For all the threads and news stories about "cash" discounts for healthcare, I've never been able to get one. Maybe because I live in Massachusetts? You ask about "cash" discount or what the "cash" price is, and they look at you like you have 3 heads.

BrodyInsurance said:   As an example, how does it make any sense that if my son needs speech services, the agency will happily accept $24 if I have Blue Cross, but if I'm going to pay cash, they need $75?

Often how it works is, the insurance company presents the rate sheet and the physician either accepts it or not. The physician will make the calculation as to whether it is worth accepting the rate sheet in it's entirety or refusing it and not being able to take patients with that flavor of insurance.

So when you compare a specific service, such a speech therapy, the doctor may be (and likely is) losing money at the $24 price point, but is able to accept it from the insurance company because other procedures he performs are compensated better and on the whole he comes out ahead by accepting Blue Cross.

This is really the core of the reason why the health industry is so messed up, and also why the current government's current attempt to fix or improve it will fail. The fact that the same procedure can cost $6 or $600 depending on who is paying is what undermines the normal economic forces that help to regulate reasonable pricing and availability of services. Inasmuch as the government should be involved in fixing this, what they should be focusing on is increasing price transparency and regulating how reimbursements from third party payers are negotiated. Perpetuating the current "insurance" model will just make things worse.

BTW, government involvement vis a vis Medicare and Medicaid plays just as big a role as private insurers in the market's price distortions. Oftentimes Medicare rates are reimbursed as "x% of the cash rate" which encourages physicians to just raise the cash rates in order to maintain their margins.

... and this way your Dr. doesn't have to show this as income and pay income taxes on this. Very nice!

okwiater said:   BrodyInsurance said:   As an example, how does it make any sense that if my son needs speech services, the agency will happily accept $24 if I have Blue Cross, but if I'm going to pay cash, they need $75?

Often how it works is, the insurance company presents the rate sheet and the physician either accepts it or not. The physician will make the calculation as to whether it is worth accepting the rate sheet in it's entirety or refusing it and not being able to take patients with that flavor of insurance.

So when you compare a specific service, such a speech therapy, the doctor may be (and likely is) losing money at the $24 price point, but is able to accept it from the insurance company because other procedures he performs are compensated better and on the whole he comes out ahead by accepting Blue Cross.

This is really the core of the reason why the health industry is so messed up, and also why the current government's current attempt to fix or improve it will fail. The fact that the same procedure can cost $6 or $600 depending on who is paying is what undermines the normal economic forces that help to regulate reasonable pricing and availability of services. Inasmuch as the government should be involved in fixing this, what they should be focusing on is increasing price transparency and regulating how reimbursements from third party payers are negotiated. Perpetuating the current "insurance" model will just make things worse.

BTW, government involvement vis a vis Medicare and Medicaid plays just as big a role as private insurers in the market's price distortions. Oftentimes Medicare rates are reimbursed as "x% of the cash rate" which encourages physicians to just raise the cash rates in order to maintain their margins.


Except in this case, this is a place that solely does speech therapy and there are no doctors and no procedures.

BrodyInsurance said:   okwiater said:   BrodyInsurance said:   As an example, how does it make any sense that if my son needs speech services, the agency will happily accept $24 if I have Blue Cross, but if I'm going to pay cash, they need $75?

Often how it works is, the insurance company presents the rate sheet and the physician either accepts it or not. The physician will make the calculation as to whether it is worth accepting the rate sheet in it's entirety or refusing it and not being able to take patients with that flavor of insurance.

So when you compare a specific service, such a speech therapy, the doctor may be (and likely is) losing money at the $24 price point, but is able to accept it from the insurance company because other procedures he performs are compensated better and on the whole he comes out ahead by accepting Blue Cross.

This is really the core of the reason why the health industry is so messed up, and also why the current government's current attempt to fix or improve it will fail. The fact that the same procedure can cost $6 or $600 depending on who is paying is what undermines the normal economic forces that help to regulate reasonable pricing and availability of services. Inasmuch as the government should be involved in fixing this, what they should be focusing on is increasing price transparency and regulating how reimbursements from third party payers are negotiated. Perpetuating the current "insurance" model will just make things worse.

BTW, government involvement vis a vis Medicare and Medicaid plays just as big a role as private insurers in the market's price distortions. Oftentimes Medicare rates are reimbursed as "x% of the cash rate" which encourages physicians to just raise the cash rates in order to maintain their margins.


Except in this case, this is a place that solely does speech therapy and there are no doctors and no procedures.


A SLP is a licensed practitioner (like a doc), and bills all insurance carriers just like a doc. And they most certainly are performing "procedures."

http://www.asha.org/practice/reimbursement/medicare/SLP_coding_r...

Edit... I have to type this word about 70 times a day, and I still spell practioner...practicioner... practictioner wrong.

FutureDilemma said:   gatzdon said:   ...

Then after you pay, get a copy of the receipt with the icd and cpt codes and mail the receipt with the doctors order to your insurance, they will apply the amount to your deductible.

That part may not be so easy.


I have never had a problem with this, but I do tell them up front that I will need this receipt, rather than after the fact.

traderneal said:   We were thinking of going the high deductible route.

My daughter had appendecitis like symptons so we took her to the ER. Long story short, after a full day in the ER, it turned out to be a virus that memics appendicitis and she was fine. Anyway, we got the bill about two weeks later and it was over $6k. The insurance only had to pay $479 and I had to pay my $100 deductible.

What a crock. Without insurance or if I had the high deductible plan, I would have been responsible for the $6k+


That is incorrectly, with a Hight Deductible Plan, you would have had to pay $579. You make them submit the bill to the insurance first, the insurance adjusts the amount based on the "negotiated" rate, then determines who owes wait based on your deductible.

It doesn't matter wether or not you have met your deductible yet. The contracted rate is still the same.

FKAKS said:   BrodyInsurance said:   okwiater said:   BrodyInsurance said:   As an example, how does it make any sense that if my son needs speech services, the agency will happily accept $24 if I have Blue Cross, but if I'm going to pay cash, they need $75?

Often how it works is, the insurance company presents the rate sheet and the physician either accepts it or not. The physician will make the calculation as to whether it is worth accepting the rate sheet in it's entirety or refusing it and not being able to take patients with that flavor of insurance.

So when you compare a specific service, such a speech therapy, the doctor may be (and likely is) losing money at the $24 price point, but is able to accept it from the insurance company because other procedures he performs are compensated better and on the whole he comes out ahead by accepting Blue Cross.

This is really the core of the reason why the health industry is so messed up, and also why the current government's current attempt to fix or improve it will fail. The fact that the same procedure can cost $6 or $600 depending on who is paying is what undermines the normal economic forces that help to regulate reasonable pricing and availability of services. Inasmuch as the government should be involved in fixing this, what they should be focusing on is increasing price transparency and regulating how reimbursements from third party payers are negotiated. Perpetuating the current "insurance" model will just make things worse.

BTW, government involvement vis a vis Medicare and Medicaid plays just as big a role as private insurers in the market's price distortions. Oftentimes Medicare rates are reimbursed as "x% of the cash rate" which encourages physicians to just raise the cash rates in order to maintain their margins.


Except in this case, this is a place that solely does speech therapy and there are no doctors and no procedures.


A SLP is a licensed practitioner (like a doc), and bills all insurance carriers just like a doc. And they most certainly are performing "procedures."

http://www.asha.org/practice/reimbursement/medicare/SLP_coding_r...

Edit... I have to type this word about 70 times a day, and I still spell practioner...practicioner... practictioner wrong.


Ok, you probably know more than I do. They do "procedures" like testing for speech issues. The bulk of what they do, however, is ongoing speech therapy. I don't believe that they are willing to lose money on this because they can make it up on other "procedures". Instead, I think that they can function just fine on what they are willing to accept from Blue Cross. My point is simply that I don't think that it's fair to charge somebody more simply because they don't have insurance or insurance isn't paying for the service.

Example:
Jim has a $10,000 deductible. His son needs speech services. He pays $24.
Jon doesn't have insurance or won't cover speech therapy for his kid. He needs to pay $70 for his speech services.

Jon is paying more because of his lack of insurance. This is supposed to be illegal. Instead, it just gets framed that Jim is paying less.

FKAKS said:   BrodyInsurance said:   okwiater said:   BrodyInsurance said:   As an example, how does it make any sense that if my son needs speech services, the agency will happily accept $24 if I have Blue Cross, but if I'm going to pay cash, they need $75?

Often how it works is, the insurance company presents the rate sheet and the physician either accepts it or not. The physician will make the calculation as to whether it is worth accepting the rate sheet in it's entirety or refusing it and not being able to take patients with that flavor of insurance.

So when you compare a specific service, such a speech therapy, the doctor may be (and likely is) losing money at the $24 price point, but is able to accept it from the insurance company because other procedures he performs are compensated better and on the whole he comes out ahead by accepting Blue Cross.

This is really the core of the reason why the health industry is so messed up, and also why the current government's current attempt to fix or improve it will fail. The fact that the same procedure can cost $6 or $600 depending on who is paying is what undermines the normal economic forces that help to regulate reasonable pricing and availability of services. Inasmuch as the government should be involved in fixing this, what they should be focusing on is increasing price transparency and regulating how reimbursements from third party payers are negotiated. Perpetuating the current "insurance" model will just make things worse.

BTW, government involvement vis a vis Medicare and Medicaid plays just as big a role as private insurers in the market's price distortions. Oftentimes Medicare rates are reimbursed as "x% of the cash rate" which encourages physicians to just raise the cash rates in order to maintain their margins.


Except in this case, this is a place that solely does speech therapy and there are no doctors and no procedures.


A SLP is a licensed practitioner (like a doc), and bills all insurance carriers just like a doc. And they most certainly are performing "procedures."

http://www.asha.org/practice/reimbursement/medicare/SLP_coding_r...

Edit... I have to type this word about 70 times a day, and I still spell practioner...practicioner... practictioner wrong.


I'm not sure the post captures the entire story. $24 seems like either a group therapy rate (or possibly a hour rate in an clinic setting). $75 seems more like a full 1 hour individual therapy session. For $75, you might even be able to get a therapist to come to your house for the session depending on the nature of the therapy.

With many types of services, I think the insurance providers intentionally make it very difficult to compare costs/services. For something like SLP services, I wouldn't pick my provider based on price, rather I would pick my provider based on referrals/track record/personality/etc..., then negotiate a price. The effectiveness of the therapy will be highly dependent on the skill/ability/personality of the therapist.

This same goes true for your personal physician. You want a physician that you can get along with, talk to, listens to you, etc... These are getting more difficult to find. When you do find one, you will often find that they are not accepting new patients because they already have more than they can handle and care about the quality of their services.

I would recommend limiting shopping around based on price to more standardized, non-surgical procedures that are very repetitive and the outcome is relatively independent of the skill of the person performing it. Even with surgical procedures, if you are going to spend the time to shop around, I would focus more of the effort on finding a highly skilled provider rather than the cheapest provider.

Due to insurance provider practices, some services will be very difficult to shop around and others will be much easier. The one key disadvantage that we have when shopping around is that we don't know what the contracted rate is between our insurance provider and the medical provider. It varies from one provider to the next. One has to guess, then make a decision on whether to present the insurance ID up front when receiving the services.

Appelski said:   sueruns said:   cr3s said:   Appelski said:   Much as I hate to point it out, why does someone want to be a doctor or chiropractor, when he gets paid $35 or $50 for an office visit?
Costs to run the office, and pay the outrageous insurance doctors pay, have to eat up that income pretty damn quick.
It's one thing to spew against corporate greed at Best Buy, but to cut short the guy or gal who I want to have MY best interest at heart, seems more than a tad shortsighted & foolish.


Most primary care doctors see about 12-14 patients per hour. Do the math.


My math says that is 4 to 5 minutes spent per patient. no way


And MY experience is that a Doctor's visit takes a minimum of 15 minutes, usually more.
I prefer to go to a doctor who knows me,
and who can & *will* take more than 30 seconds to scan my chart/history,
and is not so stressed that he misses the diagnosis.
Again, the financial math, $50 x 4 = $200/hr $100 x 4 = $400/hr
$200k/yr insurance = $100/hr
less: Receptionist/Nurse/Administrator
less: Mortgage/Rent + Utilities + Phone, Car, etc.
less: Continuing Education
less: Amortizing education cost (4 yrs Med school, 2 yrs Intern, 2-4 yrs more for Specialty)
etc
etc
etc


Don't take my word for it. I only hire doctors to run the clinics and see their financials. And where do you get $200k/year insurance for a primary care? They pay around 50-60K/year.

Cash patients or self-pay is a nice term but a misnomer. Upwords of 90% of these patients end up not paying anything or in FW Lingo "deadbeats". In an effort to collect some money, one strategy is to bill much less in hopes that they will send some payment. This is from my 12 years working as a hospital administrator.

I would assume that most of these Deep Discount cash rates quoted by the article are intended as semi-charity for poor people who have very little money and no insurance. The hospital probably figures that getting $250 out of someone is better than billing them $1500 and then having it go to collections and eventually having to write it off as a loss a year later.



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