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Cash is not cheaper, you have to pay our list price which is an artificial made up number. It gets reduced by 70% once it's been through the Medicare ringer. And insurance/billing is not based on time, typically it is based on extent of the history, exam, and complexity of the work provided. There are five levels of care and it is hard not to meet at least the third level unless you forget to ask a bunch of important stuff. Look on your bill: what code was it? Did it end in a 2,3,4, or 5? Example: 99202 or 99214 or 99243?

Contact Michael Moore, maybe if he is interested in your case for a future Sicko 2 movie he will compensate you

Diggin said:   Hardon4life said:   First of all if this happen you need to sue the Q-tip manufacture. Get a lawyer asap.Not if it clearly states on the box not to insert into ear.

If no one stuck Q-tips in their ears, they'd go out of business. Seriously, does anyone use them for anything else?

beatme said:   tjdeak said:   The same thing happened to a friend of mine several years ago who actually did not have insurance. He said they removed the cotton with tweezers and charged him $200 b/c they considered it "outpatient surgery!!!!" I told him he should have just called me or a family member to remove it. This is why the US is in such desperate need of health care reform.

I think part of the problem is that your friend felt he needed to go to a licensed professional with years of medical training to do this.
\

$200 for putting a rigid instrument (tweezers) into someone's ear? You bet, I wouldn't do it for any less in that profession. You are partly paying for the liability of all the idiots that might get an itch and throw their head. All it takes is one, and a perforated drum along with another few thousand in medical bills that Doc A is now liable for.

If it is that easy, stay at home and just have a family member do it for you.

ruinedWallet said:   I am a long-time reader. I have learned a lot from you all. I think I have something to share that I think it's beneficial to everyone too.

One time, I got cotton stuck in my ears when that thing fell off a Q-tip. Being a FWFer, I tried to ask for the price before going to see a doctor. The receptionist asked and got all the information, and even the insurance company and plan, and said it would cost at most 60 - 100. When there, even after all the BS jokes and stuff, the doctor was done in 5 minutes. I tried to pay on the spot too, but they said the insurance company said I have no copay, and they didn't know how much to charge. But when I received the bill like 2 months later (from the doc directly, not from the insurance company), they want $180 for it. I called and asked why such a huge discrepancy, all I got was a combative, rude lip service.

I have no choice but to pay, since I don't want to ruin my credit for such a small amount. But isn't it unfair that they can lure you in with one price, and then charge you so much higher? It seems like we as a nation can tolerate this kind of situations but none other(can you imagine false advertising even for your car repair shop? Fry's ads? I know your life is a lot more precious than your Crown Vic, but hey, every doc visit shouldn't be a blank check).

I guess I can print this LA Times article out and frame it to make myself feel better:
http://articles.latimes.com/2013/jan/15/business/la-fi-lazarus-2...

Maybe the FW way to see docs is to pay cash even if we have insurance?
http://articles.latimes.com/2012/may/27/business/la-fi-medical-p...


It is doubtful that your credit will be "ruined" no matter what happens here. Did you give the doctor your SSN when you filled out all their preliminary forms? Hopefully not (I never do, even though it is nearly always on patient intake forms). I have been in an on and off billing dispute with a doctor for 4 years - despite their myriad of threats, they've never put anything on my credit file...nor did I expect them to.

First question - is the doctor an "in-network" doctor under your insurance coverage? If so, the carrier should be your man advocate.

If they are not in-network, what I would do is write a letter to the doctors office explaining that you were told the range for the service would be $x-$y, and that you are unwilling to pay an amount out of that range. No threats at first. If they don't reply, then get a little hotter...try a bbb dispute. Or just ignore the bill completely. (As long as they don't have your ssn.)

nybanker said:   It is doubtful that your credit will be "ruined" no matter what happens here. Did you give the doctor your SSN when you filled out all their preliminary forms? Hopefully not (I never do, even though it is nearly always on patient intake forms). I have been in an on and off billing dispute with a doctor for 4 years - despite their myriad of threats, they've never put anything on my credit file...nor did I expect them to.
Creditors do not need your SSN to report to the CRAs.

BostonOne said:   Creditors do not need your SSN to report to the CRAs.
Unless he lied about his name as well.

I know that this has been beat to death, but the problem stems from HOW doctors are paid; They are paid based on a complex set of rules that are primarily based on what you're able to document rather than what you actually do.

Removing a Q-tip from the ear is coded pretty much the same as removing a BB stuck in your wrist; even though one is really easy and the other requires a scalpel and stitches. At the end of the day they're both "Removal of foreign body".

Unlike lawyers, doctors don't charge "by the minute". Phone calls are free. Email is free. FMLA, disability, school physical forms are all completed for free on the doctor's time. When I spend 15 minutes with a patient, consider that my billing is a "bundle" for all possible calls and issues in the future that I do for "free". I wear my pager 24 hours a day and I have never been paid a penny for answering a page at 2AM. (I'm not really complaining... just making a point.)

school physical forms are all completed for free on the doctor's time.

I guess that I'll start sending these to you instead of their usual doctor. We get charged for them.

BrodyInsurance said:   school physical forms are all completed for free on the doctor's time.

I guess that I'll start sending these to you instead of their usual doctor. We get charged for them.


Ugh .. forms are the bane of my existence. Everyone should be charging for them - they are a huge time sink, and the scope and detail these forms require from doctors is getting more and more ridiculous all the time.

Here's my suggestion if you want to help the doctor out (maybe save on the fee): Personally, I'm not gonna charge if all you need is a signature and a line or two checked or filled out. Have your form all filled out to the best of your ability and know precisely what information you need from me. Probably 75% of people don't mention the form until the end of the visit when I'm walking out the door - at which time they present a four page form they haven't even looked at and say "hey I need this in 2 days." That person is definitely getting the fee.

Wikipedia said: Liebeck's attorneys argued that McDonald's coffee was "defective", claiming it was too hot and more likely to cause serious injury than coffee served at any other establishment.
...
Stella Liebeck, a 79-year-old woman from Albuquerque, New Mexico, ordered a 49-cent cup of coffee from the drive-through window of a local McDonald's restaurant located at 5001 Gibson Boulevard S.E. Liebeck was in the passenger's seat of her grandson's Ford Probe, and her grandson Chris parked the car so that Liebeck could add cream and sugar to her coffee. Liebeck placed the coffee cup between her knees and pulled the far side of the lid toward her to remove it. In the process, she spilled the entire cup of coffee on her lap.[11] Liebeck was wearing cotton sweatpants; they absorbed the coffee and held it against her skin, scalding her thighs, buttocks, and groin
...
Liebeck sought to settle with McDonald's for $20,000 to cover her actual and anticipated expenses. Her past medical expenses were $10,500; her anticipated future medical expenses were approximately $2,500; and her loss of income was approximately $5,000 for a total of approximately $18,000.[15] Instead, the company offered only $800. When McDonald's refused to raise its offer, Liebeck retained Texas attorney Reed Morgan. Morgan filed suit in New Mexico District Court accusing McDonald's of "gross negligence" for selling coffee that was "unreasonably dangerous" and "defectively manufactured". McDonald's refused Morgan's offer to settle for $90,000.[6] Morgan offered to settle for $300,000, and a mediator suggested $225,000 just before trial, but McDonald's refused these final pre-trial attempts to settle.
...
A twelve-person jury reached its verdict on August 18, 1994.[16] Applying the principles of comparative negligence, the jury found that McDonald's was 80% responsible for the incident and Liebeck was 20% at fault
...
Though there was a warning on the coffee cup, the jury decided that the warning was neither large enough nor sufficient. They awarded Liebeck US$200,000 in compensatory damages, which was then reduced by 20% to $160,000. In addition, they awarded her $2.7 million in punitive damages


So you're right it wasn't burning her mouth, but - let's see...

- A 79 year old woman who couldn't read the warning that *was* there because it was not "large enough" and doesn't have the a) sense to realize coffee is hot and b) motor skills to properly handle potentially dangerous items.
- She then tries to settle for $20K. When she doesn't get that she tries for $300K, and then even *after* determining she was 20% at fault she is still awarded almost $3M !

Seems awfully frivolous to me.

Nessy said:   BenH said:   While the labels of Q-tips products *may* say (I don't have a box to check) and conventional wisdom is to not stick them in your ear canal, these warnings are put there for people like the woman who sues McDonalds because she burns her mouth on hot coffee.



Are you sure it was her mouth? I think the lawsuit you are referring to had nothing to do with burning her mouth and was not the frivolous suit most people think it is.

umcsom said:   tolamapS said:   jfunk138 said:   In most other situations when business transactions are conducted the way doctors and insurance companies do them, it's called organized crime.

I agree. This could be solved in one day, with one bill from Congress.

This bill would require the following:

1. At the time of service, doctor presents an estimate of service to be performed, with estimated, not-to-exceed price,
2. Doctor reserves the right to send bill to insurance, but only with patient's approval. Doctor, by submitting to insurance, contractually agrees that if submitted to insurance, the final out-of-pocket pay to patient should not exceed price in #1,
3. The above is written on a paper, "This is a binding contract by Doctor according to US Code #abcd",
4. The above #1 and #2 and #3 are law. If doctor fails to provide the above, it is now a criminal matter.

Doctor can refuse service, but can not agree to provide service and skip #1 and #2.


You really think this would work? I will then just charge everyone 1 milllion dollars *taps fingers together* for #1. I can't believe this got green. It is stupid ass ideas like this that has caused the problem in the first place.
What an idiotic rebuttal to this idea. Not saying the idea is wonderful, but the free market would prevent you from charging an exorbitant rate. Or you would go out of business...which may be a good thing...

Psycho41 said:   Diggin said:   Hardon4life said:   First of all if this happen you need to sue the Q-tip manufacture. Get a lawyer asap.Not if it clearly states on the box not to insert into ear.

If no one stuck Q-tips in their ears, they'd go out of business. Seriously, does anyone use them for anything else?
They are great for touching up small spots on walls with paint.

seylerc said:   beatme said:   tjdeak said:   The same thing happened to a friend of mine several years ago who actually did not have insurance. He said they removed the cotton with tweezers and charged him $200 b/c they considered it "outpatient surgery!!!!" I told him he should have just called me or a family member to remove it. This is why the US is in such desperate need of health care reform.

I think part of the problem is that your friend felt he needed to go to a licensed professional with years of medical training to do this.


$200 for putting a rigid instrument (tweezers) into someone's ear? You bet, I wouldn't do it for any less in that profession. You are partly paying for the liability of all the idiots that might get an itch and throw their head. All it takes is one, and a perforated drum along with another few thousand in medical bills that Doc A is now liable for.

If it is that easy, stay at home and just have a family member do it for you.
Just an FYI, my ear drum ruptured on Monday due to a rapidly growing ear infection over a 12 hour period. My only cost was for the doctor visit to get antibiotics to treat the infection and the cost of the antibiotics themselves. At least in my case a perforated ear drum did not result in "thousands in medical bills". It heals on its own.

Ben-

You forgot to add yet another part to the McD's story:

" The decision was appealed by both McDonald's and Liebeck in December 1994, but the parties settled out of court for an undisclosed amount less than $600,000.[19]"

The woman who spilled the coffee on herself did not end up getting the 3 mill as most think and most likely all her $$$ was taken by attorney fees.

at least you got some "combative, rude lip service", worth it if it's from a hot young receiptionist.

Diggin said:   seylerc said:   beatme said:   tjdeak said:   The same thing happened to a friend of mine several years ago who actually did not have insurance. He said they removed the cotton with tweezers and charged him $200 b/c they considered it "outpatient surgery!!!!" I told him he should have just called me or a family member to remove it. This is why the US is in such desperate need of health care reform.

I think part of the problem is that your friend felt he needed to go to a licensed professional with years of medical training to do this.


$200 for putting a rigid instrument (tweezers) into someone's ear? You bet, I wouldn't do it for any less in that profession. You are partly paying for the liability of all the idiots that might get an itch and throw their head. All it takes is one, and a perforated drum along with another few thousand in medical bills that Doc A is now liable for.

If it is that easy, stay at home and just have a family member do it for you.
Just an FYI, my ear drum ruptured on Monday due to a rapidly growing ear infection over a 12 hour period. My only cost was for the doctor visit to get antibiotics to treat the infection and the cost of the antibiotics themselves. At least in my case a perforated ear drum did not result in "thousands in medical bills". It heals on its own.


There is a bone that occupies the center of the ear drum (malleus). If that was damaged by a traumatic (= blunt object striking it) peforation, you could be looking at something a bit more. But yeah, a lot of the time if just the tympanum is ruptured it can heal on it's own.

SUCKISSTAPLES said:   I wonder about that new wax vac - one would think that would Damage your eardrum


I'm waiting for the class action lawsuit on this one.

If you suck your brain out, it is more than $180 can fix.
Al3xK said:   Did you try holding a vacuum to your ear? And it says right on the box not to stick those in your ear.

The greatest healthcare system in the world! Isn't it great? What? You disagree? That must mean you are a communist that supports Fidel Castro's Cuban health care system! (sarcasm)

Not sure if this has been answered above (I didn't bother reading through all of the comments) but the bill directly from the doctor's office isn't what you should be paying. You should wait for your insurance company to send you an adjusted bill. This is basically a "discount" that you get for being with the insurance company and is basically what the doctor would be paid by the insurance company if you were to be past your deductible and had 100% coverage. If I were you, I would wait a couple months for the insurance company to send you a bill which will be adjusted and probably much lower. Also, if this is your first visit to this doctor then it will be more expensive because it is a new patient visit. Those visits are always more expensive but now you are established at that doctor and it should be cheaper.

ds394 said:   I know that this has been beat to death, but the problem stems from HOW doctors are paid; They are paid based on a complex set of rules that are primarily based on what you're able to document rather than what you actually do.

Removing a Q-tip from the ear is coded pretty much the same as removing a BB stuck in your wrist; even though one is really easy and the other requires a scalpel and stitches. At the end of the day they're both "Removal of foreign body".

Unlike lawyers, doctors don't charge "by the minute". Phone calls are free. Email is free. FMLA, disability, school physical forms are all completed for free on the doctor's time. When I spend 15 minutes with a patient, consider that my billing is a "bundle" for all possible calls and issues in the future that I do for "free". I wear my pager 24 hours a day and I have never been paid a penny for answering a page at 2AM. (I'm not really complaining... just making a point.)


No reason why doctors can't charge by the minute or in block of 20-30 minutes for outpatient visits. I would rather go to a doctor who will charge me 250 for a 30 min consultation when i know the cost of my visit before the visit. A competing doctor may charge me 100 and I may choose to go see him instead. Market and skill-set will set the price. And i would push back when my school wants some frivolous form signed cause it will cost me 200.

And your expertise is valued over the other, i will be ready to pay a higher rate. You've no paperwork to file and you get to schedule your time productively.
And you're not forced to care for anyone walking in like a hospital is required to.

Direstraits66 said:   ds394 said:   I know that this has been beat to death, but the problem stems from HOW doctors are paid; They are paid based on a complex set of rules that are primarily based on what you're able to document rather than what you actually do.

Removing a Q-tip from the ear is coded pretty much the same as removing a BB stuck in your wrist; even though one is really easy and the other requires a scalpel and stitches. At the end of the day they're both "Removal of foreign body".

Unlike lawyers, doctors don't charge "by the minute". Phone calls are free. Email is free. FMLA, disability, school physical forms are all completed for free on the doctor's time. When I spend 15 minutes with a patient, consider that my billing is a "bundle" for all possible calls and issues in the future that I do for "free". I wear my pager 24 hours a day and I have never been paid a penny for answering a page at 2AM. (I'm not really complaining... just making a point.)


No reason why doctors can't charge by the minute or in block of 20-30 minutes for outpatient visits. I would rather go to a doctor who will charge me 250 for a 30 min consultation when i know the cost of my visit before the visit. A competing doctor may charge me 100 and I may choose to go see him instead. Market and skill-set will set the price. And i would push back when my school wants some frivolous form signed cause it will cost me 200.

And your expertise is valued over the other, i will be ready to pay a higher rate. You've no paperwork to file and you get to schedule your time productively.
And you're not forced to care for anyone walking in like a hospital is required to.
This is pretty funny. You actually want time based billing as opposed to the type of billing that doctors use? The hourly billing system used by lawyers has been criticized left and right for dozens and dozens of years (in many cases with very good reason), all the issues with it are well known but you'd prefer it to the type of billing used by physicians?

Read this for good info on cash vs insurance:
http://www.fatwallet.com/forums/finance/1195281/

I found out by accident that the cash price is always lower for me. I wanted to pay cash for a Dr. exam by a specialist after the exam. They said it was $700 but they had to bill my insurance. I said no it's a high deductible and they won't pay you or me a dime so I'll pay today. It was less than $400 for cash.
Another time I got a blood test bill from my local hospital. It was $150 and I called for the cash discount. She asked if I still had the same (high deductible) insurance . I said "no I have no insurance" even though I did. I paid $80, it would have been $150 if I had said I have insurance.
I think hospitals and clinics do charge more to bill insurance, wait to get turned down, then bill and hope to get paid.

Now I always get prices in advance as a cash paying patient and shop around. If it exceeds the $5,000 deductible I'll give my insurance info, so far it never has.

geo123 said:   Direstraits66 said:   ds394 said:   I know that this has been beat to death, but the problem stems from HOW doctors are paid; They are paid based on a complex set of rules that are primarily based on what you're able to document rather than what you actually do.

Removing a Q-tip from the ear is coded pretty much the same as removing a BB stuck in your wrist; even though one is really easy and the other requires a scalpel and stitches. At the end of the day they're both "Removal of foreign body".

Unlike lawyers, doctors don't charge "by the minute". Phone calls are free. Email is free. FMLA, disability, school physical forms are all completed for free on the doctor's time. When I spend 15 minutes with a patient, consider that my billing is a "bundle" for all possible calls and issues in the future that I do for "free". I wear my pager 24 hours a day and I have never been paid a penny for answering a page at 2AM. (I'm not really complaining... just making a point.)


No reason why doctors can't charge by the minute or in block of 20-30 minutes for outpatient visits. I would rather go to a doctor who will charge me 250 for a 30 min consultation when i know the cost of my visit before the visit. A competing doctor may charge me 100 and I may choose to go see him instead. Market and skill-set will set the price. And i would push back when my school wants some frivolous form signed cause it will cost me 200.

And your expertise is valued over the other, i will be ready to pay a higher rate. You've no paperwork to file and you get to schedule your time productively.
And you're not forced to care for anyone walking in like a hospital is required to.
This is pretty funny. You actually want time based billing as opposed to the type of billing that doctors use? The hourly billing system used by lawyers has been criticized left and right for dozens and dozens of years (in many cases with very good reason), all the issues with it are well known but you'd prefer it to the type of billing used by physicians?



Will the doctors bill the same way as lawyers do, that is for every 3 minutes they bill you for an hour?

boomp said:   Read this for good info on cash vs insurance:
http://www.fatwallet.com/forums/finance/1195281/

I found out by accident that the cash price is always lower for me. I wanted to pay cash for a Dr. exam by a specialist after the exam. They said it was $700 but they had to bill my insurance. I said no it's a high deductible and they won't pay you or me a dime so I'll pay today. It was less than $400 for cash.
Another time I got a blood test bill from my local hospital. It was $150 and I called for the cash discount. She asked if I still had the same (high deductible) insurance . I said "no I have no insurance" even though I did. I paid $80, it would have been $150 if I had said I have insurance.
I think hospitals and clinics do charge more to bill insurance, wait to get turned down, then bill and hope to get paid.

Now I always get prices in advance as a cash paying patient and shop around. If it exceeds the $5,000 deductible I'll give my insurance info, so far it never has.


The reason my cash price is lower for my cash-paying patients is because I take a loss on them in order to try to provide a public service to people without insurance... Thanks for pretty much throwing that whole idea out the window.

Direstraits66 said:   
No reason why doctors can't charge by the minute or in block of 20-30 minutes for outpatient visits. I would rather go to a doctor who will charge me 250 for a 30 min consultation when i know the cost of my visit before the visit. A competing doctor may charge me 100 and I may choose to go see him instead. Market and skill-set will set the price. And i would push back when my school wants some frivolous form signed cause it will cost me 200.

And your expertise is valued over the other, i will be ready to pay a higher rate. You've no paperwork to file and you get to schedule your time productively.
And you're not forced to care for anyone walking in like a hospital is required to.


The main reason doctors can't charge by the minute is Medicare. If you accept Medicare, you have to accept their rules. The only doctors that could make it charging a time-based rate are doctors that are "Cash only".

like more and more private practice shrinks, a large percentage of whom in urban areas will not take medicare.

This strategy really doesn't make a whole lot of sense...

Ok - so on your first doctor visit you find out that the cash price is $500 and the insurance price is $1500. So you take the cash price and save yourself $1000.

On your next doctor visit you find out that the cash price is $4,500 and the insurance price is $12,000. So you take the cash price of $4,500

So you've just paid $5,000 in cash prices. If you paid that towards your deductible, you wouldn't have to pay anything more for coverage the rest of the year.

Now all your future visits you will be overpaying your deductible.

If you are going to pay cash like this, you might just as well not have insurance.

Otherwise, it only makes sense if you can "guarantee" that you cash payouts are going to be less than your deductible.

The whole reason you have health insurance is because it is INSURANCE. If you know you are only going to have to go to the doctor twice a year for a total of $1500 cash - then why would you pay for insurance at all?

You never know what is going to happen - and sure you might save some money by paying cash, but you'll be out all that plus your deductible if a big medical situation hits.

boomp said:   Read this for good info on cash vs insurance:
http://www.fatwallet.com/forums/finance/1195281/

I found out by accident that the cash price is always lower for me. I wanted to pay cash for a Dr. exam by a specialist after the exam. They said it was $700 but they had to bill my insurance. I said no it's a high deductible and they won't pay you or me a dime so I'll pay today. It was less than $400 for cash.
Another time I got a blood test bill from my local hospital. It was $150 and I called for the cash discount. She asked if I still had the same (high deductible) insurance . I said "no I have no insurance" even though I did. I paid $80, it would have been $150 if I had said I have insurance.
I think hospitals and clinics do charge more to bill insurance, wait to get turned down, then bill and hope to get paid.

Now I always get prices in advance as a cash paying patient and shop around. If it exceeds the $5,000 deductible I'll give my insurance info, so far it never has.

BenH said:   This strategy really doesn't make a whole lot of sense...

Ok - so on your first doctor visit you find out that the cash price is $500 and the insurance price is $1500. So you take the cash price and save yourself $1000.

On your next doctor visit you find out that the cash price is $4,500 and the insurance price is $12,000. So you take the cash price of $4,500

So you've just paid $5,000 in cash prices. If you paid that towards your deductible, you wouldn't have to pay anything more for coverage the rest of the year.

Now all your future visits you will be overpaying your deductible.

If you are going to pay cash like this, you might just as well not have insurance.

Otherwise, it only makes sense if you can "guarantee" that you cash payouts are going to be less than your deductible.

The whole reason you have health insurance is because it is INSURANCE. If you know you are only going to have to go to the doctor twice a year for a total of $1500 cash - then why would you pay for insurance at all?

You never know what is going to happen - and sure you might save some money by paying cash, but you'll be out all that plus your deductible if a big medical situation hits.

boomp said:   Read this for good info on cash vs insurance:
http://www.fatwallet.com/forums/finance/1195281/

I found out by accident that the cash price is always lower for me. I wanted to pay cash for a Dr. exam by a specialist after the exam. They said it was $700 but they had to bill my insurance. I said no it's a high deductible and they won't pay you or me a dime so I'll pay today. It was less than $400 for cash.
Another time I got a blood test bill from my local hospital. It was $150 and I called for the cash discount. She asked if I still had the same (high deductible) insurance . I said "no I have no insurance" even though I did. I paid $80, it would have been $150 if I had said I have insurance.
I think hospitals and clinics do charge more to bill insurance, wait to get turned down, then bill and hope to get paid.

Now I always get prices in advance as a cash paying patient and shop around. If it exceeds the $5,000 deductible I'll give my insurance info, so far it never has.


What about paying cash and then submitting to insurance for reimbursement?

BrodyInsurance said:   What about paying cash and then submitting to insurance for reimbursement?

I don't have a lot of experience with that. I have seen some people mentioning it in this thread and if you can do that, then there may be reasoning behind this strategy.

I'm sure that most of you have done something like this in the past are aware of all the problems.

First off - you need to make sure that what you are having done is covered by your insurance. I have had issues (not always first hand, but know relatives who have experienced them more) when the insurance will tell you one thing over the phone and then will refuse the claim as not covered.

Sometimes this is because the bill is coded differently, and then you need to spend hours on the phone with the Dr. and the Insurance fixing things up. In other cases, they outright provide you bad information as far as what is covered and then you can't claim it.

I suppose if you have a lot of extra time that allows you to call your insurance prior to your visits and then spend hours on the phone fighting them this may work. I suppose that some people may have a preferred insurance company and a preferred medical provider and have gotten this hassle down to a minimum for basic visits - but I don't expect it is always without issue.

I don't think this is a good strategy for most people unless they are truly made aware of the extra hassle and extra risk.

BenH said:   BrodyInsurance said:   What about paying cash and then submitting to insurance for reimbursement?

I don't have a lot of experience with that. I have seen some people mentioning it in this thread and if you can do that, then there may be reasoning behind this strategy.



FWIW, I looked into insurance a couple of weeks ago and I saw this mentioned a lot (not just in one FW thread).

However, I don't know from any personal experience if it is a viable thing to do, or not.

If you have insurance with a high deductible, it might be worth checking into a little bit to see if your insurance company would apply such cash receipts after-the-fact to your deductible.

ds394 said:   The reason my cash price is lower for my cash-paying patients is because I take a loss on them in order to try to provide a public service to people without insurance... Thanks for pretty much throwing that whole idea out the window.


That is nice of you to do this, if it involves your taking a loss for assisting those patients.

===
I have read that often a doctor's office is happy to accept cash up front, because it saves them a lot of administrative hassle in dealing with insurance companies, it helps their cash flow (since insurance payments can take months to arrive), and because insurance companies often do a back-and-forth dance of trying to deny claims or lower the amount they'll pay for a procedure. So there might be some occasions where it's better for both parties to do the transaction in cash.

===
If you are concerned that people with insurance are lying and saying they don't have it, maybe these are a couple of steps you could take to learn what the reality is for those patients:

1. One doctor in my town says on his website something like, "We are happy to work with patients who don't have insurance or who are experiencing financial hardship, to try to make their care affordable. Be aware that it is up to the patient to present us with appropriate documents backing up their situation before we will discuss such arrangements."

2. I was made aware a few years ago on FW that the national insurance industry has a database of Americans who have had any kind of health insurance at ANY point in the past 7 (or something) years. On your new-patient intake forms, you could ask for the social security number and then if the patient claims not to have insurance you could run a quick check on the health insurance database to see if the person does currently have health insurance (of course, if this database is accessible to medical practitioners and affordable for them to access).

BostonOne said:   nybanker said:   It is doubtful that your credit will be "ruined" no matter what happens here. Did you give the doctor your SSN when you filled out all their preliminary forms? Hopefully not (I never do, even though it is nearly always on patient intake forms). I have been in an on and off billing dispute with a doctor for 4 years - despite their myriad of threats, they've never put anything on my credit file...nor did I expect them to.
Creditors do not need your SSN to report to the CRAs.


While indeed true, the less roadmap you give, the better. There is no reason to give an SSN to a doctor any longer.

Further, I've overheard a few doctor office staff lament while discussing a delinquent account that they "can't report the nonpayment" without an SSN. Even though they were wrong, their ignorance is your friend.

ds394 said:   boomp said:   Read this for good info on cash vs insurance:
http://www.fatwallet.com/forums/finance/1195281/



The reason my cash price is lower for my cash-paying patients is because I take a loss on them in order to try to provide a public service to people without insurance... Thanks for pretty much throwing that whole idea out the window.


Your welcome. I'm happy to see a competing doctor.

NantucketSunrise said:   BenH said:   BrodyInsurance said:   What about paying cash and then submitting to insurance for reimbursement?

I don't have a lot of experience with that. I have seen some people mentioning it in this thread and if you can do that, then there may be reasoning behind this strategy.



FWIW, I looked into insurance a couple of weeks ago and I saw this mentioned a lot (not just in one FW thread).

However, I don't know from any personal experience if it is a viable thing to do, or not.

If you have insurance with a high deductible, it might be worth checking into a little bit to see if your insurance company would apply such cash receipts after-the-fact to your deductible.


I have a $5,000 deductible per diagnosis policy. It's really more like bankruptcy insurance. My doctors insurance person says it would work to only submit it if the bill exceeds 5K.

I have a High deductible health plan, In most cases, the explanation of benefits and revised practitioner bills are reduced to very reasonable %s. But on some tests or procedures, the insurance company (Blue Cross) say they'd pay 100% of the charge as billed if I were over my deductible. That means, I am on the hook to pay the first $1200 per year.

I wait 3-5 months till just before the billing centers or hospitals send the bill to collections. I explain I hadn't realized my deductible was so high or reset. Without fail they accept 50-60 cents on the dollar as payment in full if I agree to pay it off all at once, instead of over several months/years, on my credit card. Works for me--turns my $1200/year deductible into a $600-800 a year. Since I'm still paying WAY more than the cash pay or medicare pay rate, I can sleep just fine at night.

I was encouraged to do this by an employee's relative, who used to work in a different hospital's accounts receivables dept.

My doctor is a hot chick, so she can charge me what she wants.

Al3xK said:   ...And it says right on the box not to stick those in your ear.

The things are designed to be stuck in your ears... that crap is on the box for the same reason a Snickers bar says "may contain peanuts"... They are just covering their rears because some idiot is going to cram the thing way down there and bust his eardrum.

ds394 said:   boomp said:   Read this for good info on cash vs insurance:
http://www.fatwallet.com/forums/finance/1195281/

I found out by accident that the cash price is always lower for me. I wanted to pay cash for a Dr. exam by a specialist after the exam. They said it was $700 but they had to bill my insurance. I said no it's a high deductible and they won't pay you or me a dime so I'll pay today. It was less than $400 for cash.
Another time I got a blood test bill from my local hospital. It was $150 and I called for the cash discount. She asked if I still had the same (high deductible) insurance . I said "no I have no insurance" even though I did. I paid $80, it would have been $150 if I had said I have insurance.
I think hospitals and clinics do charge more to bill insurance, wait to get turned down, then bill and hope to get paid.

Now I always get prices in advance as a cash paying patient and shop around. If it exceeds the $5,000 deductible I'll give my insurance info, so far it never has.


The reason my cash price is lower for my cash-paying patients is because I take a loss on them in order to try to provide a public service to people without insurance... Thanks for pretty much throwing that whole idea out the window.


Being a FWF patron, I find it hard to believe that you wouldn't expect at least some people to end up paying your cash rate because it was lower. Plus, he poster was right... billing insurance has a cost to it... if you are not billing them, it is a lower cost for you, especially if you are getting paid in cash right away (time cost of money, staff submitting and following up on claims, submitting bills, stamps, paper, toner, printer wear and tear, blah blah blah).

EDIT: Not to mention the racket that doctors have in general with controlling prescription drugs, in general. For instance, about every six months (Spring and Fall) I have a reaction that swells my throat and uvula. It happens only once each of these seasons and it will go away in a day or two on its own, but the feeling is far from pleasant. So, it takes exactly 1 20mg tablet of prednisone to make it go away within a couple of hours. For me to get this, my doctor expects me to stop what I am doing (assuming it is during his office hours), drive to his office, wait, have him check me out for the same thing he has seen, over and over, write the same damned prescription, send it to the pharmacist, and then wait for it again. Why? So, he can bill my insurance for a full visit on a soft pitch. I'll gladly send him a $25 gift card to just call in the prescription. Anyhow, I now have a full bottle of it and it will last me for a good long while (not due to him, but for a script my wife had filled for other issues). I fully understand that drugs have careful considerations that should be weighed, but I am adult and any problems caused impact me and perhaps my family... it's my responsibility. If I want prednisone, I should be able to get it, period. Now, given this is on his license, I am fine with calling it in to him if he won't make me go through all of these hurdles on something he is fully aware of since I have seen him on a few occasions for. THIS is a direct contribution to the cost of healthcare.



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