Is a Cash-Only or Direct-Pay Medical Practice for You?

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From experience, clinics, whether ran by doctors or non-doctor providers, can treat most basic office visits, urgent care or regular office patients. However, the patient's 'oh, it's just pink eye' complaint sometimes requires an eye doctor to examine that day because of extensive infection or pain, or the 'oh, it's just a sore throat' is a peritonsillar abscess that requires immediate ENT doctor consultation. Nothing should ever be considered run-of-the-mill. Therefore, sometimes, emergencies hide under a cloak of the understandable patient perceptions of 'I know what I have doc attitude'.
As for surgery, forget paying cash unless you've just won the PowerBall lotto. Also, doctors don't have time to bid, they're over-worked, and likely to take a massive reimbursment cut in Medicare in October at 21%. Unfortunatley, your doctor will likely have to cut employee benefits or jobs to keep in operation like other businesses have done. With less staff, maybe it'll be harder to get in for a visit. If you have Medicare, your doctor may not accept you as a patient anymore. A true travesty!
If you pay cash for an office visit, it's a win-win for everyone! Doctor would have no accounts receivables, are happier and can spend more time with the patient not having to fight with controlling insurance companies for their money. And most importantly, the patient would save money not stuffing the pockets of insurance execs. Insurance for surgery or prescriptions yes if you can afford it! No easy answers. We will see what happens in Washington. Just food for thought!

L.W. Hightower of OK 11:15AM March 21, 2010

Preventative care should be cash only. One time my daughter had pink eye. I knew it was pink eye, I am not stupid. However, there is very little effective over the counter meds for pink eye. So I went to the Doctor, paid my $15.00 copay, was given a prescription, and got billed later for the visit. I have a PPO with a high deductible. This could have been handled by a nurse or a medical practitioner. Insurance should be for catastrophic care, but this is when insurance needs to step up and pay the costs. Also, I can't believe the cost of a mammogram should be so high. I'm also tired of subsidizing for some. It should cost the same for everyone.

dsmith of CA 1:39PM March 16, 2010

The patient needs to break out of the current paradigm on large ticket medical care. When it is not an emergency, each procedure should be bid from several doctors and hospitals for the best care at the lowest price. We don't think that way now.

td39 of IL 9:29AM March 09, 2010

How would a "cash only" practice be implemented in an orthopedic surgical practice - or any surgical practice, for that matter? The fees for spinal surgery alone, say, a lumbar fusion, can run into the tens of thousands of dollars!

Peter G. Furno of IN 11:15AM March 04, 2010

Are there any cash practices in Massachusetts as we are now an insurance manditiory state?

susan of MA 4:53PM February 25, 2010

As I read it, losing $7 per patient for a total of $80,000 per month means this operation saw an AVERAGE of 369 patients a day, seven days a week, for 31 days a month. I'm guessing that's not even remotely possible.

ABillmann of WI 4:58PM February 10, 2010

It really not that big of a difference in meaning.

Ratana of WA 11:28AM January 17, 2010

You wrote, "they were losing out on about $7 per patient, or $80,000 per month".
In an article at (http://capmag.com/article.asp?ID=1509), they wrote, "Yet we calculated we were losing approximately $7 per patient or $80,000 per month." and "The losses continued, and we depleted our total net worth and assets over a two-year period."
This is a really big difference in meaning.

Pat McGee of VA 4:10PM December 11, 2009

The reason I got a high deductible health insurance plan is because I didn't see the logic of paying $3000 dollars of premiums for an additional $2500 of coverage (100% coverage).
But since getting a high deductible plan I've been more sensative to cost and I recently balked at my kids doctor for charging $250.00 for a rushed 15 minute exam (reason: underpaid bills from Medicaid). I now got a doctor that doesn't accept Medicaid and I'm paying $138 for a visit, that didn't seem rushed and very little waiting time.

Paul N of TX 6:13PM November 12, 2009

To Vivian, who was worried about the cost of this system if you are using the doctor 4 times a month: Yes, if you go to the Doctor 50 times a year, then this will mean more out of pocket expense for you. However, this is because OTHER PEOPLE ARE PAYING YOUR BILLS in the current model. If you tried to buy insurance outside your employer and had a record of going to the doctor four times a month, you would simply be denied coverage at any cost (and if someone was willing to do it your premium would be thousands of dollars a month... much more than $66 bucks a pop).
This is exactly why the system is so messed up in the first place! "I want to be able to consume anything I want, whenever I want, at any cost, so long as someone else is picking up the bill". You are the reason that my insurance premium is so expensive. Right now, when you go to the doctor, he is charging a LOT MORE the $66 a visit (look at your insurance statement next time you go to the doc), it's just that he bills your insurance, who then raises the premium on your employer, who then docks your salary (or, as in the case of a growing number of businesses, simply drops coverage or is driven to bankruptcy if that is contractually impossible). I'm not sure what you're looking for, but when you take up the time of someone who costs hundreds of thousands of dollars and decades to train, he is going to demand reimbursement, and it has to come from somewhere... it's just that in the current situation his bills can be even larger and he has incentives to run unnecessary procedures because his customer is the insurance company.
This system isn't the only solution, but you are exactly why the insurance system isn't working and why a single-payer system is likely to fail as well.
For people with chronic or acute ailments that they cannot afford, we should have something in place to make sure that they are able to get reasonable treatment, but if most people were paying directly for what they consumed, they would be a little wiser about what they bought and doctors would actually have an incentive to lower their costs to court customers.

Ben of DC 5:06PM September 03, 2009