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> a) I have no primary care physician because I don't typicaly go to the doc for any reason This is circular... you saying you don't go to the doctor because y

> a) I have no primary care physician because I don't typicaly go to the doc for any reason This is circular... you saying you don't go to the doctor because you have no PCP, and you don't have a PCP because you don't go to the doctor > c) going to the doctor involves triggering an expensive and difficult to predict system that will possibly bankrupt me. I'm having a hard time believing that a standard outpatient visit would bankrupt you. These are typically on the order of $100, and rarely more than a few hundred unless you're going in for specialized procedures, which you've already established you aren't. Sure, if you go to the doctor, you might find out you have a more serious condition that would require future, longer-term care to address, and that future care may involve additional expenses and inpatient care which you may or may not be able to afford. But that's hardly a reason not to go to the doctor today and find out - at least you'd be able to make that decision on an informed basis.

tacomonstrous 9y ago
Having grown up in India, even after I've spent almost my entire adult life in the US, I'm still reluctant to go the doctor here. In India, the process is very simple: you call the doctor in the morning, you get an appointment for the afternoon, you show up, get looked at, pay the cost of the visit (usually less than $10-15), and you're done. It's basically like any other business transaction. So even if I had a minor seeming infection, going to the doctor was the right and efficient move. Here, I call the doctor's office, and might not get an appointment for another two months, if I'm lucky. At that point there is some opaque process involving my insurance, and it just seems like a much weightier event than a simple visit should be. Of course, I'm guessing that an infection would speed up the process, but the psychological barrier is already up in my mind, and I'd rather just power through on my own. But there seems to be some hope. Recently, my wife was able to go to an urgent care clinic to treat an infection, and the process was much more like what happens in India. Still, there is some intervention of insurance, though a bit more transparently so.
- ams6110 9y ago
  As I'm sure you know, there are urgent care clinics everywhere in the USA for minor ailments and injuries, where you can be seen on a walk-in basis and pay cash if you want to.
- scarecrowbob 9y ago
  When my kid dislocated his hip, I took him to an urgent care clinic, and the process was similar. They did refer me to an orthopedist and I ended up being out about $450 dollars after they looked at an some imaging and decided it was a growing pain. That was with insurance, but hey, not wholly unpredictable and because there was nothing treatable I wasn't bankrupted.
Jemmeh 9y ago
A standard office visit tends to be about $100 in my area, sure. That'll get me to talk to the doctor. But if I want to test for Lyme that's a blood test. Now the lab is involved, they may or may not have their own billing department and they won't tell me for anything how much or even ballpark estimate of what it will cost so that they are covered if they need to do more. So I talk to the doctor and they say XYZ tests need to be run. Okay, now I know what I need exactly and get a price, right? Nope. I just get the run around and "It depends on the insurance" and "We will bill you later" and "No it's probably not $5000" and straight up "I don't know" Oh, okay, so I need to call the insurance company then, huh? Nope, they won't tell me either. I've tried. They just say "It depends". Even when I know exactly what labs they are going to run. I can say "I understand it might change if they need to run more tests." Nope. No idea. Sometimes they can give you a straight answer but very often they will not. It's hidden on purpose. It is confusing on purpose. Insurance companies don't want you to know what's going on. The doctors offices don't want to share "cash-only" info publicly because insurance companies will demand that price. The insurance companies don't want to share the info because people will complain. Etc etc it is not that easy when you go to the doctor for more than the really simple things.
- scarecrowbob 9y ago
  As to the circularity of my first point, without a PCP and no proximate cause, the wait time and cost is.... difficult to predict. With a PCP it is better, but because I don't go to the doctor I don't have a PCP.

tacomonstrous 9y ago

Having grown up in India, even after I've spent almost my entire adult life in the US, I'm still reluctant to go the doctor here. In India, the process is very simple: you call the doctor in the morning, you get an appointment for the afternoon, you show up, get looked at, pay the cost of the visit (usually less than $10-15), and you're done. It's basically like any other business transaction. So even if I had a minor seeming infection, going to the doctor was the right and efficient move. Here, I call the doctor's office, and might not get an appointment for another two months, if I'm lucky. At that point there is some opaque process involving my insurance, and it just seems like a much weightier event than a simple visit should be. Of course, I'm guessing that an infection would speed up the process, but the psychological barrier is already up in my mind, and I'd rather just power through on my own. But there seems to be some hope. Recently, my wife was able to go to an urgent care clinic to treat an infection, and the process was much more like what happens in India. Still, there is some intervention of insurance, though a bit more transparently so.

ams6110 9y ago
As I'm sure you know, there are urgent care clinics everywhere in the USA for minor ailments and injuries, where you can be seen on a walk-in basis and pay cash if you want to.
scarecrowbob 9y ago
When my kid dislocated his hip, I took him to an urgent care clinic, and the process was similar. They did refer me to an orthopedist and I ended up being out about $450 dollars after they looked at an some imaging and decided it was a growing pain. That was with insurance, but hey, not wholly unpredictable and because there was nothing treatable I wasn't bankrupted.

Jemmeh 9y ago

A standard office visit tends to be about $100 in my area, sure. That'll get me to talk to the doctor. But if I want to test for Lyme that's a blood test. Now the lab is involved, they may or may not have their own billing department and they won't tell me for anything how much or even ballpark estimate of what it will cost so that they are covered if they need to do more. So I talk to the doctor and they say XYZ tests need to be run. Okay, now I know what I need exactly and get a price, right? Nope. I just get the run around and "It depends on the insurance" and "We will bill you later" and "No it's probably not $5000" and straight up "I don't know" Oh, okay, so I need to call the insurance company then, huh? Nope, they won't tell me either. I've tried. They just say "It depends". Even when I know exactly what labs they are going to run. I can say "I understand it might change if they need to run more tests." Nope. No idea. Sometimes they can give you a straight answer but very often they will not. It's hidden on purpose. It is confusing on purpose. Insurance companies don't want you to know what's going on. The doctors offices don't want to share "cash-only" info publicly because insurance companies will demand that price. The insurance companies don't want to share the info because people will complain. Etc etc it is not that easy when you go to the doctor for more than the really simple things.

scarecrowbob 9y ago
As to the circularity of my first point, without a PCP and no proximate cause, the wait time and cost is.... difficult to predict. With a PCP it is better, but because I don't go to the doctor I don't have a PCP.