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Unfortunately, no. Your doctor is contractually bound to the insurer’s fee structure; they can’t take an extra penny off of you. You’d have to go to someone tha

Unfortunately, no. Your doctor is contractually bound to the insurer’s fee structure; they can’t take an extra penny off of you. You’d have to go to someone that doesn’t take your insurance at all (or just don’t tell them you have that insurance). The side effect of all this, honestly, is that doctors stop learning how to turn off 7-minute-mode. When it comes to very serious problems, it pays to go to a practice that doesn’t accept insurance at all, because they never got into the bad habit to begin with.

seanmcdirmid 9y ago
Almost makes the red envelope culture in Chinese hospitals seems appealing.
- erric 9y ago
  https://en.wikipedia.org/wiki/Red_envelope https://en.wikipedia.org/wiki/Red_envelope I’d never heard of this before.
  - twic 9y ago
    On the situation in hospitals specifically: https://www.seattletimes.com/opinion/the-red-envelope-capitalistic-health-care-in-red-china/ https://www.seattletimes.com/opinion/the-red-envelope-capita...
  - jotm 9y ago
    Lol, that's exactly life in Eastern Europe/ex-USSR. There's socialized medicine, but if you want better service, you have to bring a gift (whisky, chocolate, money, the latter is always desirable). Not just hand cash over, that's disrespectful nowadays.
    - linkmotif 9y ago
      My grandmother was a pediatrician in Kiev in Soviet times. Her salary was about on par with anyone else, but she got tons of gifts.
- imron 9y ago
  Not at all. Having to slip the doc and the anaethetist a red envelope and hoping it's the enough that they'll take proper care of you is not a good system to live under.
jessaustin 9y ago
You're right that it's difficult for physicians to "turn it off". The contractual requirements you reference, however, are basically unenforced. The only way a physician will get "caught" charging more than agreed is if the patient calls the insurer to complain. Presumably you wouldn't do that to her after she saved your life.
- netheril96 9y ago
  > Presumably you wouldn't do that to her after she saved your life. Oh, you grossly underestimate what people are capable of. At least in China there are many reported cases of such horrible patients. Maybe US being a developed country have fewer these people, but definitely not zero.
  - jessaustin 9y ago
    You're right of course, and this isn't limited to the Chinese. It's best to have physicians in the family; marry one if there isn't one already! This isn't practical for everyone, so perhaps it's best to choose a capable young physician early in life, so that by the time such trust is required it has already formed. Probably there are other professions in which one gets better service if one has an inside connection, but this situation really speaks ill of how medicine is practiced.
    - arkades 9y ago
      > Probably there are other professions in which one gets better service if one has an inside connection, but this situation really speaks ill of how medicine is practiced. Having a doc in the family is a mixed blessing at best. You can get priority treatment, and the benefit of your family members full attention. On the flip side, all the docs I know that aren’t fools or morons don’t treat their own family for anything more serious than a scrape. You’re biased, you don’t want the guilt of an error, and you don’t want to be the bearer of bad news. I frequently ask my wife not to ask me about her mother’s health developments; I’d rather tell comforting lies than be a source of sour truth. Being a VIP in a medical center due to your relatives gets you more ass kissing, not better care. People don’t want to step on toes, or give the impression that useful care is being withheld. And if your relative is a worse doc than the one you’re seeing? No one is going to overrule your family member to your face.
Alex3917 9y ago
> You’d have to go to someone that doesn’t take your insurance at all There are some doctors at teaching hospitals who specialize in diagnosing rare diseases and don't take insurance for this reason.
goblins 9y ago
Glad I live in a country with a free health service.
- influx 9y ago
  What country is that which doesn’t pay doctors?
  - jacquesm 9y ago
    Did you really link 'free healthcare' with 'a country that does not pay doctors'? Clearly healthcare can be free to the recipients while doctors still get a good salary.
    - jessaustin 9y ago
      I get to drive on most roads without paying, but I wouldn't say that the roads are "free"?
      - jacquesm 9y ago
        Compared to toll roads they are free...
        jessaustin 9y ago
        We've uncovered a potential ambiguity in the original phrasing of "free health service". Could the now-dead response to that comment have been highlighting this very ambiguity?
    - arkades 9y ago
      Most countries with free healthcare do have woefully underpaid doctors. The NHS has been cutting back aggressively on doc salaries for years, letting them fall well behind inflation. The only thing I can say in their defense is that at least docs in those countries don’t generally take on massive, private, un-dischargeable debt in order to do the job. In the US we treat the medical workforce as a public good, though they have to take on all the risk of entering that workforce through private financing.

seanmcdirmid 9y ago

Almost makes the red envelope culture in Chinese hospitals seems appealing.

erric 9y ago
https://en.wikipedia.org/wiki/Red_envelope https://en.wikipedia.org/wiki/Red_envelope I’d never heard of this before.
- twic 9y ago
  On the situation in hospitals specifically: https://www.seattletimes.com/opinion/the-red-envelope-capitalistic-health-care-in-red-china/ https://www.seattletimes.com/opinion/the-red-envelope-capita...
- jotm 9y ago
  Lol, that's exactly life in Eastern Europe/ex-USSR. There's socialized medicine, but if you want better service, you have to bring a gift (whisky, chocolate, money, the latter is always desirable). Not just hand cash over, that's disrespectful nowadays.
  - linkmotif 9y ago
    My grandmother was a pediatrician in Kiev in Soviet times. Her salary was about on par with anyone else, but she got tons of gifts.
imron 9y ago
Not at all. Having to slip the doc and the anaethetist a red envelope and hoping it's the enough that they'll take proper care of you is not a good system to live under.

jessaustin 9y ago

You're right that it's difficult for physicians to "turn it off". The contractual requirements you reference, however, are basically unenforced. The only way a physician will get "caught" charging more than agreed is if the patient calls the insurer to complain. Presumably you wouldn't do that to her after she saved your life.

netheril96 9y ago
> Presumably you wouldn't do that to her after she saved your life. Oh, you grossly underestimate what people are capable of. At least in China there are many reported cases of such horrible patients. Maybe US being a developed country have fewer these people, but definitely not zero.
- jessaustin 9y ago
  You're right of course, and this isn't limited to the Chinese. It's best to have physicians in the family; marry one if there isn't one already! This isn't practical for everyone, so perhaps it's best to choose a capable young physician early in life, so that by the time such trust is required it has already formed. Probably there are other professions in which one gets better service if one has an inside connection, but this situation really speaks ill of how medicine is practiced.
  - arkades 9y ago
    > Probably there are other professions in which one gets better service if one has an inside connection, but this situation really speaks ill of how medicine is practiced. Having a doc in the family is a mixed blessing at best. You can get priority treatment, and the benefit of your family members full attention. On the flip side, all the docs I know that aren’t fools or morons don’t treat their own family for anything more serious than a scrape. You’re biased, you don’t want the guilt of an error, and you don’t want to be the bearer of bad news. I frequently ask my wife not to ask me about her mother’s health developments; I’d rather tell comforting lies than be a source of sour truth. Being a VIP in a medical center due to your relatives gets you more ass kissing, not better care. People don’t want to step on toes, or give the impression that useful care is being withheld. And if your relative is a worse doc than the one you’re seeing? No one is going to overrule your family member to your face.

Alex3917 9y ago

> You’d have to go to someone that doesn’t take your insurance at all There are some doctors at teaching hospitals who specialize in diagnosing rare diseases and don't take insurance for this reason.

goblins 9y ago

Glad I live in a country with a free health service.

influx 9y ago
What country is that which doesn’t pay doctors?
- jacquesm 9y ago
  Did you really link 'free healthcare' with 'a country that does not pay doctors'? Clearly healthcare can be free to the recipients while doctors still get a good salary.
  - jessaustin 9y ago
    I get to drive on most roads without paying, but I wouldn't say that the roads are "free"?
    - jacquesm 9y ago
      Compared to toll roads they are free...
      - jessaustin 9y ago
        We've uncovered a potential ambiguity in the original phrasing of "free health service". Could the now-dead response to that comment have been highlighting this very ambiguity?
  - arkades 9y ago
    Most countries with free healthcare do have woefully underpaid doctors. The NHS has been cutting back aggressively on doc salaries for years, letting them fall well behind inflation. The only thing I can say in their defense is that at least docs in those countries don’t generally take on massive, private, un-dischargeable debt in order to do the job. In the US we treat the medical workforce as a public good, though they have to take on all the risk of entering that workforce through private financing.