3 ms·

First, let me say that I'm sorry that harm seems to have come your way. Second, unless you are extremely rich and can privately employ a doctor like a saudi pr

by rscho 7y ago

First, let me say that I'm sorry that harm seems to have come your way. Second, unless you are extremely rich and can privately employ a doctor like a saudi prince would do, I do not know of any (non-forbidden) way to directly pay your doc for his time. Hopefully I'll stand corrected. Third, and that's the most important, primarily allocate your money to proven treatment. Clinical trials are not designed to help participants. Be weary of what people try to sell you. But if you've been dealing with the healthcare system for long enough, you probably know all about it already. I realize that's not very original, but godspeed nevertheless!

geofft 7y ago
Aren't there a growing number of doctors who don't take insurance (under names like "cash-only" or "direct primary care")? Would you be able to buy a day of one of those doctors' time? It sounds like it won't run afoul of insurance but also sounds cheaper than having a personal physician.
darawk 7y ago
There are a lot of doctors now that don't take insurance, and that you pay on retainer. The phrase you want to google here is "concierge medicine". It's definitely expensive, but not Saudi prince expensive.
- arkades 7y ago
  Most concierge practices retain the same business model. They ditch insurance, and the billing staff they hired to wrangle the insurance, and reclaim the time they personally spent wrangling insurance. They then keep roughly the same business model, charging more or less what insurance would have paid them. They spend more time with patients because (a) not on the phone fighting, (b) though the patient pool goes down, they’re replaced by not having to pay for billing staff. Very very few “concierge” practices aim for any more deviation from the standard business mode than that. If you want someone to spend 40 minutes with you rather than 15, that’s your guy. If you want someone to spend a week analyzing all your old records and sleuthing it out, that model still doesn’t support it.
Elrac 7y ago
I'm guessing that what you're saying implicitly applies to the USA. Just for a bit of perspective, I'd like to describe what this experience looks like for me as a resident of Germany, a developed and prosperous country that isn't the US! The German government mandates making public-option insurance available for everybody, and exercises some of control on drug and treatment prices. That means everybody is eligible for "standard" run-of-the-mill treatment for any illness. Referral to specialists is doled out by GPs, and there may be inconvenient wait time for non-emergency treatments. Prescribed drugs may be generic rather than top-tier. Various forms of quackery, i.e. drugs and treatments without good evidence of efficacy, are not covered by public-option insurance; examples include acupuncture and applications of chiropractic not directly applicable to skeletal motion, i.e. Palmer-esque "subluxation" treatment. Placebos are non-reimbursable here, but homeopathy is still covered in Germany so it's available for placebo use, though it's being excluded in other countries. Patients can opt for non-standard products, though, if they're willing to foot the bill personally. Anyone with, I'll say, "upper middle class income," though, can opt out of public health insurance and sign up with a private insurance of their choice. For employees, half of the cost of private medical insurance is paid by the employer. Private insurers must cover at least the same drugs and treatments as public insurance but both commodities can be invoiced at much higher rates; 2x and more is common. This makes private patients like myself very attractive to doctors and hospitals, of course, and we get all kinds of preferential treatment. Yes, this results in a 2 class society with regard to medical treatment and I enjoy the opportunity to be in the upper class in exchange for paying higher premiums. I can access any doctor of my choice, including specialists, and those doctors can recommend any product. Private insurers also won't pay for just anything but there's more leeway and of course there's always the option of paying out of pocket for anything that's not reimbursed. While medical services will typically carry a steep (usually reimbursed) surcharge, drugs mostly cost the same for everybody and will be reimbursed if they pass muster as medically necessary and effective. I've heard of clinical trials advertising for volunteers, but I think policy on those is similar to what you describe: a trial isn't a treatment option for just anyone who wants it.

by rscho 7y ago

geofft 7y ago

Aren't there a growing number of doctors who don't take insurance (under names like "cash-only" or "direct primary care")? Would you be able to buy a day of one of those doctors' time? It sounds like it won't run afoul of insurance but also sounds cheaper than having a personal physician.

darawk 7y ago

There are a lot of doctors now that don't take insurance, and that you pay on retainer. The phrase you want to google here is "concierge medicine". It's definitely expensive, but not Saudi prince expensive.

arkades 7y ago
Most concierge practices retain the same business model. They ditch insurance, and the billing staff they hired to wrangle the insurance, and reclaim the time they personally spent wrangling insurance. They then keep roughly the same business model, charging more or less what insurance would have paid them. They spend more time with patients because (a) not on the phone fighting, (b) though the patient pool goes down, they’re replaced by not having to pay for billing staff. Very very few “concierge” practices aim for any more deviation from the standard business mode than that. If you want someone to spend 40 minutes with you rather than 15, that’s your guy. If you want someone to spend a week analyzing all your old records and sleuthing it out, that model still doesn’t support it.

Elrac 7y ago

I'm guessing that what you're saying implicitly applies to the USA. Just for a bit of perspective, I'd like to describe what this experience looks like for me as a resident of Germany, a developed and prosperous country that isn't the US! The German government mandates making public-option insurance available for everybody, and exercises some of control on drug and treatment prices. That means everybody is eligible for "standard" run-of-the-mill treatment for any illness. Referral to specialists is doled out by GPs, and there may be inconvenient wait time for non-emergency treatments. Prescribed drugs may be generic rather than top-tier. Various forms of quackery, i.e. drugs and treatments without good evidence of efficacy, are not covered by public-option insurance; examples include acupuncture and applications of chiropractic not directly applicable to skeletal motion, i.e. Palmer-esque "subluxation" treatment. Placebos are non-reimbursable here, but homeopathy is still covered in Germany so it's available for placebo use, though it's being excluded in other countries. Patients can opt for non-standard products, though, if they're willing to foot the bill personally. Anyone with, I'll say, "upper middle class income," though, can opt out of public health insurance and sign up with a private insurance of their choice. For employees, half of the cost of private medical insurance is paid by the employer. Private insurers must cover at least the same drugs and treatments as public insurance but both commodities can be invoiced at much higher rates; 2x and more is common. This makes private patients like myself very attractive to doctors and hospitals, of course, and we get all kinds of preferential treatment. Yes, this results in a 2 class society with regard to medical treatment and I enjoy the opportunity to be in the upper class in exchange for paying higher premiums. I can access any doctor of my choice, including specialists, and those doctors can recommend any product. Private insurers also won't pay for just anything but there's more leeway and of course there's always the option of paying out of pocket for anything that's not reimbursed. While medical services will typically carry a steep (usually reimbursed) surcharge, drugs mostly cost the same for everybody and will be reimbursed if they pass muster as medically necessary and effective. I've heard of clinical trials advertising for volunteers, but I think policy on those is similar to what you describe: a trial isn't a treatment option for just anyone who wants it.