6 ms·

Doctor stops accepting insurance, posts prices online

56 points by nick007 13y ago

psychotik 13y ago
This is how doctors in India (and a lot of other countries) work, and it's super efficient. His prices feel very competitive to me. I would carry a high-deductible insurance plan for catastrophes but this would otherwise be a great option. More doctors need to follow this lead.
- tlrobinson 13y ago
  Agreed. Why does every little doctor visit need to be paid for by insurance? That's not the point of insurance. Auto insurance doesn't cover car washes and oil changes.
  - pod4369 13y ago
    You don't need to pay with insurance.
  - CCs 13y ago
    Check out HSA. Can be used with high-deductible insurance. You can still file the claim yourself, even if you pay the doctor cash. Once you reached the deductible limit (paying with HSA), the normal insurance will kick in. With $8,000 limit that must be pretty serious stuff anyway.
  - logicallee 13y ago
    So, I'm glad you got into the subject of car washes and oil changes. We're trying to regulate car washes so that we can control that market - otherwise, let's say we succeed in a federated model where to be a car wash practitioner you must go through 14 years of very competitive school costing about $1M all told, with a car wash residency on top. This might bring car wash technique into the 21st century, it would result in amazing advances in research, everything from new detergents to car wash garage equipment that makes what we see now seem absolutely third-world. Yes, it would cost $2000-$8000 for a basic wash, but that's actually a low price to pay for clean cities and sanitation, and also it's the list price. Yes, a lot of people would stop washing their cars, that is a personal choice. For the oil changes, we're in a better position - you MUST change your oil from time to time, otherwise you will suffer catastrophic engine damage. People have very little choice. So here, we can get up into the $8000's or so, based on what happens if you don't change your oil. Again, with amazing research and so forth. How many prestigious oil change journals do you think there are today? It is just third world at the moment, this is why we need the medical model here. Then there's the usual benefits, one of the main points of leverage employers would have over any of their employees who drive or are even thinking of driving, is that in fact en masse the employer could ensure these workers for oil changes for a tiny fraction of that list price. Maybe as low as only $500-$800 per month. This keeps people from being "self-starters" who fail to produce value for large companies, instead they would have to negotiate with our federated program on a per-individual basis. But there is a big problem with both of the above utopias: unlicensed practitioners. Sure, if you look at the third world where people are free to try to put whatever they want into their cars, anything from sand to little pieces of plastic toys they melt down - at great risk to all drivers on the road should the cars explode, not to mention to themselves - the oil change prices are very low. Barely the cost of oil that has next to no research into it, plus labor that is about the skill-level of a barber in the middle ages. They do not have 14 or even 12 years of schooling, nor debts even reaching $200K let alone an amount that would motivate them to keep charging the federated prices. So the first step toward utopia is really, we have to clamp down on unlicensed car washes and oil changes. We need a board certification that includes deep understanding of all parts that make up a car, from basic metallurgy to internal combustion and battery technology chemistry. Yes, some people will wash out of metallurgy classes, or projectile calculus, but are these really the people you want taking care of your only means of transportation? Transportation is literally one of the few things that separates us from people in the middle ages, allows us to live and work more than a few meters apart, and enables us to live meaningful lives. Without transportation, we have nothing. So it makes sense to clamp down on the unregulated practices related to serious procedures such as oil changes as well as elective, cosmetic procedures like a car wash. Where the prices are such that certain individuals might not be able to bear the full burden, that's EXACTLY what insurance is for!
  - vidarh 13y ago
    That's great for those who can afford it. Not so great when it means you skimp on doctors visits until things get serious because the choice is going to the doctor or going hungry or being unable to pay rent. And not so great for society when we get to pick up the tab anyway when people delay going to the doctor and get so seriously ill they need emergency care, because we'd rather not have people dying in the streets. There's a reason pretty much no developed nations have opted to be without universal healthcare.
  - tzs 13y ago
    Failing to wash my car or change my oil does not lead to theft or covered accidents, so the insurance company does not care. Failing to get routine medical care, on the other hand, does increase the risk of conditions that insurance does cover. Hence, the insurance company does care about my routine medical care, and so covers it to encourage it. This is why my health insurance company constantly sends me emails with fitness tips and other health suggestions, whereas my auto insurance company has not once sent me any tips on washing my car.
    - bryanlarsen 13y ago
      No, but oil changes do have an impact on your car's warranty, which is also a form of insurance. Mazda makes regular oil changes a condition of the warranty, and BMW includes them in the warranty. You could use the Mazda model for regular check-ups, but what about the other little stuff? We don't want people saying "My chest pain is feeling better now. I'll save the $75."
    - jerrya 13y ago
      Really? I mean, I would think so, but I see a lot of major insurance plans with very high copays and/or limited to no coverage for annual physicals which would not be the expected behavior of insurance companies felt your annual physical saved them money.
      - danielweber 13y ago
        Annual physicals are, for the vast majority of people, completely useless in terms of health. Lots of common things people imagine "save lives and money" do neither. Vaccines and pap smears are great, but most things aren't.
    - tlrobinson 13y ago
      Insurance companies offer discounts for preventative measures, like taking a defensive driving course for auto insurance, or installing an alarm system for homeowners insurance. Surely you could accomplish the same thing with health insurance?
- davidiach 13y ago
  And this is how dental care works in Romania and why almost everybody can afford it. If you charge too high people will not come. So they charge prices that are affordable.
- vidarh 13y ago
  It's super-efficient for those who have money. For everyone else it's a barrier to access.
shanelja 13y ago
As someone who comes from the United Kingdom where the tax payer funded NHS takes care of most medical fees, it strikes me as ridiculous that any country could expect their tax paying citizens to pay for the privilege to carry on living.
- Nux 13y ago
  Any country that calls itself civilised must have something like the NHS.
  - ISL 13y ago
    It's not possible for any other system to be civilized?
    - vidarh 13y ago
      Hence the "something like" presumably. The key point is universal access regardless of personal wealth or income.
    - Nux 13y ago
      Any similar system qualifies, like Vidarh points out. :-) Actually it's the case with most, if not all european countries.
  - dnautics 13y ago
    really? As an ethnic minority, whose diseases are underresearched, and for whom drug safety and efficacy are unlikely to be statisically well-validated, I'd be paying into a system that disproportionately helps, well, to be crude, white men. That's just the way medicine is. Maybe it's just me, but I'd like to have the freedom to opt out of a system that redistributes to the already privileged.
    - ollysb 13y ago
      Your rhetoric makes me feel a little uncomfortable but ignoring that isn't the converse also true, that the system is disproportionately funded by white men.
kondro 13y ago
Australian doctors generally use a combination of this type of technique.
ewbuoi 13y ago
My doctor works like that and I love it. I've never had to wait in a waiting room or anything, appointments start promptly and last as long as they need to (I've had an appointment last over 2 hours). She charges $220/hr, but after insurance reimburses me it costs less per hour than a doctor at a traditional clinic, which was about $15 for a quick 15 minute appointment.
Dnguyen 13y ago
What happens when a not-so-good doctor charges very cheap and start a price war? Or to make it affordable, the doctor cuts corners? Who's to tell the doctor to what to do? Who watches the watchmen?
- jackowayed 13y ago
  There are laws and medical licenses for this reason. There are always incentives to cut costs, whether administering medicine for cash from patients or for insurance payments. At least with this model, the patient is choosing the doctor, paying him, and receiving he care. So if he cuts corners in a way that makes the patient less satisfied (eg. very short appointments, cramped/dilapidated office, bad on-time performance, office in a bad part of town), the patient can choose to go elsewhere. If it's the one place the patient's insurance will cover thanks to the reduced price from cutting those corners, the patient has no real choice.
- tomohawk 13y ago
  What happens when a not-so-good doctor charges the same as everyone else? What happens when really excellent doctors end up having to charge the same as really poor ones? What happens when there is no decent way for patents to know the good ones from the bad? You end up where we are now where mediocrity is rewarded and excellence is punished, and they both cost the same. It is well past time to allow some market forces to work in this area. At least things would be more rational.
qwerta 13y ago
This is how it works in Ireland. You pay GP, dentist and other small items out of your pocket and send your bill to insurance company. Hospitals and other large stuff is passed automatically and you will not even see the bill. Prices are fixed, GP visit is 50 euro (~70 dollars), MRI scan is about 200 Euro (~270 dollars).
munimkazia 13y ago
Off topic, but is anyone else concerned about the fact that the URL has a ref=relatedSidebar in it? The website will probably get a lot of hits from an incorrect referal in their traffic monitoring tool. I hate it when stuff like this happens.
- laumars 13y ago
  I was more concerned about the site wanting my location data. I couldn't see any good reason why such information would be required for a site like that other than for analytics - and that's really not a good enough reason to request location data in my opinion.
- RobAley 13y ago
  If its internal links within your own website you need to track, use cookies, they are much less likely to get "passed around" like that ref link, or update the url to the canonical one once they land on the . Its asking too much of your visitors to analyse a url and work out what they should and shouldn't post, even if they understood what they were doing.
healthenclave 13y ago
This is both great news and sad one. The great news is the doctor is doing the right thing by moving towards a direct pay model - which works great for regular visits. But this also goes to show the SAD state of health affairs. I believe we can also a lot of this problem with the aid of technology and make doctors more efficient and help them only worry about their patients. Well you can't eliminate the need of insurance but it can certainly be made much much more easier. A lot of Family Practitioners don't want to deal with insurance companies is not because they don't get paid well by them (yes they pay only a fraction of the bill) but because the paperwork and stress of dealing with them isn't worth it. Now with the upcoming ICD-10 implementation the docs are going to have a nightmare. ICD-9 has around 18k codes for the classification of various disease and with the implementation of ICD-10 this number goes to 80,000 !!!! The bigger problem is that most solutions (EHRs) are usually created not created by people who deliver healthcare. There are a few EHRs created by doctors but are not implemented very well. Using things like Eligible api (to know what procedures can be performed as per the patient's insurance plan) are helpful but are not complete in the sense of unifying the workflow for doctors. The other big thing that is severely lacking is the patient engagement and the data from Quantified self. When you walk into the office of a doc - all that information (FitBit, Nike FuelBand, etc , etc) doesn't help the doc provide personalized medicine to the patients. Nor does the patient has much engagement in managing their health (apart from taking the pills).. ZocDoc(s) and PracticeFusion(s) are doing their parts but are still half baked solutions. Hopefully we will be able to change that !

56 points by nick007 13y ago

This is how doctors in India (and a lot of other countries) work, and it's super efficient. His prices feel very competitive to me. I would carry a high-deductible insurance plan for catastrophes but this would otherwise be a great option. More doctors need to follow this lead.

tlrobinson 13y ago
Agreed. Why does every little doctor visit need to be paid for by insurance? That's not the point of insurance. Auto insurance doesn't cover car washes and oil changes.
- pod4369 13y ago
  You don't need to pay with insurance.
- CCs 13y ago
  Check out HSA. Can be used with high-deductible insurance. You can still file the claim yourself, even if you pay the doctor cash. Once you reached the deductible limit (paying with HSA), the normal insurance will kick in. With $8,000 limit that must be pretty serious stuff anyway.
- logicallee 13y ago
  So, I'm glad you got into the subject of car washes and oil changes. We're trying to regulate car washes so that we can control that market - otherwise, let's say we succeed in a federated model where to be a car wash practitioner you must go through 14 years of very competitive school costing about $1M all told, with a car wash residency on top. This might bring car wash technique into the 21st century, it would result in amazing advances in research, everything from new detergents to car wash garage equipment that makes what we see now seem absolutely third-world. Yes, it would cost $2000-$8000 for a basic wash, but that's actually a low price to pay for clean cities and sanitation, and also it's the list price. Yes, a lot of people would stop washing their cars, that is a personal choice. For the oil changes, we're in a better position - you MUST change your oil from time to time, otherwise you will suffer catastrophic engine damage. People have very little choice. So here, we can get up into the $8000's or so, based on what happens if you don't change your oil. Again, with amazing research and so forth. How many prestigious oil change journals do you think there are today? It is just third world at the moment, this is why we need the medical model here. Then there's the usual benefits, one of the main points of leverage employers would have over any of their employees who drive or are even thinking of driving, is that in fact en masse the employer could ensure these workers for oil changes for a tiny fraction of that list price. Maybe as low as only $500-$800 per month. This keeps people from being "self-starters" who fail to produce value for large companies, instead they would have to negotiate with our federated program on a per-individual basis. But there is a big problem with both of the above utopias: unlicensed practitioners. Sure, if you look at the third world where people are free to try to put whatever they want into their cars, anything from sand to little pieces of plastic toys they melt down - at great risk to all drivers on the road should the cars explode, not to mention to themselves - the oil change prices are very low. Barely the cost of oil that has next to no research into it, plus labor that is about the skill-level of a barber in the middle ages. They do not have 14 or even 12 years of schooling, nor debts even reaching $200K let alone an amount that would motivate them to keep charging the federated prices. So the first step toward utopia is really, we have to clamp down on unlicensed car washes and oil changes. We need a board certification that includes deep understanding of all parts that make up a car, from basic metallurgy to internal combustion and battery technology chemistry. Yes, some people will wash out of metallurgy classes, or projectile calculus, but are these really the people you want taking care of your only means of transportation? Transportation is literally one of the few things that separates us from people in the middle ages, allows us to live and work more than a few meters apart, and enables us to live meaningful lives. Without transportation, we have nothing. So it makes sense to clamp down on the unregulated practices related to serious procedures such as oil changes as well as elective, cosmetic procedures like a car wash. Where the prices are such that certain individuals might not be able to bear the full burden, that's EXACTLY what insurance is for!
- vidarh 13y ago
  That's great for those who can afford it. Not so great when it means you skimp on doctors visits until things get serious because the choice is going to the doctor or going hungry or being unable to pay rent. And not so great for society when we get to pick up the tab anyway when people delay going to the doctor and get so seriously ill they need emergency care, because we'd rather not have people dying in the streets. There's a reason pretty much no developed nations have opted to be without universal healthcare.
- tzs 13y ago
  Failing to wash my car or change my oil does not lead to theft or covered accidents, so the insurance company does not care. Failing to get routine medical care, on the other hand, does increase the risk of conditions that insurance does cover. Hence, the insurance company does care about my routine medical care, and so covers it to encourage it. This is why my health insurance company constantly sends me emails with fitness tips and other health suggestions, whereas my auto insurance company has not once sent me any tips on washing my car.
  - bryanlarsen 13y ago
    No, but oil changes do have an impact on your car's warranty, which is also a form of insurance. Mazda makes regular oil changes a condition of the warranty, and BMW includes them in the warranty. You could use the Mazda model for regular check-ups, but what about the other little stuff? We don't want people saying "My chest pain is feeling better now. I'll save the $75."
  - jerrya 13y ago
    Really? I mean, I would think so, but I see a lot of major insurance plans with very high copays and/or limited to no coverage for annual physicals which would not be the expected behavior of insurance companies felt your annual physical saved them money.
    - danielweber 13y ago
      Annual physicals are, for the vast majority of people, completely useless in terms of health. Lots of common things people imagine "save lives and money" do neither. Vaccines and pap smears are great, but most things aren't.
  - tlrobinson 13y ago
    Insurance companies offer discounts for preventative measures, like taking a defensive driving course for auto insurance, or installing an alarm system for homeowners insurance. Surely you could accomplish the same thing with health insurance?
davidiach 13y ago
And this is how dental care works in Romania and why almost everybody can afford it. If you charge too high people will not come. So they charge prices that are affordable.
vidarh 13y ago
It's super-efficient for those who have money. For everyone else it's a barrier to access.

shanelja 13y ago

As someone who comes from the United Kingdom where the tax payer funded NHS takes care of most medical fees, it strikes me as ridiculous that any country could expect their tax paying citizens to pay for the privilege to carry on living.

Nux 13y ago
Any country that calls itself civilised must have something like the NHS.
- ISL 13y ago
  It's not possible for any other system to be civilized?
  - vidarh 13y ago
    Hence the "something like" presumably. The key point is universal access regardless of personal wealth or income.
  - Nux 13y ago
    Any similar system qualifies, like Vidarh points out. :-) Actually it's the case with most, if not all european countries.
- dnautics 13y ago
  really? As an ethnic minority, whose diseases are underresearched, and for whom drug safety and efficacy are unlikely to be statisically well-validated, I'd be paying into a system that disproportionately helps, well, to be crude, white men. That's just the way medicine is. Maybe it's just me, but I'd like to have the freedom to opt out of a system that redistributes to the already privileged.
  - ollysb 13y ago
    Your rhetoric makes me feel a little uncomfortable but ignoring that isn't the converse also true, that the system is disproportionately funded by white men.

kondro 13y ago

Australian doctors generally use a combination of this type of technique.

ewbuoi 13y ago

My doctor works like that and I love it. I've never had to wait in a waiting room or anything, appointments start promptly and last as long as they need to (I've had an appointment last over 2 hours). She charges $220/hr, but after insurance reimburses me it costs less per hour than a doctor at a traditional clinic, which was about $15 for a quick 15 minute appointment.

Dnguyen 13y ago

What happens when a not-so-good doctor charges very cheap and start a price war? Or to make it affordable, the doctor cuts corners? Who's to tell the doctor to what to do? Who watches the watchmen?

jackowayed 13y ago
There are laws and medical licenses for this reason. There are always incentives to cut costs, whether administering medicine for cash from patients or for insurance payments. At least with this model, the patient is choosing the doctor, paying him, and receiving he care. So if he cuts corners in a way that makes the patient less satisfied (eg. very short appointments, cramped/dilapidated office, bad on-time performance, office in a bad part of town), the patient can choose to go elsewhere. If it's the one place the patient's insurance will cover thanks to the reduced price from cutting those corners, the patient has no real choice.
tomohawk 13y ago
What happens when a not-so-good doctor charges the same as everyone else? What happens when really excellent doctors end up having to charge the same as really poor ones? What happens when there is no decent way for patents to know the good ones from the bad? You end up where we are now where mediocrity is rewarded and excellence is punished, and they both cost the same. It is well past time to allow some market forces to work in this area. At least things would be more rational.

qwerta 13y ago

This is how it works in Ireland. You pay GP, dentist and other small items out of your pocket and send your bill to insurance company. Hospitals and other large stuff is passed automatically and you will not even see the bill. Prices are fixed, GP visit is 50 euro (~70 dollars), MRI scan is about 200 Euro (~270 dollars).

munimkazia 13y ago

Off topic, but is anyone else concerned about the fact that the URL has a ref=relatedSidebar in it? The website will probably get a lot of hits from an incorrect referal in their traffic monitoring tool. I hate it when stuff like this happens.

laumars 13y ago
I was more concerned about the site wanting my location data. I couldn't see any good reason why such information would be required for a site like that other than for analytics - and that's really not a good enough reason to request location data in my opinion.
RobAley 13y ago
If its internal links within your own website you need to track, use cookies, they are much less likely to get "passed around" like that ref link, or update the url to the canonical one once they land on the . Its asking too much of your visitors to analyse a url and work out what they should and shouldn't post, even if they understood what they were doing.

healthenclave 13y ago

This is both great news and sad one. The great news is the doctor is doing the right thing by moving towards a direct pay model - which works great for regular visits. But this also goes to show the SAD state of health affairs. I believe we can also a lot of this problem with the aid of technology and make doctors more efficient and help them only worry about their patients. Well you can't eliminate the need of insurance but it can certainly be made much much more easier. A lot of Family Practitioners don't want to deal with insurance companies is not because they don't get paid well by them (yes they pay only a fraction of the bill) but because the paperwork and stress of dealing with them isn't worth it. Now with the upcoming ICD-10 implementation the docs are going to have a nightmare. ICD-9 has around 18k codes for the classification of various disease and with the implementation of ICD-10 this number goes to 80,000 !!!! The bigger problem is that most solutions (EHRs) are usually created not created by people who deliver healthcare. There are a few EHRs created by doctors but are not implemented very well. Using things like Eligible api (to know what procedures can be performed as per the patient's insurance plan) are helpful but are not complete in the sense of unifying the workflow for doctors. The other big thing that is severely lacking is the patient engagement and the data from Quantified self. When you walk into the office of a doc - all that information (FitBit, Nike FuelBand, etc , etc) doesn't help the doc provide personalized medicine to the patients. Nor does the patient has much engagement in managing their health (apart from taking the pills).. ZocDoc(s) and PracticeFusion(s) are doing their parts but are still half baked solutions. Hopefully we will be able to change that !