High Deductible? As Doctor: Here’s what Doctors Can do to Save You Money. Hospitals, Health Insurers Hate it
by Michael Gorback, M.D.
WolfStreet.com
March 26, 2016
“Just tell me the effing price.”
“There’s something happening here. What it is ain’t exactly clear.” — Buffalo Springfield, “For What It’s Worth.”
Dateline 2000. You go to the doctor. At the end of the visit you are asked to pay your co-pay. The doctor files a claim with the insurance company for the rest. You might not even have to pay the co-pay at the time of the visit if you have a naive doctor who is unaware of how many people don’t pay their bills.
Dateline 2016. You go to the doctor. After the visit you have a discussion as to whether you want to use your insurance or pay cash (actually credit card, etc., not cash-in-fist).
That’s different, to say the least.
In days of yore, insurance paid a high percentage of the costs. After the advent of managed care, many people figured a doctor visit cost $20 or so. Insurance covered most of the fee, and the patients were blissfully ignorant of what medical care really costs. You could get a one month supply of medication for a co-pay of $10-20.
In recent years, we have evolved a system where deductibles have risen in order to keep premiums from rising. This allows employers to offer health insurance at lower rates, with the cost being passed to the employee. After a certain point, rising deductibles turn everything upside down.
High deductibles have rendered many people functionally uninsured for the first several thousand dollars of care every year. Whereas 10 years ago, your share of a $500 surgeon’s bill might have been $50, now it’s $500 unless you’ve met your deductible to the point where at least some of that $500 is covered. Even then, there’s often coinsurance after the deductible has been met. You could still be on the hook for 30% of the $500.
Unfortunately, the medical profession has not kept pace with what’s happened, nor is it equipped to deal with it. Like negative interest rates, this is new and hard to conceptualize: cash (credit card, etc.) might be better than insurance. In the past, doctors preferred insured patients, and it was best if they had private insurance. Nobody was thrilled about Medicare.
In response to the functionally uninsured, various fragmented approaches have been tried. Now we have concierge and other forms of cash practices that bypass insurance. This can work for practices with low patient costs, like family practice. It won’t work for a heart surgeon. Nevertheless, cash payment is on the rise.
The Rest…HERE
