Sunday, September 21st, 2014

Money Talks, Obamacare Walks: Some Doctors to Accept Cash Only

Lily Dane
The Daily Sheeple
October 6th, 2013
Reader Views: 10,174

doctors cash

If you can’t afford “Affordable Care” and do not have employer-provided health insurance, what are your options when you need to see a doctor?

The answer may be to find a physician who offers “concierge” or direct care (also referred to as membership medicine, cash-only practice, direct practice, or boutique medicine). Doctors who use this business model charge patients a monthly or annual membership fee or retainer for unlimited office access (usually including 24-hour email and/or telephone accessibility), and bill patients for tests and supplies that are used.

This business model is a win-win for doctors and patients – both parties avoid having to deal with insurance companies and the associated high costs, paperwork, and red tape.

According to data from a national survey of nearly 14,000 physicians conducted by physician staffing firm Merritt Hawkins for The Physicians Foundation, 9.6 percent of “practice owners” are planning to convert to concierge practices in the next one to three years.

“Physicians have been running for cover for several years now,” said Mark Smith, president of Merritt Hawkins. “There is a lot of uncertainty in health care now and the only certainty is there is a lot of talk about cutting physicians fees. One way to get out of it is to go off the grid.”

After accepting insurance for five years, Dr. Doug Nunamaker and his partner switched to a membership-based practice. Their patients pay a flat monthly fee to have unlimited access to the doctors and any service that is provided in the office. Their fees vary depending on age. For children, it’s $10 a month. For adults up to age 44, it’s $50 a month, and senior citizens pay $100.

Dr. Nunamaker’s practice, which is located in Wichita, Kansas, has negotiated pricing for services that aren’t offered in their office. He can get cholesterol tests done for $3 instead of the $90 labs typically bill to insurance companies. And MRIs, which normally cost $2000, can be done for $400.

In April 2013, Dr. Michael Ciampi of South Portland, Maine, stopped accepting all forms of health insurance. Insurance companies no longer dictate how much he charges, he can offer discounts to patients who are struggling, and he can make house calls. His prices are listed on his website.

“I’m freed up to do what I think is right for the patients,” Ciampi said. “If I’m providing them a service that they value, they can pay me, and we cut the insurance out as the middleman and cut out a lot of the expense. If more doctors were able to do this, that would be real health care reform. That’s when we’d see the cost of medicine truly go down.”

Dr. Kevin Wacasey of Colleyville, Texas, runs what he calls a cash clinic. On the Colleyville Medical Clinic website, Dr. Wacasey says he “took an oath to do no harm to my patients. To me, that includes financial harm.”

When Congress was busy debating about Obamacare, a small group of doctors formed the Direct Primary Care Coalition. Dr. Erika Bliss, a coalition leader, said she receives monthly alerts about new concierge practices or converting practices. She now estimates there is a direct primary care practice in nearly every state.

In March, the American Academy of Family Physicians issued a statement in favor of the direct care model.

The DPC website provides a list of direct primary care practices in the United States.

Perhaps if more doctors and patients shift to this model, we’ll get the truly affordable, high-quality healthcare we need.

Delivered by The Daily Sheeple


Contributed by Lily Dane of The Daily Sheeple.

Lily Dane is a staff writer for The Daily Sheeple. Her goal is to help people to “Wake the Flock Up!”

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  • Zellie

    We are going to do this; thank you for bringing it to more people’s attention.

    We cannot afford $1,100 a month in premiums and $12 – $13,000 in annual deductibles.

    We are in very good health.

    It is criminal what is going on in healthcare.

    What these doctors are doing is ALWAYS the better way to less expensive healthcare.

    Let’s leave out the corrupted middle man.

  • Steve

    I’m seeing this now with my wife’s foot dr. He explained how he is going to a cash or monthly plan and simply drop any insurance billing. Funny when bozo’s plan first was talked about he like so many others believed it would be a good thing. Now he can’t stand bozo, and when the clown was re elected thanks to all the liberals, and gib me dats, he wore black scrubs. He stated many of his friends are looking into the same thing, but a lot of drs. who have aligned with a group practice are trapped till their contracts run out.

  • Jeff Walters

    This is the way health care used to work when I was just a kid. $5 for an office visit $20 for vaccinations. Insurance was only for bigger medical expenses, like major injuries or surgery. Until the insurance lobbyists and the politicians got together and changed the rules. The more Government got involved the worse things got, and now they want to take over the whole show so they can “fix” the mess they created in the first place. I refuse to participate. What are they gonna do, lock me up and throw away the key?

  • gmathol

    What the US press is not allowed to report about the European health care system:

    1. It is not free – everybody pays.

    2. Prices for services such as Doctor, drugs etc. are negotiated by the governments. That’s why services, medicine and treatments in Europe are much, much cheaper than in the US.

    3. People, who can’t really afford (also if you own a house) healthcare getting if for free and that is the minority.

    The US healthcare system is also overburdened with administration expenses. Japan’s administration costs for healthcare are about 3% in Europe less than 5%.

    America has a problem called CEO.

  • arf

    This is a great idea…I ruptured a disk in my back, found a great Dr that only charged me $2,500 to do the surgery, but the hospital cost me $7,500(rip off) I was in at 8am out by 11am. Backs never been better!

  • PJ London

    I am offering odds of 10 to 1 that it will be outlawed within 24 months. It may continue as a “Black-market medicine” but I am sure that there will be a law against it.

    • C

      It is my understanding that there already is in Obamacare. We will see how long it takes for them to enforce it.

  • Hank

    These cash-pay concepts are all fine and good, as long as you NEVER need to be hospitalized and ALL of your medical care can be delivered in the doctor’s office.

    The minute you need to be hospitalized for an emergency, serious illness, elective surgery or day patient procedure too involved for the doctor’s office all bets are off. The best thing you can hope for is that the hospital will demand a SERIOUS cash deposit up front, on the order of 5 – 10 THOUSAND dollars for a minor procedure. At worst, the hospitals will be made the unwilling police force for Obamacare and report you to the appropriate authorities where all the penalty procedures will grind you into compliance.

    Concierge medicine is all about ACCESS, not cost. The principle is that affluent folks pay CASH up front in exchange for unlimited access to the doc. Any other governmental obligations are still in place. So you may not be obliged to USE Obamacare, but you WILL have to pay for it.

    • js

      A lot of the increased cost of insurance these days is due to 1) high administration fees 2) over-prescription of medications/procedures due to “defensive medicine” (since healthcare providers will often be sued if they don’t “do everything”). and 3) the desire of people to have every little thing covered by their health insurance…even routine checkups!

      The best way to go, in my opinion is to use concierge medicine for “routine” care (paying cash for services at discount prices) and to also have a “stripped down” inexpensive health insurance policy that covers the “big stuff” (surgery, hospitalization, serious illness or injury, long-term care).

  • Hank

    Also, it will only take a simple stroke of the pen to tie mandatory participation in Obamacare by the doctors to the renewal of their medical licenses and prescribing rights. IOW, no O’Care – no license to practice. It is already being done for Medicaid participation in some locales – do you think they will hesitate one whit in applying this to Obamacare?

  • Evie

    Do you have a web site?

  • Vlad the Skewerer

    The ACA will do to healthcare what the 401k did to retirement,move all the costs off the back of the employer onto the taxpayer/employee (excluding the fees paid for an over 50 employee/40 hr a week business who drops current coverage of course). Actually, I can see a insurance based revenue stream generating security being developed to fuel a new financial scam/bubble. It’s required by law, it’s money in the bank!

  • AnnGreenleaf

    Here’s another list of Direct Pay practitioners, this one from the Association of American Physicians and Surgeons:

    https://aaps.wufoo.com/reports/m5p6z0/

    I think the “default” setting is for it to be sorted alphabetically by state.

  • md

    In Canada, private docs are outlawed. You are either in the system or outlawed. It is currently against federal law here in the US to see a medicare or medicaid patient if you are not part of the system. We will be forbidden from practicing any medicine soon unless we are part of the “system”

  • get real

    this concept of concierge doctors is not new. My old doctor switched over to being one 10 years ago. I could not afford to pay the price he charged once he did. This does not help if you need to go to the hospital. You need insurance to cover those cost. Some hospitals in the US will not touch you if you have no insurance.

  • 5 War Veteran

    It is refreshing to find doctors who will work with the patient.
    In the near future trading chickens may become the currency of choice once again.

  • Judy

    Maybe I’m missing something – as of January, everyone in the USA is required to have insurance. Everyone will be paying premiums to an insurance company or get fined on the tax returns. So…if everyone has to have insurance, how can doctors not accept insurance as of 2014? Who is willing to pay $300/mo or more for insurance and then never use it, especially since well care visits will be free (I think).

  • drkennethnoisewater

    Well, if you need heart surgery, go to India flying first class and have it done there and save a f–kton of money.. http://content.healthaffairs.org/content/27/5/1260.full

    • PSNewton

      I have a co-worker who went to Peru to get surgery!

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