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cut the insurance companies out and take cash

Discussion in 'Family Medicine' started by goldfish85, Dec 8, 2005.

  1. goldfish85

    goldfish85 Member
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    is it possible for FP to simply take cash instead of an insurance?
    can a practice be runned this way...?

    if so, are many doing this?

    i know its more like serving the wealthier and whatever but just wondering if it is done in FP ever. thanks.
     
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  3. raptor5

    raptor5 Fooled by Randomness
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    Yes it is possible. Yes it is done. From a business standpoint it will be difficult to build a patient base in the time needed to start turning a pseudoprofit. I call it a pseudoprofit b/c most practices zero the books at the end of the year and pay potential profits out in the form of capital investment, dividends, bonuses, etc. An idea is to not sink all your eggs into one basket but rather diversify your patient base. Start the business up w/ Medicaid/Medicare set a cutoff, take minimal HMO, PPO contracts that won't pay well but may balance out if agree to only take their subscribers. Then market to potential cash patients. This is an aggressive marketing procedure and must be done carefully as not to create a negative image of yourself as a physician and as a businessperson.
    I am an advocate of using the money made off of cash patients to subsidize the care of the HMO/PPO, Medicaid, and less fortunate patients. this means spending an equal amount of effort and time on all patients even though insurers will not pay you for it. You will likely get audited by insurers and the gov't b/c your billing codes will appear as if you are over billing but with excellence documentation and metrics in place to measure health outcomes you can probably defend your coding. The key is to not get greedy.
     
  4. goldfish85

    goldfish85 Member
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    wow thanks that was a very helpful response.

    correct me if i am wrong but i can imagine that this type of practice would generate a nice cash flow once there is a solid patient base formed?

    how about different types of practice, such as superior service? ie no waiting, fast attendance to patients. Also, was just wondering how realistic this is, and how successful others have been?

    thanks...
     
  5. iatrosB

    iatrosB trying not to kill anyone
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    Do a search on here for this subject. It is called boutique medicine and many people are successfull with it.
     
  6. emedpa

    emedpa GlobalDoc
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    I know of practices that only take cash, medicare, and medicaid.no private insurance of any kind. the medicare/medicaid game requires a few things to actually make money. do little things like document a pulse ox, bp counseling, smoking cessation counseling,etc on every pt on every visit and these little billable things really add up. as opposed to cxr nl, document cxr read by me as nl and then you can bill for the interpretation, etc
    strep tests, mono screens, pregnancy tests, cbc's to check for anemia, etc all generate more $$ than they cost to perform and interpret.obviously you need to use some judgement to only order when appropriate but any in house lab you do(as opposed to send out) can turn a big profit. also having a limited license xray tech/MA on staff can make you some big bucks as well as you can bill for the cost of the xray as well as the preliminary interpretation. you can also send out the films to rads for overreads and charge a processing fee for this in addfition to the rads fee.
     
  7. erichaj

    erichaj Membership Revoked
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    Yes, its is possible and being done.
    There are risks. You should most likely do this in an area where people are more likely to pay cash. You can also give discounts and see patients based on time. ex: 15 minutes = 50 dollars. etc.

    You can publish a price list for your procedures as well.

    It will take time, even more time than a traditional practice to build a cash practice. However, if you market yourself to individuals with higher net worth, and offer value added services, then you can stay in business and do well and charge a little higher prices.


    Good luck.
     
  8. Blue Dog

    Blue Dog Fides et ratio.
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  9. billydoc

    billydoc Senior Member
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    Yes, it's possible, and is being done more and more these days. Granted that your practice has right "LLL" (location). Many ppl with no HMO insurances will get a good chunk of that cash fee back. You will have to give them a superbill, and possibly itemized printout of billable services. Also you can target employers which provide flexible, or medical spending accounts to their employees.I wish more ppl will expand on it. It'll work even better for my acupuncture practice, which is traditionally cash only :D I'm starting med school this year, and kind of hope it's not a step backwards for me financially :laugh:
     
  10. cooldreams

    cooldreams American Mensa Member :)
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    r u thinking about boutique or??
     
  11. cooldreams

    cooldreams American Mensa Member :)
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    to practice acupunc, dont you have to work under a doc?? i know not every state is the same, but this is what i think ive read in my state.

    and if that is the case, then being a doc, you earn more because youre not under a doc right??
     
  12. iatrosB

    iatrosB trying not to kill anyone
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    No, it's not really my style. I'd rather be the entire town's doc in a rural area.
     
  13. billydoc

    billydoc Senior Member
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    I hold license to practice acupuncture in NY and NJ. I don't have to work "under" anyone at all. NYS mandates for the acupuncturist to advise their patients to seek medical treatment for the same problems they seek acupuncture. In NJ they also require areferral, but not supervision from MD/DO,however I have yet to see it being observed :laugh: .I suppose if I took insurance it would be relavent b/c a referral implies medical neccessity.
    When I worked with no-fault and personal injury cases, they've been seen by MD/DO anyway. But other than that...most insurances still don't pay for acupuncture :mad: But in this case I have a lot of time to spend with the pt and to cut down on the stupid paper work.
    To reflect on your other point ...there are many,many docs who work under other docs, or employed as salaried employees by hospitals and corporations.
    If we are talking about just primary care,well, these days money is really tight in that field.So between my RN (which I also do as independent contractor) and private acupuncture practice being in the 6 figure income is not a problem. Money alone would not be a good enough reason for me to enter medicine. So I just hope that I know what I'm doing,b/c no question I want to be a doc, and will take "good and bad" that comes wit the territory. But I'm a bit older than most who go to med school, and my personal health is not really that optimal at least for now.Naturally I'm anxious about the whole thing.
    Thanks
     
  14. cooldreams

    cooldreams American Mensa Member :)
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    is it possible to do that without an hmo?? i dont know if it is, if you can that would be cool. i am really dreading the hmo interaction, but would like to help as many ppl possible....
     
  15. cooldreams

    cooldreams American Mensa Member :)
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    thats cool. thanks for the nfo. sorry about your health though :/

    i think acupunture is pretty cool, im really into pressure point stuff... which i guess is part of my reasoning for going back and forth with ns
     

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