F you. pay me !

[Dr McSteamy]

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i was just reading this old article on cnn
http://money.cnn.com/2009/07/09/new..._creditcards/index.htm?postversion=2009071114


"if you can't pay your doc, charge it to your credit card."

sounds like a good plan. let the credit card companies pay me up front, and patients can worry about how they'll pay their bill later. I got my money. If you don't wanna pay your cc bill.... not my problem....

doctors shouldn't have to worry about how and when they'll get their money.

All this crap about people not being able to afford health care is bullsht.
most doctor's visits are under $100. If they can't afford it, they should stop buying the fast food and soda, and start learning how to be smart with their money.


I love the idea of having uninsured patients who pay by cash or credit.

I think I'll even have a 'cash or credit only' sign in my future office.

but is it sustainable?

 

[asmallchild]

All this crap about people not being able to afford health care is bullsht. most doctor's visits are under $100. If they can't afford it, they should stop buying the fast food and soda, and start learning how to be smart with their money. I love the idea of having uninsured patients who pay by cash or credit. I think I'll even have a 'cash or credit only' sign in my future office

Forget medicine, you should run for president on this platform 😉

 

[deleted87716]

I love the idea of having uninsured patients who pay by cash or credit.

Why does this strike you as a foreign concept?

The policy at my office has always been that payment is due at the time of service unless other arrangements (e.g., billing your insurance) are made in advance. There is a sign saying exactly that next to the check-in window in the lobby.

What that means is that uninsured patients pay in full before they leave the office. We accept cash, checks, and major credit cards.

Patients who have a problem with this policy are free to receive their healthcare at another office. The decision is theirs.

Incidentally, the article you referenced sounds more like it's talking about major medical bills rather than penny-ante primary care-type stuff. I doubt anybody ever went bankrupt from primary care bills.

 

[Ariee]

Ya agree with BlueDog above, this is quite popular in the "doctor's care" offices I've been, to just see the "doctor" is $100. The doctor was a nurse practitioner by the way in this orthopedic surgeon's office...

 

[Dr McSteamy]

Incidentally, the article you referenced sounds more like it's talking about major medical bills rather than penny-ante primary care-type stuff. I doubt anybody ever went bankrupt from primary care bills.

i dunno. there's a chart on there that shows office visits being the 2nd highest expense behind drugs.

i dunno how it really is at hospitals. but i thought many people get away without paying hospitals, and they just eat the cost.

 

[deleted87716]

Ya agree with BlueDog above, this is quite popular in the "doctor's care" offices I've been, to just see the "doctor" is $100. The doctor was a nurse practitioner by the way in this orthopedic surgeon's office...

A typical visit for a cash-paying patient in my office is around $60.

 

[Ariee]

Here we are BD:

http://www.doctorscare.com/

This is the website for the "Doctor's Care" Office...I couldn't find anything about their fees. I put up the website, just in case you weren't familiar with this particular set of clinics, I sure wasn't until a while back. The $100 was for an uninsured quick visit. Was also told that there were no physicians in the office that day yet (1pm)...

 

[chartero]

http://www.doctorscare.com/

This is the website for the "Doctor's Care" Office.

Doctor Scare! They could have thought this through. (Though there are worse. Then there are therapists, like this one.)

 

[Winged Scapula]

Catchy title - caught my eye. 😉

I dunno what's so novel about that idea either.

Although as opposed to BlueDog, my patients don't get put in a room unless they pay UP FRONT.

When the appointment is made, insurance information is requested and verified. If it cannot be verified and they show up, another form of payment is requested.

Patients without insurance are required to pay cash or with a valid credit card, for their visit. No checks are accepted for patients without insurance.

No billing for co-pays; a few times a year, I get someone who can't afford the co-pay. They are usually patients who don't have insurance and therefore, cannot afford the office consultation (which is around $220 for a new patient). Even if they can scrape up the money for the consult, they often cannot afford the cost of biopsy, additional testing, etc. and I have to refer them elsewhere.

 

[GoodmanBrown]

Catchy title - caught my eye. 😉

I dunno what's so novel about that idea either.

Although as opposed to BlueDog, my patients don't get put in a room unless they pay UP FRONT.

When the appointment is made, insurance information is requested and verified. If it cannot be verified and they show up, another form of payment is requested.

Patients without insurance are required to pay cash or with a valid credit card, for their visit. No checks are accepted for patients without insurance.

No billing for co-pays; a few times a year, I get someone who can't afford the co-pay. They are usually patients who don't have insurance and therefore, cannot afford the office consultation (which is around $220 for a new patient). Even if they can scrape up the money for the consult, they often cannot afford the cost of biopsy, additional testing, etc. and I have to refer them elsewhere.

If you don't mind me asking, WS, how often are patients put off by the paying before even seeing you? Not that it isn't sensible, but it seems to be a change in the natural order of things. Also, do you do any consults or work that doesn't pay? Finally, logistically-speaking, how does that work? Most people I assume wouldn't want their insurance status and payment methods/troubles to be viewed by the entire waiting room. Do you have a small sub-room or area out of sight of everyone where people can handle billing issues right away?

 

[montessori2md]

My PCP does the pay-first thing. At first, I was put off (so was my mother when her PCP started the pay-first). But logistically, I like it. You're sitting around waiting your turn, you might as well pay the co-pay while you're sitting around, rather than it taking longer to get out of the office b/c you're paying afterwards. Also, if there is a problem w/ your insurance, you know before you've had 14 labs drawn and are thinking crap! I can't pay for all that. (this is what usually happens to me when I take a pet to the vet, except for the insurance part).

 

[deleted6669]

A typical visit for a cash-paying patient in my office is around $60.

including or not including labs, ekg, xray, etc that are a common source of health care bills...
I just ended up paying 800 dollars out of pocket for a minor ortho visit for my wife with a radial head fx(and I have insurance...this was my share of the bill).
that was for 1 three view xray , a splint/sling, and a 5 min consult. no labs/injrections/procedures.

 

[deleted87716]

including or not including labs, ekg, xray, etc that are a common source of health care bills...

Most acute care visits require none of that. You certainly won't find any of that stuff available in your local in-store "nurse-in-the-box."

 

[Winged Scapula]

If you don't mind me asking, WS, how often are patients put off by the paying before even seeing you? Not that it isn't sensible, but it seems to be a change in the natural order of things.

If there has ever been a problem, I'm not aware of it.

When they call for an appointment, they are asked for their insurance information (which is verified) and if they are cash pay, they are told what the consultation will cost but reminded that if they need a biopsy, any testing or surgery, that those will be additional costs to them, requiring payment up front. This is pretty standard in most specialists offices AFAIK.

Also, do you do any consults or work that doesn't pay?

While I am tempted to say that NONE of the work I do pays my medical liability company advises us that we are not to do work without charging for it. Their reasoning is that, in a extremely litiginous specialty, you don't want any appearance of deviating from the standard of care, including in your billing.

I do plenty of talks in the community, advise on community and hospital panels and the like for free. It may not sound like much, but it takes several hours each month and frankly, with the debt I incurred to become a surgeon, I am not often tempted to work even more each week without being paid.

Finally, logistically-speaking, how does that work? Most people I assume wouldn't want their insurance status and payment methods/troubles to be viewed by the entire waiting room. Do you have a small sub-room or area out of sight of everyone where people can handle billing issues right away?

If there are "troubles", then they are taken to my Office Manager's office where they can have some privacy. I haven't heard any problems with patients worried that others might see them writing a check or pulling out a credit card. Do people really care about this?😕

However, I think you have misread my patient population. I have very very very few self-pay or indigent patients, so its the rare situation in which someone doesn't have their co-pay, or their credit card is denied and they cannot otherwise pay. Most of my patients have good insurance and are able to pay the co-pay and relevant deductible.

The biggest problem we have is the patient with the extremely large deductible (ie, $10 or $20K) who needs major surgery and then acts surpised when not just I, but the hospital, asks for the money up front. One of them, when my Office Manager looked for some financial resources for her, was disclosed to have earned $100K the year before.🙄 But off topic...

My PCP does the pay-first thing. At first, I was put off (so was my mother when her PCP started the pay-first). But logistically, I like it. You're sitting around waiting your turn, you might as well pay the co-pay while you're sitting around, rather than it taking longer to get out of the office b/c you're paying afterwards. Also, if there is a problem w/ your insurance, you know before you've had 14 labs drawn and are thinking crap! I can't pay for all that. (this is what usually happens to me when I take a pet to the vet, except for the insurance part).

This is the major issue. It would be one thing if the patient's insurance didn't cover a $60 office visit, but I cannot be faced with patients owing me hundreds or thousands of dollars because their insurance was termed.

 

[deleted6669]

You certainly won't find any of that stuff available in your local in-store "nurse-in-the-box."

not a fan of "retail medicine" but they do offer the following:
strep test
pregnancy test
ua
monospot

as well as flu shots, td, etc

you don't do these in your office for free, do you?

 

[deleted87716]

you don't do these in your office for free, do you?

No, and neither do they.

From the MinuteClinic web site:

Services and Costs

* Minor illness exam $62
* Minor injury exam $62
* Skin condition exam $62
* Wellness & prevention $20-$66
* Vaccinations $30-$112

Additional charges may apply. Most insurance accepted. Contact your insurance company to verify coverage.

 

[deleted6669]

No, and neither do they.

From the MinuteClinic web site:

I wasn't implying that they do. my point is that it's hard to say "an office visit will only cost 60 dollars" when in fact many office visits include some type of ancillary testing or vaccination which isn't free. sure, if they are coming in for a refill of their bp meds it's 60 bucks. but what about when they need an hba1c or tsh, etc
my "yearly physical" (and I'm a healthy 5'9' 146lb ultramarathon runner with a bmi of 21 or so) typically runs well over 150 dollars after labs, travel vaccinations, etc
my initial visit was probably 500 bucks with baseline labs, ekg, etc
a lot of folks who work at low income jobs can't afford 150 bucks for a medical visit.
I see these folks at the free clinic where I volunteer. many of these folks have several jobs, are single parents, etc and 150 bucks just isn't in the budget.

 

[MOHS_01]

I charge $50 for a self pay visit, which would include minor procedures such as freezing or a biopsy if indicated. If they can't pay it, and they offer to make payments, they get it for free. Why? In part because I enjoy a specialty that can still afford to practice the old way; I earn enough on the rest that it comes out in the wash. When I was in solo practice it was less of a financial burden to do so; last year I made the mistake of joining a multispecialty group that eats a substantial portion of my profit margin anyway. I still provide self pay care, but I have tried to manage it so that it is less than 10% of the visit mix.

Again, I realize that this is a luxury that is afforded me due to my chosen specialty, so don't shoot the messenger.....

 

[deleted87716]

I wasn't implying that they do. my point is that it's hard to say "an office visit will only cost 60 dollars" when in fact many office visits include some type of ancillary testing or vaccination which isn't free.

The vast majority of my self-pay office visits are for acute care or simple follow-ups, and it really does cost around sixty-odd bucks.

Yes, if they need something more than that, it will cost extra. The costs are known and disclosed up-front, so there are no surprises. We can and do work with people if they aren't able to pay the full amount.

As for your physical example, you should know that most of what's done during a "routine physical" (even the physical itself) is probably unnecessary, especially for the young, healthy, and asymptomatic. If a self-pay patient wants a physical, I can usually find a way to make it affordable for them.

It sounds like perhaps you're advocating for an affordable monthly fee-type arrangement, which I'm actually trying to put together (similar to what's been done in Rhode Island: http://www.healthaccessri.com/ ).

 

[deleted6669]

The vast majority of my self-pay office visits are for acute care or simple follow-ups, and it really does cost around sixty-odd bucks.

Yes, if they need something more than that, it will cost extra. The costs are known and disclosed up-front, so there are no surprises. We can and do work with people if they aren't able to pay the full amount.

As for your physical example, you should know that most of what's done during a "routine physical" (even the physical itself) is probably unnecessary, especially for the young, healthy, and asymptomatic. If a self-pay patient wants a physical, I can usually find a way to make it affordable for them.

It sounds like perhaps you're advocating for an affordable monthly fee-type arrangement, which I'm actually trying to put together (similar to what's been done in Rhode Island: http://www.healthaccessri.com/ ).

thanks- yes, I would like to see some type of afordable healthcare for the working poor like what you describe.

 

[Mikemed08]

Dr McSteamy

Re: "F u pay me post"

-Dude you're an absolute idiot in the full sense of the word! I was actually debating whether or not to challenge your stupid views on healthcare but decided not to. Its VERY obvious you have no idea about the stuggles poor uninsured people have in this country. Why dont you take some time to read some academic articles about this issue.

Read!
http://www.pnhp.org/PDF_files/ForProfitCare.pdf

http://www.pnhp.org/PDF_files/MedicalBankruptcy.pdf

http://www.pnhp.org/facts/myths_memes.pdfhttp://www.pnhp.org

 

[deleted87716]

I was actually debating whether or not to challenge your stupid views on healthcare but decided not to.

So, you just decided to call him names instead? Brilliant. 🙄

 

[Mikemed08]

So, you just decided to call him names instead? Brilliant. 🙄

Yes Blue Dog...

There really does come a point where people need to be called out...

His comments were utterly offensive and ignorant....as was the title of his comment....

I cant believe people like him get into medical school...

Its no wonder we have such a crappy healthcare system...

No one ever bothers to blame insurance companies, politicians, or our economic/social/political system that screws poor people over....

Its so much easier to blame the victims...

If we had national healthcare along (to cover everyone not insured) w/ a private system (for those not wanting to be part of public systm) we wouldnt have a problem...

www.pnhp.org

 

[GoodmanBrown]

So, I'm going to hijack the thread with a different question. How many docs out there don't accept credit/debit cards? I ask b/c I was at a new doctor's office yesterday, and I tried to pay my co-pay with a credit card (technically debit, but whatev). But the receptionist kindly told me that they don't take credit card, only cash or check. I walked out without paying a penny because I didn't have either. They'll send the bill after working with insurance.

So, I found this very interesting because if the ins. didn't work out and I didn't pay, the doctor's office just lost 100%, as opposed to 65% or so if I paid my copay before leaving. Now, I know CC take out ~2% and debit cards charge a fixed fee ($0.10 - $1.00?), so you don't use them for free, but it still seems like a gamble to me.

Any thoughts?

 

[deleted87716]

How many docs out there don't accept credit/debit cards?

I suspect most do.

We accept Visa and Mastercard. We do not accept Discover or AmEx because their fees are excessive for the relatively low volume of credit card transactions that we do.

 

[Dr McSteamy]

Dr McSteamy

Re: "F u pay me post"

-Dude you're an absolute idiot in the full sense of the word! I was actually debating whether or not to challenge your stupid views on healthcare but decided not to. Its VERY obvious you have no idea about the stuggles poor uninsured people have in this country. Why dont you take some time to read some academic articles about this issue.

you don't faze me

 

[GoodmanBrown]

I suspect most do.

We accept Visa and Mastercard. We do not accept Discover or AmEx because their fees are excessive for the relatively low volume of credit card transactions that we do.

Oh, yeah, I definitely assumed this doctor's office was out of the norm. But, my main question is, has anyone examined this? If you only accept cash or check, do delinquencies go up 2%? So, is it a net win to not take credit cards? Or between delinquencies and theoretical lost business with people finding more convenient offices, would you lose that 2% of revenue? Obviously not an easy question to answer, but I don't know how well EMRs do data collection. I have a stats background and want to be as business savvy as possible when I run an office, so I'm just curious about these things.

Anyone ever thought about tacking on an extra 2% when someone uses a credit card? Or is that breaking the credit card policy? I've had 2 small businesses do that, but they were literally 1 person shops, so they probably could get away with bending the rules whereas a doctor's office has so many levels of checks (from the ins. company, government, etc.) that you couldn't break a rule that was that big...

 

[RGMSU]

I know some FPs who have become very selective about insurances they accept, and I know some who are moving back over to cash only practices. I don't know very many who will see a patient without having them pay the copay first. Physicians have to look out for their own financial welfare. It's obvious in our society that nobody else is going to. It's funny how some of the same people who "can't afford" healthcare drive brand new $40,000 Chevy Tahoes and such. There are some middle class people who fall through the cracks to be sure, but there are a lot of folks who just don't want to prioritize. I'm actually surprised FP isn't more popular. Seems to me it would offer a lot of reimbursement options and plenty of patient base to pick/choose patients if people used their thinking caps a bit.

 

[chartero]

Anyone ever thought about tacking on an extra 2% when someone uses a credit card? Or is that breaking the credit card policy?

Rules are complicated:

Agreements between retailers and credit card processors, such as Visa and MasterCard, prohibit stores from charging more for purchases made with plastic than for those done with cash. However, it's OK under these agreements to offer discounts to customers who pay with cash. Even though they essentially amount to the same thing -- it's cheaper to pay with cash than plastic -- a semantic loophole means one is fair game and the other isn't.

In some states, it's more than just against Visa and MasterCard's rules, it's against the law. New York has a law that prohibits retailers from charging a surcharge for credit cards.

Filling up the tank? It may pay to use cash: More gas stations offer discounts to customers who say no to plastic

Cash may pose security concerns.

 

[digitlnoize]

FWIW, I've never been to a doctor's office that didn't take Visa or MC. It's the 21st centruy people...customers expect to be able to swipe their check card...at least until they can just wave their chip implant at you...

 

[deleted87716]

We also allow patients to pay their bill online.

http://www.hcplive.com/pmdlive/in-depth-for-doctors/physicians_online_bill_pay

http://www.freshnews.com/news/214938/intuit-transform-way-patients-pay-their-doctors

 

[RGMSU]

We also allow patients to pay their bill online.

http://www.hcplive.com/pmdlive/in-depth-for-doctors/physicians_online_bill_pay

http://www.freshnews.com/news/214938/intuit-transform-way-patients-pay-their-doctors

I think I would allow them to pay before they get seen, unless it is known to be a charity situation.

 

[deleted87716]

I think I would allow them to pay before they get seen, unless it is known to be a charity situation.

When we see uninsured patients, we have them pay the cost of a level three (new or established) office visit at check-in. At checkout, they may owe more, or (rarely) receive a partial refund, depending on what was actually done.

The online payment option is only available to insured patients, since they're the only ones who receive a bill.

Co-payments for insured patients are always collected at the time of service (typically at check-out, unless we've had collection issues with a particular patient in the past, in which case they pay at check-in).