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How to Get Your Medical Money's Worth Michael Arnold Glueck, M.D., and Robert J. Cihak, M.D., The Medicine Men We recently wrote about how medical regulation makes medical charity illegal (see: No Good Medical Deed Goes Unpunished). One of the side effects of this hyper-regulation is to cause many doctors, hospitals and other health practitioners to set their posted prices higher than the amounts they accept as full payment from government programs or insurance companies.
Because a growing number of people are paying cash for at least some of their medical services, today we're focusing on what you can do to pay a fair price for medical services.
The most important first step is to have a private medical doctor open to your concerns about your pocketbook as well as your health.
"Insurance-free" doctors don't have contracts with Medicare or insurance companies and have more flexibility than doctors who have signed these contracts. They are better able to focus on your personal medical needs because they don't have to worry about whether an insurance company might pay them. Story Continues Below
For example, Dr. Vern Cherewatenko of Renton, Wash., president of SimpleCare.com, provides only medical services and does not provide insurance services. As a result, Dr. Vern charges a fraction of what most other doctors charge for comparable services.
Dr. Robert Berry of Greeneville, Tenn., also finds that providing only medical services at his PATMOS EmergiClinic [www.emergiclinic.com] allows him to charge very reasonable fees. As Dr. Berry puts it, "fees at our clinic run anywhere between an oil change and a brake job." If patients with insurance want help with filing their insurance claims, Dr. Berry refers them to specialists who can help take care of the paperwork.
Dr. Robert Morgan and Dr. Nancy Morgan of Guardian Family Care [http://www.guardianfamilycare.net] in Mill Creek, Wash., provide personalized medical care for monthly retainer fees ranging from $35 to $75 per month, depending on age. The fee covers all the services the patient needs and that the doctors can provide.
Other third-party-free medical practices are listed by the Association of American Physicians and Surgeons (AAPS) at http://www.aapsonline.org/freemarket/.
These doctors find they're practicing better medicine because they're responsible only to their patients instead of to insurance companies or government bureaucracy.
It's often possible to negotiate with doctors who don't unbundle their medical and insurance services. We tell them we want to pay for medical services but don't want insurance services. Some of these doctors have then charged for the essential services provided – for example, a basic rather than a comprehensive examination, resulting in a reasonable fee.
Other doctors and dentists have a lower fee or discount for payment at the time of service ranging from 5 percent to 50 percent, in our personal experience. Although some doctors post notices inviting inquiries about prompt payment discounts and fees, we've usually had to ask about this option.
If you don't have a doctor you know and trust, you can find your pocketbook as well as your body hurting. Two friends recently suffered intense chest pains that caused them to worry about a heart attack. One went to her doctor, who did a history, physical examination, electrocardiogram (ECG) and diagnosed a hiatal hernia; the doctor gave advice on how to manage this fairly common condition, for a fee of $85, including the ECG. The other friend checked in to the hospital emergency room with his pain. He still has no diagnosis, even after $30,000 worth of emergency examinations, tests and aggravation. But they've told him his heart is in "perfect condition."
If you want health insurance, low-deductible health insurance is very expensive, largely because it covers day-to-day medical encounters. Covering common and relatively inexpensive medical services generates a maximum of paperwork and overhead expense compared with the cost of the medical services. As a result, providers have to charge more to cover this administrative overhead.
More and more people are cutting their own insurance costs by self-insuring for everyday health needs and buying high-deductible insurance plans, such as a Health Savings Account (HSA). These plans allow tax-exempt cash savings coupled with a high-deductible insurance policy. See HSA Insider [http://www.hsainsider.com], the Association of American Physicians and Surgeons (AAPS) [http://www.aapsonline.org/msa.htm], search the Internet and ask your insurance agent for more information.
Some hospitals make allowances for cash-paying patients but again, you'll probably have to ask about these options.
Identifying actual hospital costs can be a valuable first step in hospital negotiations. The Hospital Victims Project [http://www.hospitalvictims.com] provides just this information for most hospitals. It's part of the work of the Fairness Foundation, a national nonprofit organization that educates and assists the uninsured. The Project Web site shows the Cost to Charge Ratio for hospitals all over the country.
According to the Web site: "Most hospitals will tell you that Medicare pays too little, causing the hospital to lose money on Medicare patients. That is not true. The law requires Medicare to pay on average 1% more than cost at an efficient hospital. What Medicare pays should be a starting point in determining a reasonable charge for you." The Project Web site also shows how to find out what Medicare pays the hospital and concludes: "We believe in general you should pay no more than Medicare plus 25%. That is a generous payment from you. Minnesota has required hospitals [to] accept Medicare plus 5%. We suggest you offer Medicare plus 25%."
The best time to negotiate is before you start receiving medical services. But even after the fact, doctors and hospitals can make adjustments. Telling the billing staff that you're paying cash for the service or that you don't have health insurance can lead to adjusted charges.
Ask, and ye might receive.
Editor's Note: Robert J. Cihak wrote this week's column.
Robert J. Cihak, M.D., is a Senior Fellow and Board Member of the Discovery Institute and a past president of the Association of American Physicians and Surgeons. Michael Arnold Glueck, M.D., comments on medical-legal issues and is a Visiting Fellow in Economics and Citizenship at the International Trade Education Foundation of the Washington International Trade Council.
Editor's note: Read more on this subject in related Hot Topics:
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