After I graduated from grad school, I paid my teaching dues by working as an adjunct instructor at three different community colleges and working part-time at a social services office.
The pay for all of the jobs was lousy, and I had no health insurance.
I wasn’t brave enough (or stupid enough, depending on your view), to go without health insurance completely. I paid for a catastrophic insurance policy that was fairly low cost, but would only pay for incidents over $5,000. I was sick a few times that year, and though I would have liked to have gone to see the doctor, I simply didn’t have the money to pay for the entire doctor’s visit myself.
Unfortunately, many others are in this same position.
The Health Insurance Crisis
When we think about the health insurance crisis, we often think about those without insurance or those who go bankrupt thanks to outrageous medical bills.
As consumers, what we often fail to see is the flip side can be just as frustrating for doctors.
Doctors have to spend hours and hours documenting for insurance purposes, and they need to hire office staff to deal with mountains of paperwork. There are delays in payment. (My husband’s insurance comes from our state, and they are routinely paying bills 10 to 11 months after the fact. I’m sure not too many doctors are pleased to wait that long for payment.)
Overall, insurance is often as much of an inconvenience for doctors as it for consumers.
Some Doctors Are Taking a Different Path
Recently, Dr. Michael Ciampi made news because he decided to no longer accept health insurance. Even if you have health insurance coverage, he won’t accept it.
Why?
First, he can offer lower costs than the insurance company would allow. Now, he’s offering a flat fee of $50 for office visits.
Second, he gets payment immediately, which makes a difference in his office’s cash flow.
Third, he doesn’t have to hire extra workers to handle all of the insurance paper work.
As a result, he’s lost plenty of patients, but he’s also gained some.
Related: What is a Health Savings Account and How Does it Work for You?
Is a Doctor Who Doesn’t Accept Insurance Right for You?
If your doctor stopped accepting insurance, would it be in your best interest to continue seeing her? What is the advantage for a patient?
Obviously, if you don’t have insurance, it’s to your benefit to see a doctor like Dr. Ciampi who doesn’t accept insurance. His fees are low, which will save you money, especially if you typically wait until your condition gets so bad you have to go to the emergency room.
However, just because you have a doctor who will accept your payment out of pocket, you still should be concerned if you face a major medical issue or have an accident. One event like that could wipe you out financially. At the very least, you should have catastrophic coverage.
But what if you do have insurance?
Should you only go to a doctor who takes insurance?
Well, that depends.
Here are a few questions you’ll need to consider:
- How high is your co-pay?
- Will you pay less overall if you pay out of pocket?
- Do you get more flexibility in your care if you don’t have to have everything approved by the insurance company?
Of course, you wouldn’t want to eliminate your insurance entirely, but just because a doctor quits accepting insurance doesn’t mean she’s no longer a good choice for your care.
Related: What You Need to Know About Obamacare.
The Darker Side of Doctors Who Don’t Accept Insurance
While Dr. Ciampi sounds altruistic, that isn’t always the case when doctors stop accepting insurance.
In some areas like New York City, doctors have stopped taking insurance because they want to charge more than the insurance companies will let them.
The New York Times raises an interesting question: “The cash-upfront trend raises an uncomfortable question. Can the Affordable Care Act, intended to widen access to health care, succeed by expanding insurance coverage if primary-care doctors are walking away from insurance?”
While Dr. Ciampi wants to make health care MORE affordable, many other doctors are dropping health insurance to make more money. Their wealthy patients can afford the change, but what about the other patients?
The more doctors who stop taking insurance, the more difficult it may be for some in certain regions of the country to get adequate care.
Good article Melissa! I think it would depend on the situation for us and if we had a doctor like Dr. Ciampi. We would likely stay with our pediatrician as he is great at what he does and the kids love him, but for us we might look elsewhere.
A good pediatrician that really knows how to handle the kids is something worth keeping.
Tough call! My doctor is what I call a doctor’s doctor. He is the best and makes you feel like you are his only patient. My answer is qualified, how much would it cost me. I can always submit the fees and receive reduced reimbursement because he would be out of network and above contract rates.
Good point! And yes, a lot of plans do allow you to see doctors out-of-plan.
A system where people cannot afford the insurance (as many Americans are in this situation) or get bankrupt after a major surgery (even with insurance or because the company doesn’t approve their claim) is BROKEN. We rant and moan in my country about our system, but it does look better than what you have there. In our case the state hospitals are mostly pretty ‘dreary’ and dirty and, while still paying the state insurance (which is taken from your salary each month), you usually have to bribe the doctors and nurses to give you some decent care (this mostly comes when needing surgery or something serious).
Our issue is that, we do pay the monthly taxes and yet have to pay more in bribes in many cases to be treated right.
There are some private insurances, but the hospitals don’t accept them, only some private clinics. The people who are more affluent (or at least middle-class) can choose to go to private clinics and get some decent care in many cases. I am giving birth in such a clinic and have done all my medical checkups like this. It’s frustrating to pay the bill entirely on my own (even if I am insured), but at least I get some good service for my money.
For the poor people (or those who don’t want to pay extra for their healthcare), the state hospitals, as ‘old’ as they are, still do a decent job. I don’t know people who got bankrupt over a surgery, even if, by not paying the bribes, they might not be treated with a smile on the face.
The doctors in the state system are VERY BADLY paid, so are all the other medical staffers. Yet there are quite some who still provide an amazing service and care about the people.
We need to solve a lot of issues with our healthcare, but at least we do not sell our houses over a heart-attack and don’t pay insane premium each month just to find out we’re not covered for a major surgery.
The state takes around 11% of our money each month for this health insurance. If you make any wage, you are paying this money, no matter how big/small the wage is. Based on it you can go to the hospital and get their service or go to a private clinic (that might give you a discount, if you’re insured or not). EVERYBODY is paying this money, except for the people who are on welfare.
I kinda like what this doctor is doing. The middleman should be cut from the equation. This allows for the patients to know exactly what they’re paying for, the costs are less inflated and everybody wins.
What also needs to be done in your case: there are many people who are on welfare and shouldn’t be. Here, if you are being supported by the state, you cannot own a car or anything that’s considered luxury. I mean, if you can afford a car, you should be able to afford to live. I have seen many people who are on welfare in the US and yet they drive new cars and play cards all day. If you can work, you should work and not expect anyone to support you.
There’s a lot of work to do in both our societies (since none is perfect), but the main issues I see are: people rely on welfare, even if they can work (this means they shouldn’t get health insurance unless they pay for it) and the insurance companies in your country (together with the hospitals) and driving the prices to some pretty horrible highs. Here in this part of Europe, a transplant is not more than few thousands Euro and a birth (since that’ what I care about now) is around 2000. Last I heard from our US friends, a simple birth got them to around 14K dollars, and that was 7 years ago.
There is a long way to go yet for healthcare to be “fixed.” We have yet to see what real affect the Affordable Care Act will have. But I agree that a surgery shouldn’t ruin your finances.
Birth are expensive. I recall our bill in that same range.
We are on the Kaiser HMO family plan. We pay $234/month and our work pays the rest. Co-pays are $15 per doctor visit and are often waved. I never pay anything extra when I go in for weekly lab tests. Prescription drugs are included at zero cost. We are happy with Kaiser.
Sounds like a great plan for you. But what would you do if your regular doctor wasn’t part of the plan?
We have had to pick new doctors who are in the plan, because the old ones left. It wasn’t a big deal to us. Pretty much the same as what would you do if your regular doctor retired? or died?
If a doctor retired then he might sell his practice to someone else that you would have the chance to get to know and then decide for yourself if you wanted to stay with him. I think for most general practitioners it’s probably not a big deal to find a new doc but some people have specialists that aren’t as easy to replace. Then the decision becomes a little tougher.
Thanks for adding your experience!
Is it even legal for doctors to do this now with Obama care? I know some people from my church that are doctors and they told me that if you accept insurance, then sometimes you never see the full payment. Sometimes patients or health insurance companies with settle with them instead of paying the full cost, which in turn drives up the prices on everyone else or makes the doctor lose money. In my opinion, we shouldn’t need healthcare. Doctors should have to compete prices in order to get patients, and patients should save money in case of a medical emergency. But we don’t live in a perfect world, so until then we will have to deal with the ins and outs of healthcare insurance.
Yes, it is legal. In fact many plans being offered on the exchanges will have less choices for doctors, at least the lower plans.
From what I understand insurance companies have set rates they pay out for different treatments. I’m sure there are plenty of cases that get negotiated. From bills I’ve seen it always looks like the doctor submits a huge bill then gets paid a lower amount. Whether a doctor sees full payment is really a matter of perspective I guess. If you know the rate you will be paid by the insurer and you submit a higher amount then you won’t see the full payment you asked for but it doesn’t mean you didn’t get paid. (Though it wouldn’t surprise me if there are also cases where an insurer just doesn’t fully pay what they are supposed to).
I agree we don’t live in a perfect world. There are a lot of politics involved in health care right now so I don’t think the issue will be solved anytime soon.
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This is an interesting topic, one I was not aware was an issue. I think it is a tough call to make. As others have noted, if your doctor is particularly good then you want to stay with him or her, but on the other hand if it is going to cripple you financially to do so – can you justify it? It seems to me like a catch 22 situation. I will say that I find the idea that doctors can choose to stop taking insurance a little uncomfortable.
Luckily, as a Canadian, I don’t have to think about this, but if I did, I think I’d stick with the same doctor. It’s hard to find one that is right for you.