It’s a bummer, I know. You navigate the nonsensical world of insurance and medicine to finally discover your doctor. The office has great reviews, their staff seems nice and friendly, the support staff is knowledgeable but….they don’t take your insurance. In fact, they don’t take any insurance. Your excitement is replaced with frustration. How could anyone, in 2019, not take insurance? How are they still in business? Is it even possible that they can do that?
By the end of the article, I’ll show you that what you see as a deal breaker is actually the best feature of that office.
We are at a crossroads currently in medicine.
At this time there are more corporate doctors than those in a private, owner-operated practice. We are changing the way medicine looks and feels. We are creating large groups under nationwide corporations. This is the essence of franchised medicine or McMedicine as we call it. Just like its restaurant counterparts it is very predictable, rooted in strict policies, procedures and protocol. Spotting these franchises may be obvious such as surgical centers or hospitals. The corporate brand is proudly posted at the highway exit and all along the entrance corridor. Other times these clinics are smaller and purposively camouflaged into your small towns and cities. Believe it or not, your small-town doctor may be part of a larger entity cleverly disguised as the same clinic you went to as a child. These types of offices are desirable for corporations to absorb into their system because they come with years of community presence and patient loyalty.
McMedicine appears to have a distinct advantage over independently owned clinics. It happened to pair nicely with the merchant service we know as health insurance. They have worked in the system for decades and have developed tried and true billing practices with complex codes and specialized language. The more complex the more we want them involved to help navigate these complexities in hopes to avoid massive billings. This has been seemingly mastered by McMedicine thus making it an appetizing choice when shopping for a doctor. Why should you be bothered with all those phone calls, pre-authorizations and letters of decline? They are probably better at it anyway, right?
Wrong. All these fabricated benefits are smothered in some major flaws. This is a functionally-dysfunctional relationship.T hey depend on one another for survival. Corporate medicine must continue to inflate costs of medical services and the insurance companies love it! Seems counterintuitive. You would think insurance companies would be fighting for more affordable services but introduce affordable out of pocket therapies and there would be no fear to pay the high premiums and deductibles of insurance. If you’re not really familiar with insurance and how it works, don’t be embarrassed, we are all confused. Just when we think we have figured it out there is another piece of the puzzle that doesn’t fit but here are the basics. Insurance is a third-party payer and it has no place in medicine. I know they seem to go together like spaghetti and meatballs but I am telling you the noodles are gluten free and those meatballs are Styrofoam! The main reason is, the laws of simple consumer driven commerce do not apply. Hell, you’re not even the customer that McMedicine is trying to satisfy! You as the patient, have lost all basic benefits and control of being the direct consumer. There is no competition, no need to make services or drugs more affordable and no incentivizes to get you better. Inventiveness and advancements are halted by a reimbursement model that rewards profitability over effectiveness. Unfortunately, this is getting worse and as the public demands more insurance, more coverage, more assistance it all equates to more money.
“Health insurance has about as much to do with your health as life insurance has to do with keeping you alive”
There are groups of doctors that have seen the decline in care driven by this franchised model. They were tired of being told what their patient does and doesn’t need by some mysterious entity that has never interacted with the patient in any way. They’ve decided to enter into the open market offering services and therapies that must be backed by customer satisfaction, affordability and efficiency. Even though you feel like you’re shelling out your hard-earned money, this is where you get the best bang for your buck. Here are the top 3 reasons why you should be glad your doctor doesn’t take insurance.
Reason #1: We Need You, and We Are Motivated
Offices that are not part of large corporations must engage in traditional business operating and marketing practices. In this model, your doctor’s office is more similar to your business than you might think. Being absent of a corporate “big brother”, the fee for service practice must try their hardest to impress you. I know it’s strange to think of your doctor’s office this way, but this is benefit #1 of a “cash” practice. In this model you are the customer, not your insurance. Cash practices are not manipulated by insurance. This is a patient centered model and you are the boss. Your insurance doesn’t much matter at all as this is a patient centered approach. A fee for service clinic wants to earn and keep your business. Just like any other business, this is how they profit. The better you are treated, the more likely you are to stay and refer friends and family. This is their incentive. A nice, clean and orderly experience up front should be followed by dedicated medical staff in the back.
There is a competitive market outside of health insurance. Imaging centers, laboratories and clinics are all competing for your business. This is great news for the YOU! In this market not only will you experience motivated facilities that are there to EARN your business you will also see advances in therapies, techniques and services much like you experience in the car and appliance industry. Take a look at Lasik or teeth whitening procedures. The consumer has benefited from this competitive market for at least a decade. Not only have these procedures improved in the results they deliver but they have also become much more affordable. Better features, higher efficiency and a sleeker look are all popular objectives in all other areas of commerce and can be translated into a cash practice. Corporatized medicine does not have this pressure to advance and provide better and leaner services. You are not their customer, your satisfaction matters very little as long as they have a healthy relationship with your insurance provider.
You vote with your dollar—this is an awesome position to be in as a customer. If you don’t like something, you stop contributing to that business. If this feeling is shared by others, then the natural progression sets in and that business ceases to exist. This doesn’t happen in medicine. Many poor performing practices are still open with doctors practicing old medicine. Can you guess why? You have no voice and your vote is not tallied because they don’t have a financial relationship with you. They have a relationship with your insurance provider.
Those that run a fee-for-service practice understand that the customer is the boss, to a certain extent. You are paying your doctor to provide a service; much like your mechanic to fix your car. If you are not happy with your service, in either industry, you won’t return. This drives the very basics of commerce and now your doctor is no longer immune, like in traditional medicine. They must meet your standard of care both in customer services as well as results. Fee-for-service practices are incentivized to get you better so not only will you continue to attend our practice, but you are more likely to refer your friends and family.
Reason #2: Price Shopping and Lower Costs
Many operations such as labs and imaging centers offer very similar if not the same services and technologies. Sometimes your doctor may have already pre-negotiated a special price for their patients. Make sure you ask so you can ensure you are getting the best rates.
“Sorry, we do not take insurance” normally is translated as “This is going to cost a lot out of my pocket”. It may not seem like you are going to save money but let us review. The average monthly insurance premium is $450-$1100. Co-pays and deductibles can quickly add up to $5,000-8,000 annually on top of your monthly premium. Some quick napkin math and we are looking around $14,000 a year. Don’t forget if these so called “benefits” are coming from your employer its actually costing you much more than that! For your $14,000 contribution into The System, your employer is likely paying another $10-15,000. This is money that is part of your income though you never see it. Thus your $25,000 annual salary is theoretically $40,000 but $15,000 is taken off the top without your knowledge! I cannot speak for all, but many fee-for-service clinics can treat your entire family and then some for a fraction of that amount.
Reason #3: No Pre-Authorization
What a pain—for the patient and for the medical staff. Insurances will dictate what therapies you receive, regardless of the experience or education of your attending physician. It doesn’t matter, they are in charge. The doctor is the middleman and merely makes suggestions and it is the insurance that decides what you receive.
If we remove the third-party payer, you now have a DIRECT relationship with your doctor. That is a very powerful relationship. Your options are broadened, the patient’s negotiating power is restored and your treatment timeline can be accelerated. We no longer have to wait for the “boss” (the insurance company) to get back to us.
Most medical procedures are inflated to meet the price your insurance company is willing to pay. Here is an example. A comprehensive thyroid profile normally costs between $90-200; get your insurance involved and you are easily 3-4x that amount. A routine MRI will cost you $300-500 (cash price) and with insurance $3-4000. An EKG may run between $85-150 and with insurance $2100.
At the end of the day you need to make the right decision for you and your family regarding your healthcare. What may surprise you is that insurance may not be the best form of healthcare for you. Your insurance company is motivated by money and so is the local self-pay clinic. I don’t know about you, but I would rather pay directly to those who immediately benefit from my commerce. The insurance model, if it is to continue to exist needs to drastically change. As of now, there are no discussions of re-writing these uber profitable operating procedures so if you’re looking for something different out of your medicine, consider finding an office that puts you in the center.