[J_9]

are you saying there arn't any doctors who receive payment in cash or have they all become employees of insurance comapnies

That's not at all what I said. Did you even read what I wrote? Nah, didn't think so.

Doctors are not required to accept the ACA insurance. They can accept cash or private insurance, thus leaving people with this unaffordable health insurance without primary care physicians, hence they will line up at the local ER for ordinary complaints.

[Wondergirl]

Doctors are not required to accept the ACA insurance.

The "ACA insurance" in Illinois is private companies.

[paraclete]

That's not at all what I said. Did you even read what I wrote? Nah, didn't think so.

Doctors are not required to accept the ACA insurance. They can accept cash or private insurance, thus leaving people with this unaffordable health insurance without primary care physicians, hence they will line up at the local ER for ordinary complaints.

Why can't these people pay cash and sort it out with their health care provider later, this is what I haven't understood from your remarks, why must a doctor accept a health care provider?

[Wondergirl]

why can't these peopel pay cash and sort it out with their health care provider later, this is what I haven't understood from your remarks, why must a doctor accept a health care provider?

For years, we have looked for area medical people who accept our insurance plans. If we want a certain doctor and he doesn't accept payment from a certain company, then the insured is considered "out of network" - still covered but not as much.

[talaniman]

why can't these peopel pay cash and sort it out with their health care provider later, this is what I haven't understood from your remarks, why must a doctor accept a health care provider?

Because only a rich man can pay the rates a doctor charges. Most of us depend on insurance providers.

[paraclete]

For years, we have looked for area medical people who accept our insurance plans. If we want a certain doctor and he doesn't accept payment from a certain company, then the insured is considered "out of network" - still covered but not as much.

This is why single payer works better, where I come from there are various options, we can seek out a doctor paid by the system, we can just go to any doctor pay them and get reimbursed from the local office or we can trot along to the ER who obviously wish we wouldn't but the benefit under the system is always the same irrespective of who the provider is, and for hospitalisation we can have insurance, or use the state hospital or the private hospital system but you wouldn't want to do that without insurance but the beauty of the system is it works no matter where you go in the country

[tomder55]

Because only a rich man can pay the rates a doctor charges. Most of us depend on insurance providers.

Another distortion .the truth is that doctors are burdened with all the regulations. Doctors setting up their own practice actually have a hard time practicing their profession . They spend a lot of time being office managers . They needs staffs of clerks to comply with all the paper work ;and their fees(which are controlled by government if they accept Medicaid /Medicare patients ) have to cover all the over head ,including what I mentioned ,buying or renting space ,payroll and human resources ,very expensive liability insurance ,and a decent profit to cover the expense of years of education to obtain their license to practice .

To answer Clete's question... there is a growing movement by some doctors to "opt out " of the whole gig and are setting up cash only practices.

In Wichita, Kan. 32-year old family physician Doug Nunamaker switched to a cash-only basis in 2010 after taking insurance for five years. ("Cash-only" is a loose description. Nunamaker accepts payment by debit or credit card too.)

Under the traditional health insurance system, a large staff was required just to navigate all the paperwork, he said. That resulted in high overhead, forcing doctors like Nunamaker to take on more patients to cover costs. Plus, the amount insurance companies were willing to pay for procedures was declining, leading to a vicious cycle.

"The paperwork, the hassles, it just got to be overwhelming," Nunamaker said. "We knew that we had to find a better way to practice."

So Nunamaker and his partner set up a membership-based practice called Atlas M.D. -- a nod to free-market champion Ayn Rand's book Atlas Shrugged. Under the membership plan -- also known as "concierge" medicine -- each patient pays a flat monthly fee to have unlimited access to the doctors and any service they can provide in the office, such as EKGs or stitches.

The fee varies depending on age. For kids, it's $10 a month. For adults up to age 44, it's $50 a month. Senior citizens pay $100.

The office has negotiated deals for services outside the office. By cutting out the middleman, Nunamaker said he can get a cholesterol test done for $3, versus the $90 the lab company he works with once billed to insurance carriers. An MRI can be had for $400, compared to a typical billed rate of $2,000 or more.

Nunamaker encourages his patients to carry some type of high-deductible health insurance plan in case of an emergency or serious illness. But for the everyday stuff, he said his plan works better for both doctor and patient.

"It would be like if car insurance paid for gas, oil and tires," he said. "It would be very expensive, and you'd have to get pre-approval for a trip out of town."

Most of his clients are self-employed, small business owners, or employed at small firms that have found the monthly fee, combined with a high-deductible plan, a cheaper option than traditional insurance.

Nunamaker now has a patient list totaling 400 to 600, compared to the 2,500 to 4,000 he said a typical family physician usually maintains. He's quite happy with his annual salary of around $200,000.

"My professional life is better than expected, my family life and personal time is better than expected," he said. "This is everything I wanted out of family medicine."

Read the rest .
Cash-only doctors abandon the insurance system - Jun. 11, 2013
I think it's very affordable ;and in fact ,my wife has gone to a cash only doctor for many years .

[Wondergirl]

Doctors setting up their own practice actually have a hard time practicing their profession . They spend a lot of time being office managers . They needs staffs of clerics to comply with all the paper work ;and their fees(which are controlled by government if they accept Medicaid /Medicare patients ) have to cover all the over head ,including what I mentioned ,buying or renting space ,payroll and human resources ,very expensive liability insurance ,and a decent profit to cover the expense of years of education to obtain their license to practice .

That's been the norm for years. Few doctors practice alone, but become associates and establish group practices in which they share an office manager, clerical staff, PAs, nurses, rent space, buy furniture and medical equipment. Each has his own liability insurance (I had mine as a counselor in a group practice). Licenses were not yet needed for counselors, but we would have had them if they were. We charged a fair market price that people paid out of pocket or through insurance. If we (or a doctor) was too expensive, the patient went elsewhere.

The ACA shouldn't affect that.

[talaniman]

A tactic here Clete is to charge you to pay for health services and let you argue how much you get reimbursed for those services with your provider, or bill you the difference (out of pocket expenses).

But some of us got checks back for the provider not spending a fair share of our premium payments for health care.

[tomder55]

That's been the norm for years. Few doctors practice alone, but become associates and establish group practices in which they share an office manager, clerical staff, PAs, nurses, rent space, buy furniture and medical equipment. Each has his own liability insurance (I had mine as a counselor in a group practice). Licenses were not yet needed for counselors, but we would have had them if they were. We charged a fair market price that people paid out of pocket or through insurance. If we (or a doctor) was too expensive, the patient went elsewhere.

The ACA shouldn't affect that.

The ACA will not relieve the overhead burden . If anything it will make it worse . That is why these doctors are opting out of the game. Others are just leaving the profession in droves .

[talaniman]

Overhead is a slave to whatever the market will bear. Nothing to do with insurance at all. Talk to the real estate guy or power company for overhead concerns.

You just keep piling on the excuses don't cha? Sooner or later you will acknowledge EVERYTHING is too damn EXPENSIVE, and your wages can't keep up.

[Wondergirl]

the ACA will not relieve the overhead burden .

It's not supposed to and has nothing to do with it. Overhead is the cost of doing business. ACA or not, overhead is there.

Why would doctors flee? They're going to get more patients (and thus more money). The same patients who headed for the ER (and the hospital got the Medicaid payment) will now seek out a doctor (and the insurance coverage the patient pays for will pay the doctor).

[tomder55]

So the doctors are lying ? From an AARP article on the same subject

Why is this happening?

Physicians and researchers cite three reasons — but all relate to one thing: insurance hassles.

Money: Under the traditional system, most medical practices need a large staff to ensure that they are reimbursed by health insurers. This results in higher overhead — which eats up to 60 percent of a typical practice's revenue — and forces doctors to see more patients in order to cover costs.

Direct Primary Care - Cash Only Doctors Say No to Your Health Insurance - AARP

[tomder55]

It's not supposed to and has nothing to do with it. Overhead is the cost of doing business. ACA or not, overhead is there.

Yes it is ,as all compliance with regulation results in added overhead costs

[Wondergirl]

yes it is ,as all compliance with regulation results in added overhead costs

I have no idea what that means. My doctor hasn't changed a thing in his office.

[tomder55]

I have no idea what that means. My doctor hasn't changed a thing in his office.

Unless the doctor is administering care to the patient ;everything else that goes on in the doctor's office is overhead. If the law requires more staffing ,more hours to comply with the paperwork for added mandates then overhead costs have to go up . You can't make the statement you made until you know the details . Perhaps your doctor compensates by taking a reduced salary . Anyway ,Obamacare tries to regulate the details with the HHS " Medical Loss Ratio Regulations”. That effort will fail ,and more than one provider is betting that their overhead will be too high to continue their practice. That is why J-9 mentioned that many are opting to work out of hospitals as paid staff .

[Wondergirl]

If the law requires more staffing ,more hours to comply with the paperwork for added mandates then overhead costs have to go up

Does the law mandate that -- or does the increased patient load mandate that? Seems like it's a win-win situation.

[smoothy]

I really hope everyone who voted for Obama ends up with $10,000 deductible plans...

Then tell us how much you are saving from your old plan when you pay twice as much to begin with.

[Wondergirl]

No changes in the plan we have. Or in my son's private pay.

ACA is for those who have NO insurance.

[tomder55]

I gave 2 links including the Obamacare friendly AARP. Guess the doctors are lying .

Here's another :

Many doctors — particularly those nearing the end of their careers — will simply hang up their scrubs instead of spending heavily to comply with ObamaCare. According to Dr. Jeff Cain, president of the American Academy of Family Physicians, "Almost a third of family doctors in rural America are thinking about retiring in the next five years."

A 2013 Deloitte survey of physicians found that six in 10 doctors believe that many in their profession "will retire earlier than planned in the next one to three years."

Those who can't afford to retire may look to partner with hospitals in order to offload increases in overhead fueled by ObamaCare. That's bad news for physicians, hospitals and patients alike.

Dysfunctional ObamaCare Is Making Our Doctor Shortage Crisis Worse - Investors.com