Why People Are Choosing to Self-Pay for Their Healthcare.
More and more often, people are choosing to pay cash for their health care instead of just depending on insurance. There was a stigma attached to self-pay patients, but no more. Why is paying cash for healthcare becoming a common place choice? Should you be thinking about self-pay yourself?
Recently, I experienced a rushing noise in my left ear. My left ear bothers me often but this noise was something different. I went to my ear doctor who recommended I have a MRI and an MRA to rule out any blockages in my arteries, an aneurism, brain issue, among other potential problems (serious and simple). Needless to say, with such serious conditions being possible, I was nervous. The doctor advised me that he wanted to schedule the tests right away and that his office would call me once the insurance company approved payment and the procedure was scheduled. A week later, I called the doctor’s office and heard that the insurance company needed to actually speak to the doctor because the paperwork he submitted was not enough. Another few days later, I received a letter from my insurance company stating that they would pay for only 1 of the 2 procedures because both were not “medically necessary.” Interestingly, although they had a medical opinion that both were not needed, they did not have an opinion on which one was needed. My doctor ordered the MRA and scheduled it. When I called the hospital to pre-register, they advised me that my cost for the procedure was $985.00! The procedure cost $1,050. In other words, I waited almost 2 weeks to get a test for a possible life-threatening condition for $65 in benefits! So, I shopped around for a better price and found it. Happily, I am fine. I am still working on getting the MRI scheduled, the cost of which will be completely out-of-pocket. I refuse to put my health at risk based on an insurance company’s opinion instead of my doctor’s. In this article, I would like to discuss why some patients are choosing to pay cash for some of their healthcare treatment and why many of the best doctors are becoming cash-only practices.
Who Is Diagnosing and Treating You? Are you Getting the Best that Healthcare Has to Offer?
Your medical records are signed by your doctor but in many cases, your care is not really being decided by them. Doctors are handcuffed to recommended treatment protocols dictated by the insurance company. Doctors may want to treat you in a different way but they know what the insurance company will pay and what they will not. They also know that if they order what the insurance company deems not “medically necessary,” the insurance company is not happy with them, potentially causing harm to the financial well-being of their practice. In an article from 2014 in the New York Times,, Lee Spangler, Vice President of medical economics with the medical association in Texas noted that, “[a] physician has very little ability to negotiate all policies and procedures that come with insurance contracts.” 
Recently, the Toledo Blade interviewed over 100 doctors in dozens of states about their experience with insurers. The investigation “found some people with health insurance were harmed because insurers interfered. Whether prescriptions, medical tests, or surgery, dozens of doctors told The Blade that insurers overruled their decisions and patients suffered.” The investigation brought to light an insurance company ranking system known as “tiering.” Insurance companies rank doctors based on their clinical treatment decisions. “[T]he groupings are of dire concern to many doctors who contend insurers’ rankings deceptively cause patients to question their physicians’ performance and create wrong incentives for physicians to cut down on prescribing expensive drugs and tests.”
Interestingly, it is often the newer and more advanced treatment protocols for which insurers refuse to pay. If you’re going to provide coverage for a procedure, shouldn’t the insurer be required to cover the most up to date version? “We want to live in a society that encourages advancements in medical technology and care. We don’t want anything in the system that’s going to hamstring improvements, or deny patients from receiving the optimal amount of care.”
Because of the control being asserted by insurers, many doctors “find freedom by shunning insurers” and managing their practices “without accepting insurance plans, removing the constraints and hassles that come with having insurers preapprove tests, procedures, and medication.” When they don’t have to worry about insurance company rules, doctors are then free to treat their patients with the latest and greatest medical science has to offer giving them job satisfaction and patients a piece of mind knowing that their chosen doctor dictated their healthcare. [Click To Tweet]
There will be some bumps along the road as insurance companies pay for less (especially cutting-edge testing and treatment protocols) and more and more doctors choose to treat their patients as they see fit, and not as insurance companies dictate. This may lead patients to wonder, as it did me, is health insurance really worth it? As noted by Sean Parnell, a health policy economist, consultant, author and blogger who has written the ultimate guide to being a self-pay patient in an interview with Mary Pat, a physician advocate, “[o]ne of the things that I expect to happen, and in fact have heard some stories about already, is that people will become upset once they realize they are paying hundreds of dollars each month for insurance but the first time they go to the emergency room or a specialist to treat an illness or injury, they still have to pay for most or all of their health care. This will probably lead to a lot of people reconsidering whether they should even have insurance, if it isn’t going to pay for any of their healthcare.”
In our office, we see people who have suffered with health issues for years. Their doctors (or their insurance companies) could not get to the bottom of it. They come to us because they want an educated doctor with passion to get to the bottom of his or her patient’s health issues, no matter what it takes. Our doctors make treatment recommendations based on their education and experience, the latest in medical science and the patient’s needs and goals, even if their insurance company might not to pay for some of it. [Click to Tweet] In the end, this is what they want. Look where the insurance-company controlled medical treatment they have had has gotten them so far! They want something different and it is. Yes, they still have medical insurance and it provides some coverage, but they have decided that they do not want their health to depend on someone’s decision who did not even know them and who made decisions about their health care based on mathematical formulas. They refuse to short-change themselves with mediocre health care. With payment plans available in most doctors’ offices, they don’t have to. Neither do you!
Have you ever felt like you did not get the best medical treatment because of your insurance coverage?
August 26, 2015
Functional Endocrinology of Ohio
Akron: 2800 S. Arlington Road, Akron, Ohio 44312 (330) 644-5488
Cleveland: 6200 Rockside Woods Blvd., Ste. 100, Independence, Ohio 44131 (216) 236-0060
Dr. Keith S. Ungar, Dr. David Starkey and Dr. Andrew Kender, Chiropractic Physicians
 Id at fn 2.