Self-Pay Vs. Insurance
Every time I go to a medical procedure that is not covered by insurance, I have a much better experience. While this is not unusual or unexpected, I am always surprised at the difference. Today, I went to the dermatologist to have some skin treatment and to have them look at some spots on my face. Grand total: $75 out of pocket but more importantly, the treatment I got going to the side of the office that was self-pay was so different than the treatment received on the other side where the insurance patients sat.
I strolled into the left side of the office at my designated time and only one person was ahead of me. I looked through the door to my right at about twenty or more patients waiting on the other side with a couple of slightly harried-looking receptionists dealing with them and the paperwork. Last time I was there, I went to the ”insurance” side. It wasn’t fun. It was tedious with paperwork to fill out, annoyed tones when I asked a few questions and a rushed session with a nurse practitioner where half my questions weren’t answered. This time, in the self-pay area? A polite assistant took me to a back room immediately, asked me how my day was and brought in the aesthetician to work her magic and look at the spots on my face. There was no rush and I left feeling happy and relaxed. Yes, I know going to the cosmetic side is much different than doing an actual medical procedure but honestly, not that much. Sometimes, you just want to go to a dermatologist and say, “what is this spot on my face and what do I do about it?” You just typically won’t get a cheerful reply or good treatment when you ask.
Well, from the doctor side of things I am advising my children to avoid medicine, except for the areas where there is much less insurance involvement- orthodontist, endodontist, cosmetic surgery, optometry. They may not be the most fulfilling or of glamorous specialties compared to some others, but the hassle factor is less. On the other end of the spectrum, I have in no uncertain terms warned them against any kind of primary care- but after watching their dad deal with that I don’t think my warnings are, sadly, all that necessary…..
A business will always cater to the customer. In your self-pay scenario, you are clearly the customer. The poor clods on the other side of the room aren’t customers, they’re revenue units. The customer is the insurance company, which, as far as the medical office is concerned, really makes the paperwork the customer. It all goes back to “how do you get paid”. On one side of the room the Doctor gets paid by seeing patients, on the other side by doing paperwork. On one side you’re a welcome guest, on the other you’re a distraction from the important form filing.
Be important, don’t be a form!
ChrisS nailed it. It is all a legacy of FDRs price controls. Insurance is a financial product used to spread risk. Trying to make it anything else leads to unintended problems.
“Wasn’t ObamaCare supposed to bring us equality?”
‘Equality’ is always achieved by making everyone equally miserable.
The problem when the government starts mandating “equality” is that it always comes back to “some animals are more equal than others”. Those of us docs that care, will quit. Those of us that don’t, will stay. Who would you prefer to have taking care of your loved ones?
Oddly, administrative ease is a big advantage of the NHS at least for paying the bill. The rest is a pain. I did a post on this a while back. Relevant bit:
Next, since the NHS is a single payer system, it is easy for people to use. When going to an NHS facility, you see whomever you see, provided your visit was routine or minor, you do what needs to be done, get whatever meds your doctor prescribed, and walk out–at least this is how it works in theory. Waiting times are a problem. Prescriptions are a problem. I found that you can only get a prescription written at the hospital filled at the hospital chemist. At the eye hospital–I had a piece of metal in my eye–I did not want to wait in line for the hospital chemist. It was a good hour plus long and I needed to get back to the children. So I took the scrip to my local chemist. I suspected I might have to pay more; I did not know that they weren’t supposed to fill it. It was antibiotic eye creme that they had on hand, so they took pity on me, the newbie American expat, and filled it anyway, mumbling something about NHS kickbacks with meds.
Getting to the hospital or specialist can be a problem too. If you need the ER, you can go directly, but for any other non-emergency problems, you are supposed to see your General Practitioner first. Your GP then has to refer you to a specialist or the hospital. So for instance, with my eye problem, I called the GP first. He had to refer me. You can’t think, “Oh, I have something in my eye, I will call an eye doctor.” Except in an emergency, you need a referral.
Can’t wait for all that, can we? As for equality, ha. Query “NHS post code lottery”.