Self-Pay Vs. Insurance
A couple of weeks ago, I went to a dental procedure with an oral surgeon; I had to pay the entire bill out of pocket as it is not covered by insurance. Though I did have to do some waiting while they worked me in, they were kind, cheerful and extremely competent and concerned about my well-being. After I got home, my dentist and surgeon sent me some beautiful flowers to help with my recovery. The whole experience was so much better than I thought it would be. That is rare to say for any doctor’s visit I have gone to over the years. More often than not, there is waiting, a brisk appointment with a harried doctor or nurse and more waiting while the staff looks at you like you are a leper. The other patients look depressed, angry and sick or just pathetic while you wonder how and why you are such a sicko yourself.
I cringe when I think about ObamaCare and how much worse it will get and I just pray that my health holds up long enough to escape sitting through what will probably be hours in an anonymous setting full of too many people needing too much care and filling out too much paperwork. Or worse, being denied even the “privilege” of sitting through such hell. I hope that with ObamaCare there will come more practices signing up for concierge service where self-pay will buy a better standard of care. But is that really the answer? Maybe it is, but then the care becomes even more divided, just like my dermatologist’s office where the self-pay people have one type of care and those with insurance another. Wasn’t ObamaCare supposed to bring us equality?
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Image created courtesy photo via shutterstock / Cheryl Casey
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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”.