Direct Pay Health Care Part 3

In the last article, we took a basic look at concierge medicine, and why it’s worth exploring. But where concierge plans aren’t available or are too costly, there is always basic direct pay. The American Association of Private Physicians has a growing network of physicians listed that are straight cash doctors. And paying cash doesn’t cost nearly as much as you would think, either.

Why Pay Cash?

First of all, most of these physicians won’t take any form of insurance, government program or otherwise. As such, they avoid one of the largest cost drivers in medicine, the paperwork burden to get reimbursed for the work they do. In addition, you’re in charge. You have a much greater say in which tests you take, and why, and you never have to worry about a medical visit being “denied” by your insurance company either. Cash payers also get scheduled for appointments far more easily, and faster, than is otherwise the case.

There can be tax advantages as well. Most people completely overlook the line in their tax forms about “allowed medical expenses”, but if you’re close to moving from one tax bracket to another, those deductions can make a real difference. By using an online tax filing program and checking out both the itemized and non-itemized tax burden, you might find you save a good chunk of taxes by paying cash and taking the allowed deductions.

With many direct pay doctors, you have negotiating room. All of the cash only doctors I know in my area have discount rates available for seniors and the working poor, and many also do a great deal of pro bono work. Quite a few take barter, credit cards, checks, cash, debit, Paypal, and precious metals. Five doctors I know also take Bitcoin.

In many states, there are now medical barter networks, and in my area, there are over one hundred medical professionals of all types willing to barter their services for everything from janitorial services to car care. You might even find doctors advertising barter deals on Craigslist. Other places to look would be a general search for “barter networks” in your area, or freecycle. If you are a professional or have a marketable skill of any kind, joining some of the larger barter networks can also help you grow your business.

Barter networks are the best way to get into trading, as they keep all the paperwork in order for tax purposes, and offer you the widest variety of ways to use your “trade credits”  efficiently. This also offers the “safest” introduction to the wide world of barter, as the people and businesses that belong to such networks tend to be highly reputable.

When Cash Is A Good Idea

Cash is a great idea if you’re young and healthy. In Tucson AZ, an annual physical and a complete blood screening will cost about 150-200.00. If you use one of the nine different ways to get out of paying the fine for not having obamacare, and you take the money you would have paid in insurance premiums and invest it in precious metals, then you have a stash of cash handy if you do have a real emergency at some point.

As a typical example, a 26 year old male who has to buy insurance through his job at a local school district is paying just over 100.00 a month for that insurance. Were he able to “opt out” of the employer’s health insurance program, he’d have on average an extra 1000.00 a year to invest in precious metals for emergencies, or pay off old debts. If his girlfriend did the same, between the 2 of them they’d have 2000.00 a year more than they do now.

Many employers will be happy to get off the hook for your insurance also. Several local companies give their employees an extra 10-15% in their paychecks if they opt out of company insurance, as long as they can document they are either in compliance with obamacare, or have been waived. This translates into an extra 90 cents to 1.35 per hour at our local minimum wage. When you combine that extra money with paying cash or bartering, the financial advantage can be significant.

But What About Emergencies?

This is where things can get interesting. Most people don’t realize that hospitals will negotiate bills. In some cases, if you have your own direct paid doctor that has hospital privileges, you can have your doc take care of you, for starters. And if you’re willing to be direct and persistent with the hospital billing department, it’s not uncommon to get a hospital stay cost reduced by 50-60%, or more, before you even start paying, and when you do start paying, you’ll have low monthly payments with no interest.

Many states require hospitals to accept whatever good faith payment a patient makes, even if it is as little as 20.00 a month. And most hospitals are more than willing to work out payment plans, if you show them what you can afford and stick with it. Some hospitals also have private accounts that are funded by benefactors to partially cover medical care for those who can’t afford it as well.

Instead of an ER visit, it’s also a good idea to look into the urgent care clinics in your area. Many of these are open on average 18 hours a day, and a typical visit is around 100-150.00. The wait times are also considerably shorter in most cases than an ER visit, and also significantly cheaper. Many direct pay physicians, like their concierge care associates, will  make house calls if you’re actually sick as well.

Direct Pay And Diagnostic Testing

Another thing many people don’t know is that you can pay cash for diagnostic testing, and in many places you can even order simple blood work, like complete blood counts, without a doctor’s referral. This varies from state to state, but it’s worth checking into so you know your options should you need tests. Imaging centers have basic cash fee schedules, and many also offer discounts for seniors, cash payers, and the working poor.

If your employer doesn’t offer an HSA and you want to go the cash medical care route, then it’s a good idea to open a savings account, and deposit anything you can afford into it at least once a month, if not more often. Whether it’s a “keep the change” savings account at your local bank or credit union, or a traditional savings account, setting aside money starting right now for those emergencies is the wisest option.

Saving For Your Medical Independence

The best way to save for medical expenses is actually precious metals. With the price of gold and silver artificially low right now, you can easily buy a few silver dollars or 1/20th of an ounce of gold once a week, and put it aside. Make arrangements with friends or family to have them buy the metal from you privately at market value should you need to cash it in for bills, to avoid having to declare the sale on taxes. Different coin shops will charge different “premiums” on your purchase, so shop around for the best deals.

Precious metals are the savings of choice because they actually do appreciate in value, effectively earning “interest” in excess of what a savings account would pay, and as long as you sell them privately, they are essentially not tracked by the government. At current prices, a few silver quarters will cost about 20-30.00, and are easily stored in a small fireproof safe or even a change bowl on the top shelf of the closet. Just be sure that any real silver coins are kept totally separate from household change. When buying silver for savings purposes, you’ll want to ask for “junk silver”, and steer clear of “numismatic coins”. Junk silver coins are very worn, or very common (like Roosevelt dimes), and so they sell at or very near “melt value”.

It’s also a good idea to check your change when you get it, especially dimes, and half dollars. There are a very large number of 1964 and earlier Roosevelt dimes still in circulation, and they are silver. You can check a large pile of dimes quickly by stacking them and looking at the edges–one or two without the copper stripe really stand out that way. This is especially good if you run a small business and get a lot of change. We have found quite a few silver coins among the change we get from customers over the years.

As for half dollars, the 1965-1970 Kennedy Half dollars were 1/2 silver, and all pre-1965 were full silver. Nickels minted during the WW2 years are also silver, and sometimes show up in change. It doesn’t hurt to ask your doctor if he or she will take gold and silver coins at market value, either. As a rule, direct pay doctors tend to be independent minded people, and often very flexible when it comes to forms of payment.




Direct Pay Health Care Part 2

When people think of “direct pay health care”, they think of the 1% paying cash. But direct pay health care is available to everyone, and you don’t have to be “rich” to use it, either. In this article, we’ll focus on one common type of direct pay health care that is often viewed as for the rich only–concierge care.

Concierge Health Care

In “concierge care” the patient pays an annual “retainer”, which can be as low as 100.00 a month for an individual. This retainer gives you the services of a group of doctors and specialists, on an unlimited basis, for a small co-pay when you schedule appointments. The average concierge medical network will also include inpatient and outpatient medical care for surgeries, and emergency room services and even ambulance/transport services at a discount.

As concierge physicians focus on wellness–keeping you healthy–the average plan will include basic health services annually in the retainer fee, and also offer a wide range of alternative medical treatments, from acupuncture and chiropractors to massage therapy, yoga, and even Tai Chi. Many plans also allow you to add ancillary services like dental and optical to a standard package, and arrange to keep accounts similar to HSAs, so you can have some money set aside for unexpected medical expenses within the practice itself.

Many concierge plans also offer house calls, and 24/7 on call nurses for general questions in addition to 24/7 access to your primary doctors, and some also offer telemedicine, online visits with your doctor. The advantage of a good concierge plan over insurance at comparable rates is simple–you not only get more for your money, the good concierge plans often have reciprocating services with medical teams in dozens of states and cities. Some plans have nationwide coverage, so your medical care and records go wherever you go, and there are also international plans available.

Is A Concierge Plan For Me?

Concierge plans are the best choice for young, healthy people who don’t need to see doctors often at all. The savings over insurance premiums can be substantial on an annual basis, and if you choose a large network, your health care is very portable. It is also a good choice for older patients with stable, chronic conditions, as many concierge plans offer reduced rates for seniors as well as offering some pro bono care.

For those with families and young children, the financial benefit may be small, but the benefit of your child being able to develop a long term relationship with one group of doctors more than outweighs the financial angle, just as it does for adults. Concierge doctors have smaller patient loads, and because they have the same patients for years and in some cases decades, they know their patients, and can often spot changes in a patient that other doctors would miss.

Choosing A Concierge Plan

Concierge plans range from simple to complex, from as little as 100.00 a month to 1000.000 a month or more, for the luxury, worldwide programs. All of them tend to focus on promoting wellness proactively, as such you’ll find an emphasis on diet, exercise, and a holistic approach to being healthy that is an important part of the system. As an example of one of the best ones for “boomers”, you can check out MDVIP, one that is a popular choice and has been in operation since the very early 2000’s. I highly recommend subscribing to the newsletter.

Another good resource is American Academy of Private Physicians , and in certain states, you can also check out Concierge Choice Physicians. Contacting your state’s Medical Board, or local hospitals, can also be a good place to start.

Important Things To Keep In Mind

It’s not only OK to “shop around”–it’s highly advisable. You’re paying for a service, not just “insurance”, so finding the right doctor or team is worth the time it can take. Also keep in mind that it’s a good idea to still have basic catastrophic coverage–and some concierge plans require you to have insurance available in case something big comes up.

Also, if you have an HSA option available at work, you can typically use HSA funds to pay for your concierge service retainer fees, and in many cases your concierge related medical costs will be tax deductible–so whether you go a standard “direct pay” route and just pay your doctors cash or you go the concierge route, you’ll want to keep all your receipts and take the extra few minutes to figure out whether filing an itemized tax return is “worth it”.

While Medicare  doesn’t cover concierge costs in most states (California has exceptions to this), if you have to be hospitalized or require diagnostic services you can typically arrange to have those billed through your Medicare, at the standard rates. And in some states, a concierge plan that covers all that is required by obamacare is accepted as being on obamacare.

If the idea of a full concierge plan doesn’t work for you financially or otherwise–then shop around for direct pay doctors outside of concierge networks. Most people don’t realize that just about every doctor will take cash–and that many doctors will also negotiate their fees with you, as will hospitals and in some cases diagnostic testing centers.

We’ll be covering other ways to lower your medical bills in the next several articles, including barter. But it never hurts to call your current doctor and ask them what their cash fees are if you don’t file an insurance claim–the answer might surprise you.

As we said before–concierge medicine isn’t for “everyone”. But if you’re someone with chronic conditions, someone who is a believer in proactive wellness, or someone who rarely needs more than the typical annual checkup, a reasonably priced concierge plan can make a difference financially, especially if you take the money you would have been shelling out for insurance and either invest it prudently, or buy precious metals.


The Case For Direct Pay Health Care Part 1

With the inevitable collapse of obamacare looming on the horizon, people are once again making the case for “healthcare reform”. Sadly, even the so-called experts are ignoring the best reform of all–transitioning back to, as far as possible, direct pay health care.

Once Upon A Time, Health Care WAS Affordable…

Those of us who grew up before the government got involved in health care remember “affordable care”. You paid your doctor cash. And for things that were expensive, you made payment arrangements. The indigent and the working poor had a wide variety of options, from sliding scale and free clinics to special funds that hospitals managed and funded through donations from individuals and from profits.

People weren’t being refused care for inability to pay, and they weren’t dying in the streets by the thousands either. And health insurance was a benefit that came to those who were proven “good employees”. Private health insurance was also reasonably priced, in real dollars, compared to what we have now.

Why Did Health Care Become So Expensive?

There are a few reasons for this, but the main cost drivers were lawyers and the government. Lawyers due to changes in medical malpractice laws that allowed for an increase in frivolous law suits and more out of court settlements, and the government through increased legislation and regulation of the healthcare industry.

Were things perfect before then? Nope. There were cases where people didn’t get necessary care, and where people fell through the cracks. But had we addressed those issues with free market based solutions rather than government regulation we would have been far better off than we are now.

Now, we have the most expensive health care in the world, and we have more people falling through the cracks. Now, instead of your general practitioner handling 90% of your health care, regulation and fear of lawsuits forces the GP to refer many cases to specialists for treatment rather than treating their patients themselves.

In the past, your primary care physician or GP would prescribe your pain medication, and take care of the vast majority of your healthcare. If you did get referred to a specialist, it was because something was seriously wrong. Now, a GP can’t diagnose asthma–he or she refers you to an expensive pulmonologist to confirm what they already know. Rather than prescribing Tylenol 3 for your arthritis, your GP must refer you to a pain management specialist. Instead of sending you directly to a testing facility to get a colonoscopy, and then to a gastroenterologist if the results come back looking odd, you have to go to the gastroenterologist first, then to the testing phase.

This, along with the horrific amount of coding doctors’ offices have to do just to get paid by an insurance company or the government, is one of the largest drivers of health care costs. The same group of people who ironically protested for the government to keep its laws out of the doctor’s office and “off my body”, are responsible for the crippling layer of bureaucracy that currently stands between the average person and quality, timely health care.

Time To Bring Back Affordable Health Care

In the following articles, we’ll be looking at some of the alternatives to obamacare that are available for everyone, not just “the 1%”. Because as it stands now, the government has, through over regulation, legislation, and interference, taken much of the privacy out of the doctor/patient relationship. More than that, the average healthy person is paying far more for health insurance than is necessary–and health insurance does NOT equal health care.

If you want actual health care, obamacare is far from the best answer. If you want to be able to develop a long term relationship with one doctor or a team of health care providers, then using insurance as it currently is sold isn’t the best option either. The best option is the oldest option around–direct pay health care.