A recent article on KEVINMD.COM entitled, “Keep your medical insurance, but pay the doctor with cash,” was of particular interest to me.  My practice was unique in that I ran a Concierge practice side by side with a typical fee for service practice.  Comparing the two practices is easy.

The Concierge practice was fun.  If I needed a test or procedure, I could order it without hassles.  Concierge patients bought their freedom by paying cash and appreciated the care they received.  For the most part, my Concierge patients were not wealthy.  Instead, they were hard-working middle-class individuals who prioritized their health above all else.

Fee for service/insured patients relied on their insurance companies and gave up their freedom trading it for a copay.  Their care carried more overhead than the Concierge patients and they really didn’t appreciate how much back office work it took just to get them an x-ray.

You may not know it, but your doctor’s office is forced into taking insurance products and putting up with the insurers’ discounts.  Did you ever stop to think that your doctor is your banker, carrying your debt until the insurance company pays him/her?  Did you realize that your $20-$40 copay represented the majority of your doctor’s income?  I bet you didn’t know that it cost me $10 every time I sent you a bill.

Giving a discount for cash paying patients makes sense.  The only drawback is a theoretical one.  Medicare and your insurance company could look at your doctors’ discounted fee as his/her real fee and claim that your doc over charged them.  Medicare could then claim that your bills were fraudulent and file criminal charges against your doc.  Sound insane? It is!

My suggestion is that, if possible, pay cash and ask for a discount.  In lieu of paying for your whole visit, make sure that your account is zero’d out every time prior to leaving the office. Recognize that if your insurance company requires “prior authorization” that it requires extra work and expense.  Make sure you show your appreciation.  A cake, cookies, etc. says thank you.

Personally, I think tipping your provider is appropriate but I’m in the minority!  Things are different today as many docs work for large corporations.  A five-star review says thanks in an acceptable way.

Frankly, I think it’s best to look for a concierge practice.    However you do it, don’t forget to say thanks.

Here’s today’s joke:

A man was admitted to hospital today with twenty-five toy horses stuffed up his rectum. doctors have listed his condition as ‘stable’.

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