More physicians requesting payment upfront and not filing insurance

These are a couple of different physicians that members of my family have been to in the recent months. They provided a detailed receipt which identified all of the appropriate diagnosis codes, so that we could file for reimbursement from our health insurance plans, which while time consuming, wasn’t that difficult. When asked they claimed that it is in response to reimbursement rates under many of the new Obamacare insurance plans, which are extremely low.

Historically physicians have relied on a payer mix that included full insurance reimbursements, and lower medi-care reimbursements, but such that the average payer rate was high enough to support their practices. But if that trend is shifting to lower reimbursements from Obamacare policies, these physicians have told me that they have moved to a different model to keep their practices afloat.

While this is anecdotal, just curious if anyone else is seeing similar trends. Seems like the people on Obamacare policies might not have the ability to front a payment to their doctor, and then only get reimbursed for a % of their out-of-pocket expense.

My dentist, who I have known for close to 30 years, has moved his practice primarily to Medicare in the last decade. His reasoning is that he used to employ three people in his office just to file various forms with the various insurance companies and try to collect from them. With Medicare, he only has to have one person and one form. So while in theory Medicare pays him less, his actual income is higher as his expenses are lower.

I would be glad to recieve a detailed price for services from a physician and I wouldn’t mind filing the insurance papers afterward. The way medical services are paid now is designed to hide the costs from the consumer. I find it hard to believe that any medical practice could make more money by revealing, up front, what their services cost. Maybe a few types of services for some wealthy clients could but for the rest of us, no.

It has been going on well before Obama Care. Medicare pays the least (and pay less for some stuff with Obama Care). and most insurance does not pay a whole lot more. Especially to the primary care docs. So some, feel they are worth much more $$,and others just hate all the beureouracy and paperwork. And, if they if enough rich clientele, the more power to them. Though I know of one who tried it the last few years…and already had to close his practice down. Insurance may not pay as much as the docs would like. But it does pay. Many people do not. Just stuff all those medical bills into the wood stove, and forget about them.
But, if medicine in the United States was actually a free market, there would 2x or 3x as many doctors. And they would actually have to compete with each other. And I suspect they all would be happy to get whatever kind of payment they could. So, I am not too sympathetic.

I’d love to see what some of these practices charge for things, versus the “in-network rates”. I’ve vented here before about how grossly inflated the claims are - a couple of specific examples I’ve seen have been for durable medical equipment where the “fee” is 3 to 6 times retail for the item; then the in-network rate knocks that right down to about the retail cost.

And I definitely understand the trend - insurance reimbursement is a HUGE pain in the ass even when they do it right. Such a model, though, makes it tough if you have an insurance plan that requires you to use in-network doctors (and which plans DON’T, these days?). The deductibles for out of network costs can make seeing such a doctor completely unaffordable.

The other scary trend is “concierge medicine” where the practice limits its patient population to, say, 1,000 patients per doctor - and to remain a patient you have to pay an annual fee of 1600 dollars or more (on TOP of whatever insurance pays).