Hospital: "Sorry - we no longer accept cash"

[Jack_Dawson]

Your Money is No Good Here
By Natalie Calegari

To say that I'm a casualty of the insurance problem would probably be an
overstatement but I'm certainly finding myself on the wrong side of the
issue today.

I've been an independent contractor for 5 years. When my COBRA ran out from
my last full time job and I tried every insurance company I could to cover
me. No such luck. Of course with a preexisting condition why should a
company cover me? Here's why; they don't want to cover people who actually
need it and might use it.

OK, so you're thinking that you use yours and haven't been denied coverage.
You probably have a full time job somewhere. Well, lucky for you the
statistics are on your side. The number of sick people or those who will
use their insurance is a hard and fast percentage of any given number of
people under a group plan. Their loss, or your medical care costs, are
already factored into their bottom-line. Self employed people on the other
hand are too hard to estimate. This means there's more of a chance for
independents to possibly cost them real money and cut into their profits.
That's how they see it. This is a fact. They're betting the odds.

All for-profit companies that need to make their shareholders happy will
have to show growth and not just profit. So when you keep hearing the
Democrats say that the cost of health care in this country is rising at a
rate that we can't keep up with, this is what they're talking about.

Take for example medical billing. My old insurance made me go to a lab that
would charge $300 for blood tests. Those tests, bypassing insurance and
paid in cash, are only $70.

These inflated costs are making several people in the chain very wealthy and
it's no different than the housing bubble. The costs are passed on to the
employers and anyone of the happy customers paying into the system. Just
wait until you get sick and need it though.

So, without insurance I have been paying cash for visits, tests and
prescriptions. I don't go to the doctor any more than any other 35-year-old
so I'm not out tons of money. A few hundred here and there as needed. I
make relatively good money so I'm in a better position than some. Still
it's a screwed up system if you ask me but I'm lucky I can afford 100%
out-of-pocket medical expenses.

Fine. You won't insure me? I'll pay the doctor myself. When I had
insurance I wasn't happy with the fact that a Blue Cross accountant was
making medical decisions for me anyway. Err.... how is that better than a
government regulated system?

Not so fast! Today I was informed that my doctor will no longer be taking
cash patients. You must have insurance to see him. Is he worried that I
can't pay? They run my card right there in the office so that's not it.
Hmm... Oh yeah. They can bill insurance a hell of a lot more for their
time than just accepting my measly $100 or so. And they can order up all
kinds of tests with the freedom of knowing they can bill up to a certain,
very large amount. So, essentially seeing me has become charity work. Aww,
cute! Look at her little office visit payment!

What now? Is this what's it has come to? I'll start to look for a doctor
who will take cash but I think the writing is on the wall. I charge a
premium for my work so I get it but I draw boxes and things for a living. I
don't have human life in my hands. I don't think that public health issues
are supposed to make billionaires out of health insurance CEOs. That just
isn't logical nor is it ethical. Things go wrong and have. And people get
greedy. It's not anti business to say that either. Because people's lives
are at stake here, this isn't something we can allow to be so recklessly
mismanaged. It IS a right to be seen by a doctor and get some form of
treatment.

This is not a socioeconomic problem. This isn't an issue of giving "poor
people who don't work and are lazy" a free ride. This isn't about free
anything. This has to be fair. How can a developed country like ours be so
barbaric and treat its citizens like this? It behooves a nation to have
healthy people, doesn't it?

No cap on private costs as it stands now will bankrupt our nation even
further. A public option would have a standard cost and offer service that
will force the private companies to compete. That's the least we can do.
If the private companies are so great then let them compete. That's the
nature of a free-market, capitalist society, right?

[Warpy]

1. Uninsured people typically pay three to five times

what an insurance company is charged for the same service, test, medication, hospitalization, or equipment. Your lab charge was an anomaly, fee for service is usually much higher than what they charge the insurance company.

[girl gone mad]

5. You're talking about hospital bills.

Out of pocket fees at a doctor's office or outpatient lab are often discounted because of the ease of the transaction. If someone is paying cash, there is no insurance paperwork involved, with the potential denials or disputes.

Even hospital charges can be negotiated by uninsured payers, but you're usually only successful if you negotiate in advance.

[Warpy]

19. Hospital bills, lab bills, radiology bills, medications, assistive

equipment, the whole lot. Some doctors and labs and a few hospitals are now offering discounts to uninsured patients, but 20%-50% off a bill that's three times what an insurance company pays is not that great a deal.

Docs have been the best about working with me over the past 22 years of being uninsurable and pharmacies the worst.

You'd think that uninsured people who are paying up front and in full would get a better deal, but we don't. We're left subsidizing the deals that insurance companies have negotiated.

[mimitabby]

7. yes. that's what i was going to pay

I paid cash once, and even though they KNEW i had insurance they charged me much more than the ins would eventually pay (i got the extra back MONTHS later) it's like $40 out of 100 is all the insurance pays

[Merlot]

12. That's been my experience.

INsurance company gets a discount because it's bulk. I pay full price because because I don't have the bulk rate. Makes no sence to anyone other than the insurance executives lining their pockets.

[orleans]

16. that has *not* been my experience.

my doctor gives me a bit of a break for a dr. visit

my hospital gave me a break on the er when i told them i had no insurance (and i got another discount for paying the bill before 30 days)

and my daughter (who has ins. through her father) pays less for eye exams when we say we don't have vision ins (otherwise we would have to meet a $500 deductible and the vision place charges more if you have ins--so we'd be paying--from what i remember--about forty dollars more...that was several years ago & we'd probably have to pay even more for just admitting we had the fucking insurance.)

i'm supposed to go in for blood work--i've been putting it off--but i think i'll ask them what the difference is from ins to non-ins.

i've heard everything is more expensive without insurance but i haven't found that to be the case with my circumstances. yet.

[annabanana]

2. "legal tender for all debts, public & private".... not so much anymore.

That's disgusting.

[abluelady]

3. I Find Your Story Surprising

I have always found the doctor makes more on me when I don't have insurance. Doctors and hospitals generally have contracts for procedures with the insurance company. For instance I had a surgery that I was billed $14,000 and change for when my insurance company denied payment. After fighting it, the insurance company did pay it and the cost for the insurance company was $4300. (That was the contract price they had agreed on for that procedure.) The hospital sure wanted my $14,000 over the $4300 they ended up getting. Your doctor doesn't sound very smart to me.

[girl gone mad]

6. Doctors usually discount their charges for out of pocket payers.

People with catastrophic policies and the uninsured often pay less for doctor visits because the doctor doesn't have to pay someone to spend time filing a claim.

I have a catastrophic policy and doctor visits aren't covered. The doctors have all given me a discount - usually 10% to 20%. There are also concierge doctors who don't take any insurance and charge very low rates for appointments, but they also charge an annual service fee.

[abluelady]

8. You're Very Lucky

As I said, generally the insurance companies pay a discounted rate. You must have an extraordinary physician. I have a catastrophic policy and have never been discounted. I have to admit I have never asked for that either.

[Merlot]

11. Not sure what doctors you're seeing but no doctor has EVER charged

me less because I had no insurance.

[girl gone mad]

22. Sometimes you have to ask.

I've always been able to get a discount.

Maybe I'm better looking than I though. ;)

[Merlot]

28. Of course I've asked.

[Canuckistanian]

9. And I'm astounded by your story

So, not only are the insurance companies bilking you, but doctors are overcharging so much that insurance companies are balking?

Sorry, I'm Canadian. I just can't understand all these multiple parties all wanting to fill their pockets for the sake of YOUR HEALTH.

Fighting doctors and insurance companies is only postponing the inevitable. Soon you won't be able to afford either.
Fight for the public option at least.

The ONE big advantage to the Canadian system is this - we don't worry about this shit. We go to a doctor, he/she treats us and we go home.

Period.

[abluelady]

14. You Have No Idea What We Go Through

on a daily basis. Our health insurance issues are huge. I wish I could pay you to do a commercial to air on American tv. I love hearing the opponents of health care reform talk about the horrors of health care in Canada, of which they know nothing!

[timeforpeace]

4. "No problemo. I wasn't going to pay you anyway. Health care is a right."

[Merlot]

10. If you were paying less than market rates, you had a nice doctor

because mine charged me "full-fare and then some. I asked if I would get a discount because I was paying in full up front, and they said no. Never mind that the insurance companies would probably not give them the full amount. They had me where they wanted me. Pay up or get out.

Oh and the bill was almost $3000. But no worries, they take visa!!!!

[TexasObserver]

13. Recommend

[salguine]

15. I may be wrong about his, but I think they HAVE to take cash, simply because

it's legal money. You might have legal recourse.

[Fla Dem]

23. Yes if a service is rendered you are probably right. But if they drop you as a patient

I don't think there is much you can do.

[Fla Dem]

24. Self deleted...

[ShadowLiberal]

17. Err, it's supposed to be the opposite, insurance companies pay less, uninsured pay 100% of the price

As an individual you don't have much leverage to negotiate a lower price, because you're just one person, so you often end up paying the full 100% price. Worse yet, the full 100% price is actually jacked up some because of people who have no insurance that will never pay that they have to by law give medicare care to (because we can't just let people die who have no coverage), and insurance companies that pay only a fraction of the cost because they bring lots of customers to the doctor/hospital in exchange for lower costs.

Just a week or two ago there were lots of posts here angry about what was basically a 'state public option' thing some congressmen were pushing (called co-op), it angered people here because state co ops would be much too small to have enough negotiating leverage to get lower costs then the insurance companies typically get, which would make the option not much better then a private plan. A federal public option with people from all 50 states signed up as customers however would have much more leverage to negotiate lower costs with hospitals and doctors.

[kirby]

21. Yes and no...

An MRI might cost $1200, the insurance company only pays $350 for the procedure. Some non-insured people can negotiate and pay a similar $350 (I bet they are the minority). But the point is, at a time when someone is sick and vulnerable, should the health care 'transaction' be treated like bargaining for a used car? Some people are worried about other things and end up with a bill for $1200. Some get the $350 rate and others somewhere in between. I have a real hard time believing anyone would get a 'cash discount' price below what an insurance company will pay.

[ddeclue]

18. Legal tender

TITLE 31 > SUBTITLE IV > CHAPTER 51 > SUBCHAPTER I > § 5103Prev | Next § 5103. Legal tender
How Current is This? United States coins and currency (including Federal reserve notes and circulating notes of Federal reserve banks and national banks) are legal tender for all debts, public charges, taxes, and dues. Foreign gold or silver coins are not legal tender for debts.

http://www.treas.gov/education/faq/currency/legal-tender.shtml#q1

FAQs: Currency

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Legal Tender Status
I thought that United States currency was legal tender for all debts. Some businesses or governmental agencies say that they will only accept checks, money orders or credit cards as payment, and others will only accept currency notes in denominations of $20 or smaller. Isn't this illegal?

What are Federal Reserve notes and how are they different from United States notes?

What are United States Notes and how are they diferent from Federal Reserve notes?


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I thought that United States currency was legal tender for all debts. Some businesses or governmental agencies say that they will only accept checks, money orders or credit cards as payment, and others will only accept currency notes in denominations of $20 or smaller. Isn't this illegal?

The pertinent portion of law that applies to your question is the Coinage Act of 1965, specifically Section 31 U.S.C. 5103, entitled "Legal tender," which states: "United States coins and currency (including Federal reserve notes and circulating notes of Federal reserve banks and national banks) are legal tender for all debts, public charges, taxes, and dues."

This statute means that all United States money as identified above are a valid and legal offer of payment for debts when tendered to a creditor. There is, however, no Federal statute mandating that a private business, a person or an organization must accept currency or coins as for payment for goods and/or services. Private businesses are free to develop their own policies on whether or not to accept cash unless there is a State law which says otherwise. For example, a bus line may prohibit payment of fares in pennies or dollar bills. In addition, movie theaters, convenience stores and gas stations may refuse to accept large denomination currency (usually notes above $20) as a matter of policy.

[onestepforward]

20. It might be a liability concern.

It has been over 10 years since I was in the medical field, but when I was, I knew of a few doctors who would not take patients without insurance because they saw it as a liability concern. They were concerned that if an uninsured patient developed a serious disease that required expensive treatment and/or surgery and the patient could not afford it, that they might be liable some how for the fate of that patient.

Regardless, our country is in dire need of health care reform. In any other civilized country, patients would receive necessary treatment and only have to spend their energy and time on getting well.

[Fla Dem]

25. Taking on only insured patients may be a stipulation in the doctor's

contract with the insurance company.

[newtothegame]

26. Good piece, but either the insurance company won't pay out for anything or they will...

your statement that the doctors can "order up all kinds of tests with the freedom of knowing they can bill up to a certain, very large amount" for patients with insurance probably won't hold water with alot of DU'ers who insist the opposite: that the insurance companies won't pay for anything. So which is it DU?

Sorry, I just reread that and I sound snooty, but I am asking a real question :)

[tigereye]

27. I think you make a really good point- health costs are often inflated for

insurance. When my husband changed jobs, we no longer had dental - so we just pay out of pocket. It is much cheaper than when they billed an insurer for it...