Medical Insurance and Paying Doctors

I read a discussion yesterday on a general chat forum where a guy was asking for advice on handling payment for medical services without insurance. There were a few issues in his posts that I wanted to respond to, but my comments, first, would not have answered his questions, and second, would have sounded rather callous and insulting. But I still want to comment on what was said, so I’m going to make my comments here.

The initial post was this:

My wife has internal bleeding. We saw our regular doctor. Says we need to see a specialist since it could be cancer. Set up appointment with specialist. Specialist cancelled appointment. Why? WE HAVE NO INSURANCE

We are “middle class” so as of so far I have found no help for us. We earn too much. Insurance at work went up 19% this year. We had to drop it.

After reminding the hospital / staff of legal need of admittance they said okay- pay up 500 dollars and we’ll see you (aka- not treat you). Spent all day trying to extend current loans and get new ones to support this 500. Still unsure if I have gotten anywhere with it.

New phone call. We need 650 to see you. “Huh?” I thought we agreed on 500.

Second doctor. aka (1150 to see not treat her)

so…. except killing myself and taking as many doctors with me as I can…. what can I do? I’m not a lazy person that lives off the state. I’m not rich or work a well paying job. I work 70+ hours a week and the wife works 50+ hours a week. We are two months behind on the morgage. We owe the garage 2000+ for car repairs. I have nothing but my anger at this point.

First, I can imagine the panic and worry at having my wife find internal bleeding. I don’t want to dismiss or belittle the feelings this guy has about the medical situation. But . . .

The situation in issue here is not medical, but rather, financial. This guy and wife decided to drop their insurance because its cost went up 19%. That’s a pretty big increase, and I can definitely see weighing the value of keeping it. I can even understand making the decision to drop it. Insurance is a gamble: on one side of the scale, you have how much the premiums cost you each month; on the other side of the scale, you have the likelihood of having a serious and costly medical situation.

This guy and wife made the decision on the side of betting they wouldn’t have a serious and costly medical situation. That’s a legitimate and maybe sound (depending on their age, health, and lifestyle) choice. If they went 20 years or more with no medical problems, they win the bet.

But they had a potentially serious and costly medical problem come up. That doesn’t necessarily mean they lose their bet, though. Most doctors will take cash payments for their services. (It’s actually a better method of payment for many — cash up front versus check payment from an insurance company in three months.) You just tell the doctor’s office you want to pay cash.

The doctor may want payment up front, but that’s not that unusual. There’re many services that you at least pay a portion of the bill up front (especially services that can’t be “undone” if you don’t pay after completion). Besides, with, “We are two months behind on the morgage. We owe the garage 2000+ for car repairs,” it’s not like the doctors’ concern about getting paid are unfounded.

As for this particular situation, I doubt $500 or $650 or $1,150 is simply for a consultation visit — “aka not treat her.”

“I have nothing but my anger at this point.” Anger at what/whom?

Anger that his insurance premium went up? Prices of everything is going up; shop around for a better price.

Anger that doctors want payment up front for their services? They simply want to make sure that they’ll get paid at all for their services. Ask the mortgage company and the car garage how well they get paid without up front payment.

Anger that a possibly serious medical problem struck his wife? This is understandable, but God, Fate, what-have-you doesn’t respond much to anger. But still, it’s an understandable emotion.

A follow-up post said:

one doctor spent 15 mintes with her on Friday. had to pay him 300 up front and still owe him 960 dollars. The main doctor spent 2 hours off and on with her. had to pay him 500 up front and owe him over 8000. I hate doctors thoiurghly now. The good news, results are not in but it appears to NOT be cancer.

The way he explains this in the first five sentences, it sounds like the doctors are charging crazy money just to hang out in the room with his wife, chatting or visually examining her. But the last sentence shows that’s a false portrayal. If there are results to get in, then obviously some tests were taken. And tests ain’t cheap, and often aren’t a cost directly from the doctor — the cost comes from the laboratory.

The most amazing thing, though, is his hate of doctors, now. He hates the people who are helping his wife? This kind of anger at people who are doing something for you amazes me. Anger at people who are helping you, just because they expect payment for the help.

If you think the payment is too much — you can and should check up front (you wouldn’t order food at a restaurant before checking the price) — then go elsewhere for the service. There are lots of doctors, and you can shop and compare them just like you can any other business. If the office tells you, “pay $500 up front,” you have every right to ask what you’ll get for that money.

But it’s dumb to get angry and start hating someone for having the audacity of expecting payment before giving you a service. (Especially when you already can’t pay for previous services rendered by other providers.)

Bullgrit