Medical Practice Growing After Refusing Health Insurance

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I’ve been hearing a lot of “concierge medicine” lately. My husband just switched jobs, he’s in the same industry, but his new employer is a start up, of sorts, and is not offering medical insurance. Instead, they’ve given us a monthly stipend to contribute towards the cost of purchasing it ourselves. I’ve been up to my elbows in all this ObamaCare crap. I’m now seriously considering going this route instead. We’ll probably be penalized on our taxes for not carrying insurance (It’s like $1000 right?), but I think this might be a better fit for us.

Those living in the US, what are your thoughts?

DALLAS — Skepticism often walks through the doors to see this doctor.
“It’s because we’ve taken out all the middle. We’ve taken out all the mark-up. It’s wholesale medicine,” said Dr. James Pinckney, founder & CEO ofDiamond Physicians.
The 32-year-old is among a growing number of doctors who no longer accept health insurance.
Instead, they charge clients like Gregg Bartus monthly fees. He pays $200 for unlimited visits and procedures without any co-pay.
“I’m one of the first people to sign up on the exchange. I was looking forward to getting insurance,” Bartus said.
He did purchase a policy through Healthcare.gov last year, but ended up at Pinckney’s office because he couldn’t find a doctor on his plan that accepted new patients.
“I just gave up after a while,” Bartus said.

“Concierge medicine,” as it’s known, isn’t a new concept. But Pinckney’s practice is growing so quickly he’s opening an office in Frisco and plans to franchise Diamond Physicians next year.
News 8 asked if he considers himself better at medicine… or business.
“I think I’m a pretty good doctor,” Pinckney said. “Most doctors are not very good businessmen.”
He makes money on membership fees rather than mark-ups. Those fees range from $95 to $295 a month, depending on a patient’s age.
Pinckney then pays other providers cash for common tests. For example:

[LIST=|INDENT=1]
[li]MRIs cost about $4,000, but his patients pay $400[/li][li]CT scans are $2,000 with insurance, he said, but are $300 through his practice[/li][li]X-rays are usually $500, but priced at $60 at Pinckney’s clinic, the results of which he can check on his smartphone[/li][/LIST]

Practicing medicine, Pinckney said, is just as important as practicing fiscal responsibility.
Most all of his patients have a catastrophic insurance policy for emergencies.
It’s tough to pinpoint exactly how many doctors don’t accept insurance. Neither the American Medical Association nor the Texas Medical Association keep statistics.
But the TMA said the concept is increasing in popularity. That is how medicine was practiced before the creation of Medicare and before employers began offering health insurance as benefits, the organization added.

Medical practice growing after refusing health insurance

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Re: Medical Practice Growing After Refusing Health Insurance

I think doctor’s cost is not an issue, but hospital costs a lot.

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Re: Medical Practice Growing After Refusing Health Insurance

It’s doctors costs too…for my family of 5, for me to purchase health insurance on our own, it will cost me anywhere from $865-$1100/mo. Appt copays are anywhere from $25-$45 a visit, for “silver or gold” plans which are the ones that will cost $1100/mo…if we go with an HSA (health savings account) the monthly premium is at the low end, but we pay for everything out of pocket until we meet a $6000 deductable, then 80/20 kicks in. A standard doctors visit (exclusive of any lab work or testing) costs appx $200 or so. And with an HSA, you still have to deposit funds into the savings account to help off set those out of pocket expenses. It’s truly insane.

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Re: Medical Practice Growing After Refusing Health Insurance

wow…I’ve known forever that healthcare in the US is ridiculously expensive but this really puts things in perspective…

it’s kind of like the “corporate travel agents” that our firm use for booking all travel…the same flight that they price for us at $900, I can find on Expedia for $300.

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I now truly appreciate the group coverage we had under his previous employer…he paid only about $500 for the whole family, our office copy was $10. It was PPO plan, so no referrals needed for specialists etc. I went through all my fertility treatments/IVF/surgeries through that, which is why, now that we’re through having kids, are all in relatively good health I wonder if I need these exorbitant plans and premiums?

I should add that on the HSA plans, you do get one yearly comprehensive exam/well women visit free every year

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Re: Medical Practice Growing After Refusing Health Insurance

you are right. it is insane.
you probably already know this but HSA is tax deductible … a slight saving grace :bummer:

I dont know anyone personally using concierge medicine as a pt or running such a practice. I also dont know all the nitty gritty details … but a few questions off the top of my head that i’d look to get answered before opting for such services …

  1. access and cost of specialized/surgical care? …
  2. cost of emergency services? broken down by EMS response cost, ER costs, d/c from ER vs admission to hospital?
  3. inpatient costs? cost of longer term inpt stay?
  4. Rehab?
  5. Cost of preventative services? (things like child/adult immunizations, mammograms, annual OBGYN exams, colonoscopy, prostate health) most conventional
    health insurances do not charge extra for these.
  6. cost of psychiatric care coverage? short term vs long term?
  7. Cost of pharmaceuticals?

i can see a lot of positives of this model as a consumer but also many negatives or issues up in the air. Last thing i’d want for myself or anyone else to be scrambling to find concierge subspecialist/services while in middle of a medical emergency OR alternatively be annihilated financially because they had no choice but to pay fully out of pocket due to lack of enough ppl running this sort of a business.

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Re: Medical Practice Growing After Refusing Health Insurance

problem lies with insurance companies, healthcare systems, big pharma and the way medical system is set up. Doctors tbh don’t make that much and general public just blows it out of proportion. It is true that we make a good comfortable living and have a job security but most physicians are not rich. I think we have a right to make that kind of money after spending decades in school/training, being in quarter of a million in debt and starting our careers in 30s

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these are the same questions i have..i’m definitely going to do some extensive research on this and find out the nitty gritty…I want to make an informed decision and due diligence is key

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Re: Medical Practice Growing After Refusing Health Insurance

do share if you have the time!

also dont forget dental/vision cost/coverage … sigh

amazing how much time n energy is spent in worrying about the what ifs … i wish i could say we really dont need to or that we over-worry … but we (as a society) actually dont worry or plan enough!

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Re: Medical Practice Growing After Refusing Health Insurance

My concern would be if I got really sick who would pay specialists, hospital fees, and ER fees?

That’s where the real bills come in and that’s the whole point of insurance. Protection against that catastrophic event.

Medical industry is overall a disaster. Main problem is that pharm companies, biotech companies that sell labs and sell medical hardware like supplies, fake joints, etc are not regulated, have monopolies protected by laws and they chart a crapload more than they need to.

When plasma TV’s are now going for 100 dollars, I fail to see why it costs millions to but a CT scanner.

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Re: Medical Practice Growing After Refusing Health Insurance

Charge*

Go to Pakistan and get labs done it will be done at a fraction of the price. Same technology. Why is a damn blood count as common as it is, cost so much here? Literally should cost 20 cents but they charge like 50-60 bucks in some places for a simple common lab test like a CBC

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Re: Medical Practice Growing After Refusing Health Insurance

My Ammi needed a total hip replacement…didn’t have insurance here as she was self employed and then was told she had too many pre existing (osteoarthritis) conditions…wasn’t old enough to qualify for Medicare…the quote was $78,000…she went to Karachi and got it done for around $1500…the exact same Johnson & Johnson prosthetic was used…the surgeon was UK trained and practiced there for 20+ years before returning to KHI…she stayed on there for 4 months after to continue the physiotherapy…it’s crazy how much the markup is here.

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Re: Medical Practice Growing After Refusing Health Insurance

I myself didn’t have insurance for good two years. And I didn’t see a doctor for a regular checkup. What if I have gotten sick seriously, the ER and hospital visit would have drained me without insurance. Our lawmakers are douchebags, they just want to keep their sponsors like hospital systems, big pharma happy. If they really want to cut down medical cost I can think of several things on top of my mind

As Pcg said, ER visit are expensive and we should get rid of ER as a tool for routine health care for the poor. But what can the poor people do. When they have no health insurance, they would obviously walk into the ER with a cold, pneumonia etc. ER physicians are mainly trained to handle sudden problems like MVA, stroke and I think they must be limited to that. But nowadays, a grandma with arthritis walks into the ER. Since these non-emergent uninsured people flood the ER, who ends up paying for their visit .. tax payers and hence rise in the medical cost. Best thing would be to open free clinics for poor in those areas where poor people are most (they are not evenly distributed) and it should be a part of federal tax.

Also we should get rid of the profit mindedness from some doctors. I have come across few surgeons and (most of them desis) who would perform a procedure like colonoscopy and other things even though the patients doesn’t have symptoms they require the procedure. They just do it so they could make more money and not always think whats in the interest of the patient. Doctors who are employed by the hospital are paid a fixed amount and so in-house surgeon do surgeries and procedures if it is required (best interest) to the patient and not just because they can make few bucks.

Many of the folks practice defensive medicine. its just sad but they have to cover their asses don’t they because even though we know its useless to do this test, we would still run it just to cover protect ourselves from getting sued by a lunatic and ruining our life. This climate where patient can easily sue doctor for whatever should be eliminated …

I could go on and on but I have an exam tomorrow sigh

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Medical Practice Growing After Refusing Health Insurance

Obamacare is such a mess! I think Obama set out to do something positive but the insurance and pharma lobbies helped water down the bill to the point where a lot of us are worse off from where we started especially people who buy their own insurance and don’t qualify for subsidized coverage.

Our monthly premium is 1100 with a deductible of 3000. We have the silver plan. Before obamacare we still had a premium of 1100 but no deductible. The high deductibles are there just so that insurance companies remain profitable. Now that they are forced to provide coverage to people with pre-existing conditions they have to make up for their profits somewhere and we end up picking up that tab.

A lot of people are saying we have health insurance but we don’t have accessibility to health care because they have the bare minimum plan but can’t afford to pay the high deductibles that come along with it so I honestly wonder what has obamacare accomplished?!

But like others I would strongly advise you to get insurance because God forbid ER visits and hospitalization can happen anytime without any warning and you don’t want to be stuck with a ginormous medical bill.

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Re: Medical Practice Growing After Refusing Health Insurance

If I remember correctly the penalty is a certain percent of your AGI or $1000 ( not sure about the exact amount ), whichever is higher. When you are comparing the ‘Concierge’ plan with insurance plan you want to take this penalty into consideration. Since you are self-employed, can you not purchase a group plan yourself?

Insurance and taxes are needlessly complicated in US.

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See this is always my concern. Why is that medical school so damn expensive. It’s almost like, oh because you are going to make millions later, we gonna charge you a million to educate you. They should start with or education system. Bring that cost down, and it will transform into lower service charges for health care

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Re: Medical Practice Growing After Refusing Health Insurance

Sometimes I feel the system is set up to cater to the elite. In UK for instance, noone could get any loans for their post grad education. Which meant a poor student would never be able to afford to pay 10 grand. The bank loans available obviously are risky as job is never guaranteed after degree. Now I think recently they have decided to give loans to post grad students.

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The plans offered through NAR (National Association of Realtors) are limited medical, and don’t meet the mandated coverage of the Affordable Care Act…they are more supplemental.

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This was exact my point in post 2, ER services, surgical procedures are expensive if you don’t have insurance.

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Agree.
At the very least their should be some sort of “tiered” system where the potential income is taken into account when you are studying…
So it you are going to do nothing but a family practice you pay less to become a dr whereas if you plan to become a surgeon then you pay more. (And maybe it does end up that way in the long-run but I think the difference should be significantly greater between the two.)