The Rise of Cash Only Medical Care

Since the Affordable Cares Act, casually referred to as Obamacare, passed in 2010 it seems that the topics of medical care and health insurance have become more popular in day-to-day conversation. With the rise of health care prices in the United States in the past decade, more and more people are suffering from inadequate medical treatment or avoiding seeking medical treatment at all. In 2017 The Commonwealth Fund released a research report on health care costs from 11 different countries. According to their data analysis the United States had the most expensive health care system in the world and ranked the lowest of the 11 countries for quality of care, access to care, and health outcomes. Part of this study involved a survey given to American citizens in regards to their health care and to no surprise ⅓ responded saying that they either didn’t take a prescribed medication, seek medical attention when sick or injured, or receive recommended care because it was too expensive.

So who is to blame for this? Most people’s first response is typically to blame doctors and medical providers for charging too much, but that is not the case. The hidden reality is that private and government insurance companies run the show, not medical providers, and certainly not patients in need of help. Commercial insurance companies have been turning health care into a profitable business since the 1950s by controlling both sides, selling insurance to patients to help pay for their medical care, while at the same time offering medical providers more money in reimbursement if they follow certain regulations.

How do insurance companies affect a patient’s medical care?

Insurance companies are masters at marketing their financial assistance to potential patients. They offer these enticing benefits and financial assistance to patients and then set requirements about where these benefits can be used. At the same time they are marketing to different hospitals and private practices, showing how they will receive financial reimbursements and be able to treat more patients if they sign a contract with them to become an “in-network provider”. 

So far this sounds great for everyone, so why is the quality of care for patients declining and the cost of insurance rising? Insurance companies create a fee schedule that outlines reimbursement rates and treatment requirements for in-network providers and as they alter the providers’ reimbursement rates and treatment requirements, the providers must adjust their treatments accordingly.

Some of the most common complaints about doctors or medical providers are that patients wait for an excessive amount of time to see their provider and when they finally enter the patient’s room they don’t appear to be truly listening to the patient or make eye contact with them while they are talking. Then they speed through explaining their treatment plan to the patient and then leave the room, not to be seen again by the patient. It feels as if they just waited hours for 15 minutes with their provider. This is not always the provider’s fault! 

1. Shorter visits are the result of declining reimbursement rates from insurance companies to providers. This forces providers to see more patients or perform more procedures every day to make enough money from their insurance reimbursements to keep their medical practice afloat financially. 
2. Having the need to see more patients everyday forces providers to pack their appointment schedule with as many patients as possible, they don’t actually enjoy being overwhelmed and behind schedule with their appointments every day. This also impacts visit times for patients and also makes it extremely difficult to schedule an appointment unless you schedule your appointment months in advance. 
3. This creates a waterfall effect that has turned urgent care offices into a madhouse. Have you ever been sick or had some kind of infection and when you called your primary care provider to schedule an appointment you were told that the earliest they could get you in was the next week so you ended up going to a crowded urgent care for treatment? It isn’t that the providers there are extremely slow, you were probably sitting in that overcrowded waiting room thanks to commercial insurance companies and their ever-changing reimbursement rates.
4. Insurance companies also set regulations on diagnosis requirements for treatment. As a result providers are only able to treat their patient if their symptoms and diagnostic test results (blood work, allergy panel, etc.) meet the requirements or the insurance company will not reimburse the provider.
5. They also set record keeping requirements for providers, and if a provider doesn’t meet the “meaningful use requirements” for EHR (Electronic Health Records), then they will not be reimbursed by the insurance company and can actually be penalized financially. That is why your provider spends more time typing on their computer than actively engaging in conversation with you. They are documenting their encounter with you, doing their best to note your responses to their questions and fulfilling their “meaningful use requirements” so they can get paid and keep their practice running.

At this point you may be thinking to yourself “but what about the Affordable Cares Act? I thought that was supposed to fix the problems of our health care system!” Since it was signed into action in 2010 it has absolutely helped people receive health insurance who wouldn’t normally qualify for coverage by commercial insurance companies due to medical conditions or predispositions for illnesses or diseases. Insurance companies have been forced to accept “high risk” patients, often referred to as “expensive” patients by insurance companies. To supplement these extra expenses that they have to pay for these “high risk” patients, insurance companies raise the price of other clients’ plan deductibles and copay rates.

Good News: Providers are Taking a Stand Against Insurance Companies!

In recent years, more and more private practices are opting out of signing contracts with insurance companies. These Cash Only practices, also known as Cash-Pay practices, are maintaining their freedom to treat patients their way. Cash Only is a blanket term, simply meaning that patients pay out of pocket at the time of service. Most Cash Only providers accept multiple forms of payment, including cash, credit, debit, and HSA or FSA. Some even accept healthcare credit cards like CareCredit. 

The key benefit here is that there is no third-party payer (insurance companies) involved to complicate a patient’s quality of care or a provider’s ability to treat their patient. Cash Only providers have complete freedom in: how much time they spend with their patients, the number of patients they see each day, how they want to treat their patients, and the rate they charge for their services. They have the freedom to do what they went to years of medical school for and  are truly passionate about: caring for people and improving every patient’s life.

The Benefits of Cash Only Medical Practices:

1. More one-on-one time with patients. When you pay your medical provider directly, they are working for you and your needs, not your insurance company and their needs. If you need an hour of their time for your appointment, you get an hour of their time.
2. More flexibility with appointments. Cash Only providers have fewer patients because they don’t rely on provider fee schedules of reimbursement set by insurance companies to keep their practice afloat. Limiting their number of patients means they can spend more time talking and listening to their patients. They also have the ability to offer patients same-day or next-day appointments. So when a patient calls saying they need to schedule an appointment because they are sick or have some kind of infection, they are able to be seen and treated as soon as possible, avoiding the craziness and stress of overcrowded urgent care offices.
3. Complete freedom in how they see their patients. Providers have the ability to offer their patients the convenience of phone or video telehealth appointments if they can’t come to an in-office visit for any reason. They also have the freedom to communicate with their patients through text or email, saving patients’ time and making themselves more available to their patients.
4. Complete freedom in how they treat their patients. There are no diagnostic test requirements to be eligible for treatment. Cash Only providers are able to treat their patients based on how they are feeling, how they want to feel, and the treatment plan they would like to take to get to how they want to feel.
5. Empowers patients to take control of their health. The treatment freedom that providers have means that patients get to have a voice in their medical treatments. They can ask questions about their condition and receive education about ways they can improve their health, and they get to work closely with their provider to set a treatment plan and work towards achieving their goals for their health and wellness through all stages of their life.
6. Cost Efficient Medications. By cutting out the insurance “middleman” and their regulations regarding brands and dosages of medications that a provider may carry at their practice, Cash Only providers can offer their patients many different medications in wider ranges of doses at a much lower cost. On average, Cash Only practices charge 10% - 15% above wholesale price for common medications. In 2017 The Moran Company, a health care research and consulting firm, performed a data analysis on the average cost of common medications sold by hospitals that showed they charge an average of 478% above wholesale for these medications, regardless if the patient had insurance coverage or not.
7. Able to provide better care to their patients. Cash Only providers freedom allows them to treat their patients as they see fit, not as an insurance company sees fit. They are able to offer innovative and proven alternative treatments that insurance companies don’t approve and they can take the time to work with their patients to develop a comprehensive treatment plan that can include behavioral and lifestyle changes, procedures, and medications all designed to address multiple issues and treat the underlying cause of the patient’s problem, rather than just suppressing their negative symptoms. They build a trusting and personal relationship with their patients to produce lifelong, impactful outcomes and optimize their patients’ health and wellbeing. 

But I already pay for health insurance every month, so why would I go to a practice where I can’t use it?

Just because Cash Only providers don’t accept insurance as a form of payment doesn’t mean you can’t use your insurance at all. There is a document called a Superbill that you can submit to your insurance company to potentially be partially or fully reimbursed for services you received at a Cash Only practice. If you are tech savvy there are online softwares that can be used to create a Superbill to send in to your insurance. Some Cash Only providers even offer the service to create the Superbill for you, so you can skip the hassle of doing it yourself.

Recharge Clinic offers this service to our patients, collecting all required information to create a detailed invoice, including information regarding the date and type of service provided, procedure and diagnostic codes, and the price of each service paid for by the patient. Once submitted, the amount of money reimbursed to the patient solely depends on the type of coverage they have through their insurance. Since Recharge Clinic has opted out of Medicare to avoid government regulations for treatment options and patient care, patients will receive no reimbursement for any services received if they try to submit a Superbill to their Medicare insurance payer.

If you’re willing to take the time to submit a Superbill, then you can receive all of the benefits that a Cash Only provider has to offer and still have the potential to put that price insurance premium that you pay each month to good use; including fast and convenient blood draws and lab work, appointments with a provider that has the time and freedom to care for you and your health goals, and the power to take care of your medical care.

Make the switch today to a Cash Only practice like Recharge Clinic for better health care! Regardless of your health insurance coverage status, seeing a Cash Only provider is the best decision you can make if you want to: build a trusting relationship with your medical care provider, address and treat the root causes of your concerns, and receive innovative and impactful treatments to achieve your lifelong health and wellness goals.