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What Happens When Doctors Only Take Cash (2017)

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11–20 of 177 posts

Re: What Happens When Doctors Only Take Cash (2017)

#11
post #9

That would be a problem, I can't even withdraw more than €1000 from an ATM. Most of my transactions are plastic or digital, like 99%.

Pretty sure they can take a debit card, which even in the U.S. is a chip + PIN transaction, with a minimal transaction fee rather than the substantial percentage applied to credit card transactions. Anyway, by cash they mean full payment now, rather than invoiced to an insurance company.

Re: What Happens When Doctors Only Take Cash (2017)

#12
post #9

That would be a problem, I can't even withdraw more than €1000 from an ATM. Most of my transactions are plastic or digital, like 99%.

"Paying cash" in this context doesn't mean a briefcase full of $100 bills. It means direct payment from the consumer to the provider. That direct payment could be in the form of a check or credit card.

Re: What Happens When Doctors Only Take Cash (2017)

#13
post #9

That would be a problem, I can't even withdraw more than €1000 from an ATM. Most of my transactions are plastic or digital, like 99%.

Go to a bank and they’ll give you significantly more money than 1000 euros. At a certain point you’ll be expected to explain what you need the money for (anti-laundry efforts).

For safety reasons, you might not want to carry around cash. So banks provide cash-like instruments that are safer to walk around with.

Also, often “cash only” includes debit cards. In which case you debit card limit is probably an order of magnitude higher than your daily withdrawal limit.

Finally, do what I’d do as a poor grad student unwilling to pay bank fees: start withdrawing a week in advance ;)

Re: What Happens When Doctors Only Take Cash (2017)

#14
post #5

I think it's an important reminder that markets need some level of transparency to function. And perhaps that relatively simple regulation (like a requirement to publish the prices -- or in other areas the first sale doctrine) might be the best regulation where feasible....

Hospital chargemasters are required to be public in California https://www.oshpd.ca.gov/Chargemaster/

Unfortunately,

1) The price agreements between hospitals and insurance companies are confidential, as both sides compete in their own industry and don't want to reveal their hands.

2) Consequently, chargemasters post some ridiculous price per procedure (with discounts available, naturally, to insurance carriers, who are the bulk buyers in the business). Which makes chargemasters similar to list prices you see at most retail establishments - only schmucks are expected to pay those.

Re: What Happens When Doctors Only Take Cash (2017)

#15
post #9

That would be a problem, I can't even withdraw more than €1000 from an ATM. Most of my transactions are plastic or digital, like 99%.

"Cash" here means 'not wacky insurance schemes'. Their FAQ says

"To keep our prices as low as possible, cashier’s checks or cash are the methods preferred. Credit cards are accepted on a case by case basis. Human resource departments or divisions of self-insured companies can make other arrangements if necessary."

(They also have a partnership with some sort of personal loan/financing company which presumably would take credit cards or bank transfers.)

Re: What Happens When Doctors Only Take Cash (2017)

#16
Since their surgery center does not employ the army of administrators that is often required to haggle with insurers and follow up on Medicare reimbursements, their overhead is smaller.

This is part of why Obamacare is fundamentally broken. Using the existing commercial insurance system to try to provide universal coverage injects unavoidable extra expense and complications.

Really happy to hear about the trend the article is describing.

Re: What Happens When Doctors Only Take Cash (2017)

#18
Cash payments don't count toward a patient's (insurance) deductible

This seems like a problem. How is this not an anti-trust violation? In order to benefit from the insurance contact you purchased, you must use a provider who will submit to an insurance company's capricious payment system.

Re: What Happens When Doctors Only Take Cash (2017)

#19
post #5

I think it's an important reminder that markets need some level of transparency to function. And perhaps that relatively simple regulation (like a requirement to publish the prices -- or in other areas the first sale doctrine) might be the best regulation where feasible....

Hospital chargemasters are required to be public in California https://www.oshpd.ca.gov/Chargemaster/ Unfortunately, 1) The price agreements between hospitals and insurance companies are confidential, as both sides compete in their own industry and don't want to reveal their hands. 2) Consequently, chargemasters post some ridiculous price per procedure (with discounts available, naturally, to insurance carriers, who…

There is an Adam Ruins Everything episode about that. Basically hospitals were reasonable, then insurance companies came along and brought extra business to hospitals. For that, they felt they deserved a cut. Since the hospitals were mostly non-profits, or low profit, they didn't have anywhere to cut, so in response they raised their rates to provide a cut. There is more to it, but that's the origin of the charge master.

Of course regulation requires administrative staff which costs more money as well.

Malpractice is ungodly expensive too.

Other costs are the requirement that hospitals treat the uninsured. I was listening to NPR when the ACA debate was going on, and the CEO of a local large hospital said about 25% of his costs are due to treating people who couldn't pay. That's a huge number.

Re: What Happens When Doctors Only Take Cash (2017)

#20
post #5

I think it's an important reminder that markets need some level of transparency to function. And perhaps that relatively simple regulation (like a requirement to publish the prices -- or in other areas the first sale doctrine) might be the best regulation where feasible....

Hospital chargemasters are required to be public in California https://www.oshpd.ca.gov/Chargemaster/ Unfortunately, 1) The price agreements between hospitals and insurance companies are confidential, as both sides compete in their own industry and don't want to reveal their hands. 2) Consequently, chargemasters post some ridiculous price per procedure (with discounts available, naturally, to insurance carriers, who…

Seconded. The healthcare market is an exceptionally complex beast, with all sorts of information asymmetries, scarcity power and adverse selection problems. It's very hard to regulate and cannot be safely deregulated, and that's the reason many countries went with a top down single payer system: it's inefficient but prevents the failed market US has, where $20K out of pocket for a basic surgery is considered a good deal.
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