Cash Pay Surgery Center

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    • #91917

        I am posting this here in case anyone needs surgery. I have no firsthand information regarding the SCO so Caveat Emptor.

        Also some people may not be aware that such places exist and there may be one closer to you.

        The Wonders of Real Free Market Medical Care

        Surgery Center of Oklahoma

        In 2015 I began my journey from RN to Nurse Practitioner. A lot has changed since getting my original degree in 1994. That coupled with the fact that I worked in outpatient specialty care for most of my 24 years of nursing, meant that I was in store for a lot of new changes.

        One of those changes is insurance since obamacare has been instituted. I also was not familiar with it because I have had Tricare since 2011.

        SO what has happened is hospitals have began acquiring formerly independent medical practices and making what used to be outpatient (or outpatient center) procedures are now done in the hospital and usually under general anesthesia. This is done so they can charge insurance more. Also means the consumer has to pay more.

        Naturally the market has begun responding with medical practices that are cash only and the above.

        I did about half of my clinical rotations at a private, cash only practice. While they did have walk-in cash pay, their model was membership. For example a single person it was 125/mo and that got you a yearly physical with labs and EKG and unlimited visits/phone calls to the MD or NP. Only addt’l charges were if tests or procedures had to be done. A family of 5 was 250. If you have small kids that is way cheaper than any type of insurance.

        The irony is that once you eliminate the middleman, medical care is usually cheaper than the cost of insurance.

      • #91918

          The irony is that once you eliminate the middleman, medical care is usually cheaper than the cost of insurance.

          Great post D!

          Spot on. Getting places to even accept cash for payment of medical services is at times, nothing short of a frickin nightmare. Spent half of this year trying to do so for some surgery I needed. A doc that I met at MVT gave me some EXCELLENT info that confirm all my doc at the time said I needed done, and he was 100% spot on. Amazing! Yet another reason to come to MVT huh!! He was also familiar with cash billing- certainly if he was closer I would have paid him to do my surgery. However the info he gave me allowed to get a quote much better. Two out of three hospitals would not honor their quotes when it came time to crap or get off the pot, and the third one I ended up going with said yes, then we drove 3 hours down to pay, wrote a check and then some other gal told us no it won’t be $15K it will be $60K My reply “get me my damn check, we are gone.” The hospital later recanted and honored the quote due to pressure from the doc. Of course after the fact they tried to bill me for $5K more, that was yet another day wasted and a helluva lot more frustration. And of course the doc who actually did the surgery made the least of all of them including the anesthesia folks who broke a tooth and chipped another one.

          In short, you would think that paying several organizations $22K for their services would be really easy, especially when they agreed to the prices upfront. But the guy that is unwilling to drop $1,500. or more a month on something he doesn’t regular use (medical insurance) that has the cash to pay is a pariah in the medical industry. Even paying in full upfront two weeks before surgery.

          I think their is a big market for this sort of thing. You’d be amazed how many docs and their offices couldn’t even begin to quote on something with all the CPT codes given. One doc did not even know WHO got paid for what- is that $17K the hospital quoted for just the hospital or the hospital and your fees? He had no idea how he even got paid.

        • #91919

            Thanks for the post Duane! This is timely and useful info for me. Much appreciated.

          • #91920

              ALWAYS ask for cash price.

              In a busy ortho practice, I did a reimbursement study (mid-2000s). Our best reimbursement was UHC (United HealthCare) at 40%. Insurance billing is a minefield for providers – as they (insurance) pays contracted or billed, whichever is lower. Since we never really know what each persons insurance will pay (you tell me you have BCBS, but WHICH plan?? There are over 200 different plans), we bill high, knowing we won’t get it (see above UHC example).

              We started offering 50% cash visits/procedures and everyone was good – the patient, the provider, (except the billing company who doesn’t collect on cash service).

              I had an MRI done several years ago. Insurance cost was $2k – my deductible was $1k and I hadn’t met it yet. Cash price was $400, including the scout XR, MRI, and radiology read – they emphasized that I could NOT apply to insurance for it. Needless to say, I went with the cash price…… it was still cheaper.

              If you have a high-deductible plan, I would start the conversation with “what’s your cash price?”

              BTW – your insurance costs are so high to pay for all the ones out there who don’t have. And greed, ever see an insurance CEO take a cut in pay??

            • #91921

                and BTW – any hospital department has an extra 15-25% tag added on to pay for administration (an expense, NOT a profit-maker). So a stand-alone will have lower overhead.

              • #91922

                  Direct Primary Care is growing.

                • #91923

                    Wheelsee- Definitely. I think the problem though is 95% of the many, many folks in medical arena have no idea cash prices. Most I talked to couldn’t even tell me if they accepted payment upfront and many just said no if you don’t have insurance we can’t help you. That was with me stating categorically upfront that I am self pay and will cut a check prior to services rendered- i.e, no risk of no pay.

                    I get it, lots of dirtbags out there and unfortunately “self pay” equates to “no pay” with a lot of admin types in the med field. And then when they get a paying upfront customer they want to absolutely rape them to recoup some of the dirtbags that didn’t pay. Sinus surgery quotes once wrangled out of places, ranged from $15K to over $60K WITH supposed “50% cash discount” for the same CPT codes (6 total) and one was $130K “discounted” to $17K with only one CPT code showing- same place quoted me $536. for an CT scan cash pay, I paid then was billed for $2,000. That alone took a month to straighten out. Later I got a better CT scan in a larger city for $200. cash price and without any stress of being billed later for more money.

                    Basically, the medical industry has to get it’s shit together when it comes to these sorts of things. No offense to anyone in the industry but it was pretty insane what we went through to pay upfront. Literal emotional roller coaster for several months.

                  • #91924

                      SO if you need some tips to find what you need.
                      1. Choose a primary care Doc NOT owned by a big medical facility. They are more likely to serve you and not the hospital. Plus they may already have the network established
                      2. Search out “concierge” medical offices. These are the ones that are cash only. Many have providers that are happy to see you without the need to join their membership.
                      3. Seek out hospitals in small towns that are not affiliated with major hospital groups. You may have to travel a bit. While Caveat Emptor, you would be surprised at what goes on there. I got shot with a nail gun in the hand and had to go to a tiny hospital in IL. Xrays, meds and the ER doc’s phone consultation with ortho and the total was 1200$ before insurance.
                      4. Broaden your search to Nurse Practitioner run medical offices. They are starting to appear even in South Carolina where we still have to have a supervising physician and most of them are cash only.

                      5. Don’t eat junk, don’t smoke, lose weight and exercise. Along with a couple of multivitamins, this goes a long way to never needing medical attention.

                    • #91925

                        A little medical advice for all of you. It doesn’t matter if a provider takes cash only or if they take insurance only, the most important factors in the care of your loved one or yourself is to make sure that the provider is professional and reputable. Period the end.

                        Beware of cash only doctors or NPs!!! Sometimes they are cash only is because they are unable to be on insurance panels. There are several cases of fraudulent behaviors of providers. These providers are then kicked off of insurance panels and then they are forced to survive via cash only services.

                        Some of the worst health care problems in my state are from cash only Suboxone clinics and pill mills run by NPs and crappy MDs. Just because docs and NPs are going to the free market (and private insurance is part of the the free market economy) via cash only means does not mean you are getting quality care.

                        The individual provider’s competence in his/her chosen field is the most important factor! If they are excellent care takers then get the damn insurance to see them. If they so happen to be cash pay then great. If you have a life threatening condition or your child has a debilitating problem you need to go to the proper expert no matter what you have to pay or how you have to pay for it. Incompetence is more costly than you could ever think!!!!!!!!

                        Most quality specialists will still be a part of the insurance game. I don’t know any cash only oncologists, neurosurgeons, urologists, anesthesiologists, etc. I’d be skeptical if a pediatric orthopedic spine surgeon on his/her own just started taking cash for a complex multilevel fusion outside of the insurance system. Do your research on your doctors!

                      • #91926
                        Joe (G.W.N.S.)

                          For some reason your post (mdbjjc) activated the spam filter, I’ve corrected it.

                          Period the end.

                          Your obviously passionate about this discussion, but understand both DuaneH and Wheelsee are medical professionals. There are many here that have chosen alternatives to insurance for their needs.

                          Do your research on your doctors!

                          This is something everyone agrees on! ;-)

                        • #91927

                            I am a doctor and i respect others desires for alternatives. I have also seen the worst in care and it should frighten everyone. I have fought many battles to curb the abuses of those going outside of traditional payment systems legislatively and through other venues. I have seen these folks destroy lives and communities. I continue to deal professionally from the aftermath of unscrupulous physicians and providers. Just want folks to make sound decisions to protect their lives.

                            I am also married to an NP so my stances aren’t based off of a physician’s only point of view. Be careful.

                          • #91928
                            Joe (G.W.N.S.)

                              I am a doctor

                              Outstanding we appreciate your insights, I have insurance, but I also don’t believe in one size fits all solutions. ;-)

                            • #91929
                              Joe (G.W.N.S.)

                                Just want folks to make sound decisions to protect their lives.

                                Agreed! :yes:

                              • #91930

                                  Some pointers on determining how reputable a provider is would be useful.Or are we relying on google reviews to determine this?

                                • #91931
                                  Joe (G.W.N.S.)

                                    Some pointers…

                                    Hopefully others will have more quantifiable suggestions, but I start with word of mouth. Then I get a appointment to basically interview potential Doc. I use the internet also, but with mixed results.

                                    I have been exposed to far too many Doc’s due to my military career, I want an honest, experienced, and confident Doc who can admit when he/she just doesn’t know something.

                                    Medical professionals are my advisors, but I am the final decision maker regarding what choice is made and I’ll not accept being told what to do. They can argue their recommendations, but I expect a well reasoned diagnosis, not just because they say so.

                                    Pill pushers need not apply!

                                    I have politely cutoff Docs and left those that don’t meet my requirements.

                                    There are some wonderful quality Docs out there, but too many dirtbags as well. Like any field of work.

                                  • #91932

                                      Some pointers on determining how reputable a provider is would be useful.Or are we relying on google reviews to determine this?

                                      That’s the tough part I think.

                                      When going through the tedious “please take my money” process earlier this year I was also “researching” the subject. Bought a book on the subject and one of the authors was one of the docs I was checking out. Doc did good work on the surgery, immediate relief afterwards. 2nd followup at his office I got a staph infection from instruments he used that did not come out of an autoclave bag or even from little plastic wrappers like at the dental office. Being a person that notices stuff like this, I felt it odd that scopes and instruments that were used invasive came out of a wooden drawer. Well sure enough, next follow up ten days or so later he announces that I have a sinus infection. He pulls some of it and sends it for culture. He gives me Bactrim and says they will call with a better Abx once they get culture results. It was a staph infection that I nearly died from. When I called them, they wanted no part of dealing with it- go see your GP. Told them bactrim wasn’t working- “keep taking it”.

                                      Two GP’s including a lifelong friend say the same thing- give me rocephrin and decadron and before I get home my 103 fever is down to normal temp. I tell both of them about the instruments at the ENT, their condition, how they come out of the drawer, etc. They both say that’s probably the culprit and I ask specifically how to discuss this respectfully with the ENT. Both GP’s tell me how to do it respectfully and pretty much agree this is the problem. In the meantime I have to cancel a trip out west to go to a buying show, I lose a week of income, put my family through all kinds of hell while I almost die. Next visit to ENT before they start shoving shit up my sinuses I ask to talk to the doc. Very tactfully and respectfully I discuss what happened, how I informed them the bactrim wasn’t working and got no where, ask about how the instruments are sterilized, when, etc. He gives me a cock and bull story that if I had zero medical knowledge I might have believed- essentially boiling down to “we have an autoclave in the back, they are autoclaved once in the morning and considered sterile all day.” Really? Damn I thought sterile was an absolute term??? Got pissy with me, playing the “I’m the doc” (aka small g god) card. I should have walked out then but I didn’t and went ahead with the same procedures- and lo and behold, got an infection again. This time I didn’t bother with this jamoke, started a course of doxy via recommendation from my GP buddy. I stopped going there and have not had any other infections since.

                                      Moral of the story, even the better known, respected docs that have their names on medical books can/do mess up. So it’s hard to say who to trust. My guy was great on the surgery, but absolutely piss poor on the followups- to the point of nearly killing me.

                                    • #91933

                                        Medical professionals are my advisors, but I am the final decision maker regarding what choice is made and I’ll not accept being told what to do. They can argue their recommendations, but I expect a well reasoned diagnosis, not just because they say so.

                                        THIS!!! And that’s where I messed up.

                                      • #91934

                                          Thanks for the advice Robert and Joe!

                                        • #91935

                                            Some pointers on determining how reputable a provider is would be useful.Or are we relying on google reviews to determine this?

                                            One of the ways of finding who is knowing who to stay away from. This gets sticky due to slander/libel suits, and to a lesser degree, professionalism. Just as non-verbal communication speaks louder than verbal, the same applies here.

                                            Talk with a variety of healthcare professionals (HCPs), including RNs, techs, etc. I spent $24k out of my own pocket to get the best neurosurgeon for a broken neck. I could have gotten it for free at my facility but the surgeon there had a high rate of post-op infections…..something the public had no knowledge of. BTW, for surgery, you ain’t looking for Dr Feelgood….you’re looking for the most accurate technical which may come across as a bit of an ass (read bedside manner may be a bit gruff).

                                            For a surgeon, some basic questions –
                                            1. Where did you train (NOT Med school, but residency and any fellowships)
                                            2. How long have you been doing this?
                                            3. How many in a week/month/year? (Even Medicare recognizes that the cardiologist doing 10 heart cath a week is going to be better than the one doing 10/month)
                                            4. What is your infection rate? (Hint – they ALL of something, look for the lowest)
                                            5. What is the infection rate at the facility?
                                            6. How many surgeries of type does the facility do in a week/month? So much is also dependent on support staff and equipment.
                                            7. What is the recuperation time?
                                            8. How often will you be seeing me post-op?? Every couple of weeks/months?? Or 1 and done??
                                            9. What are the expectations of the surgery, I.e. regain function (full?? 50%?? Etc) or just pain relief??
                                            10. What are the risks (downsides)?? Hint – under general anesthesia, death should be listed. There are risks to ANY procedure/surgery.

                                            These are all designed for surgeons and just quickly typed via cell but should get you started.

                                          • #91936

                                              BTW, as a NP (family nurse practitioner), my job is NOT to tell you what to do. I have always viewed my job is to identify the problem and to present treatment options for us to discuss (I don’t discuss bad options). The final decision ALWAYS rests with the patient and I respect it. Even those who choose to continue self-destructive behavior (assuming no immediate self-harm, i.e. suicidal)

                                            • #91937
                                              Joe (G.W.N.S.)

                                                One of the ways of finding who is knowing who to stay away from. This gets sticky due to slander/libel suits, and to a lesser degree, professionalism. Just as non-verbal communication speaks louder than verbal, the same applies here.

                                                Two excellent points!

                                                …you’re looking for the most accurate technical which may come across as a bit of an ass (read bedside manner may be a bit gruff).

                                                Hurt my feelings and please tell me what I don’t want to hear, just don’t bullshit me! I give my Docs a free pass in this! Quality information is priority.

                                                One of the best Surgeons I’ve dealt with was a prick, but when pressed he told me giving my situation; if he was in my place, he wouldn’t get surgery at that time!

                                                This is golden in my book!

                                                Confident, but knew his/her limitations.

                                              • #91938

                                                  How to choose medical providers?

                                                  There is no one size fits all response for that. Your own medical mission will drive how you choose.

                                                  While my above posts would seem to indicate that I am against large hospital affiliated medicine, a lot of that depends on the situation.

                                                  If I had cancer, I would want the resources of providers that had access to the multi-disciplinary approach that cancer requires which usually comes with large systems.

                                                  Obviously I am my own primary care “physician” (so to speak) with friends (MDs) in specialty practices. I still have to go out and find a doc every once in a while.

                                                  I do some google searches look for patterns of complaints. Not just the typical “I am a special snowflake and I didn’t get my way” rant, but frequencies of complications, repeat issues, etc.

                                                  I also check the court records for the county they are in to see what kind and how many lawsuits they have had.

                                                  I steer clear of practices that service a majority of medicare and medicaid patients. Seems biased I know. It is. The simple fact is that insurance reimburses more that M&M and the providers in M&M practices are under more pressure to see more patients to pay the bills.

                                                  So I depend on a lot of word of mouth, research, reputation and ultimately the encounter.

                                                  Providers that do not spend enough time with me and tell me what to do are very low on my list.

                                                  Providers (MD, DO, DPM, NP, PA, etc.) that allow enough time to discuss my issues with me are high on my list. And most importantly the ones who tell me what they think is going on and what they think my options are get my return business.

                                                  So yeah, I expect them to act like advisors and consultants.

                                                  Another thing I think is important is to establish a relationship with some type of primary care provider. You may not like or need a physical every year, but in going you are continuing a relationship and building a medical history. That can be important for if/when you need some type of specialty care.

                                                  This gives you time before you NEED medical care to sort out the good from the bad. So plan ahead.

                                                  Hope this helps.

                                                • #91939

                                                    Awesome thread.
                                                    I have two things to offer food-for-thought-wise.
                                                    1) a web article I read and bookmarked on how to negotiate a more reasonable (cash) price for medical services

                                                    I work in the medical field but haven’t had to use this, yet. I totally share the frustration Robert and others express, hell I work here and I can’t understand the rules and the rules change every few months it seems. This article seemed to make sense to me, if it helps then rock on. I’m a technical person not a business person and I know that I don’t yet know this, drives me nuts.

                                                    2) Along the lines of identifying “which doctor should you seek?” or how do you find a good doctor, I recommend the book “How to Survive Your Doctor’s Care” by Pamela Gallin M.D.

                                                    Here’s a different link, I’m not sure about that open library thing.
                                                    My own copy of this is a paper copy.

                                                    I found this book by accident in a medical library while I was looking for information to get my dad medical care for a kind of rare condition, that I thought was beyond the experience of the guy he was seeing.
                                                    This book tells you how the medical system is *supposed* to work, and what the different people in it do, so that you have a better chance of making it work the right way for you. The prologue to the book describes how the author (an eye surgeon at a big-name medical university in the U.S.) needed surgery herself, so she went to see Dr Famous supposedly one of the best people in the world at this. Long story short, he made a mistake, and after the surgery when it started going bad she (the M.D. who was the patient) went to see him and he brushed her off. Problems ensued. She realized, that she as an academic physician (one who trains other M.D.s) could run into trouble, how the hell is a layperson going to be able to tell that things aren’t right and get things fixed before it’s too late? That’s what the book is about.
                                                    My dad, for instance, thinks that he must talk only to the doctor about whatever it is that’s bothering him. The nurse or anyone else isn’t good enough. That isn’t the way the system works though, for good reason. If you understand this, you can talk to a nurse or someone else to address minor problems (like drug refills, or minor complications from a procedure) yet be able to escalate to the doctor if you’re really experiencing something that needs attention. If you know (this book will help teach you if you don’t know) what a physician extender such as a P.A. or an ARNP is, you can help use them to your advantage to help you tell if you’re just having normal recovery pains or if something is going wrong and you need to go the the head of the line now. Insisting that you have to talk to the doctor about everything usually doesn’t get you what you need or at least not the fastest. I’ve had trouble getting my dad to believe this (he thinks he’s a customer rather than a patient).

                                                    Unfortunately, it seems that one needs savvy in both of these arenas, the financial and the medical, to get through medical care these days.

                                                  • #91940

                                                      Don’t be so quick to look at Press-Ganey scores either….several studies have debunked the relationship (how “pleased” patients are with their doctors equalling better outcomes)

                                                      Here’s one from an orthopedic standpoint (yes, it’s technical)

                                                      Then this landmark study from UCDavis.

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