U.S. Politics: Hairpiece In the Middle East Part 2

[Cas Stark]

LOL, well multiple people on this thread have said it's illegal for doctors to take cash or offer a cash discount, but lo and behold, google shows multiple news articles from the last 2 years advising people to do just that...

Interesting.

 

[Gareth]

4 minutes ago, Cas Stark said:

Concierge medicine is not illegal.  There are some doctors who don't even take patients with insurance, only those who are paying directly.  So, I don't see how me, a private pay patient, getting a price that is less than the standard fee is a 'kick back' or would be illegal.

As far as I know, concierge medicine can not accept any type of insurance.  Everything is out-of-pocket and you pay a monthly or annual fee right?  Thats how concierge medicine circumvent the kickback law.

[Kalbear]

1 minute ago, Cas Stark said:

LOL, well multiple people on this thread have said it's illegal for doctors to take cash or offer a cash discount, but lo and behold, google shows multiple news articles from the last 2 years advising people to do just that...

Interesting.

 

They said it can be, which it can be depending on the circumstances. We didn't know you were going to a concierge doctor that doesn't accept any typical insurance; that is kind of a big deal.

It also means you kind of lied about the insurance issue. It's not that he won't take ACA  - it's that you went to a very specific doctor with absurdly high prices and then complained that they won't take your insurance. Yeah, I'm sorry that your groupon doesn't cover renting an Aston Martin. 

[Manhole Eunuchsbane]

1 hour ago, dmc515 said:

Yeah, see, that's where the other side of the argument is more compelling to me.  I adore Madison, Jefferson, Washington.  But if there was ever an effort to demolish their monuments because of their slave owning, I wouldn't put up a fuss.  I don't know how that makes an African-American feel.  I imagine it makes them feel uncomfortable.  It's just a goddamn statue, no reason to make a scene.

Yeah, I think that's a reasonable take as well. I can see both sides of this one. 

[Cas Stark]

3 minutes ago, OldGimletEye said:

I have got say, this whole just pay your doctor with cash and it's no problem, sounds suspiciously to me like the "Chicken Healthcare Plan".

Brought to you by the Party O' Bidness.

Yeah, it's much better when your expensive ACA 'insurance" won't cover your actual doctor at all, so you can just go see whatever schmuck the insurance company says you can.  Yes, that is much better than me self paying and oh my god, getting a discount for it.  

[Cas Stark]

2 minutes ago, Kalbear said:

They said it can be, which it can be depending on the circumstances. We didn't know you were going to a concierge doctor that doesn't accept any typical insurance; that is kind of a big deal.

It also means you kind of lied about the insurance issue. It's not that he won't take ACA  - it's that you went to a very specific doctor with absurdly high prices and then complained that they won't take your insurance. Yeah, I'm sorry that your groupon doesn't cover renting an Aston Martin. 

He does take regular insurance.  Please do not accuse me of lying.  It's incredibly rude and inappropriate.

He takes regular insurance.

He also has a concierge practice.

I am a self pay patient for him because he does not take my crap ACA exchange insurance.

[LongRider]

No, Sue Lowden's 'Chicken Insurance' wasn't better than ACA because it wouldn't fly.  The folks in Nevada weren't fooled by her fowl plan sent her back to the hen house.  She was just another dirty bird from the Party 'O Bidnezz.

[OldGimletEye]

Just now, Cas Stark said:

Yeah, it's much better when your expensive ACA 'insurance" won't cover your actual doctor at all, so you can just go see whatever schmuck the insurance company says you can.  Yes, that is much better than me self paying and oh my god, getting a discount for it.  

But the fact of the matter, without insurance, many people won't get the medical services they need when they get sick.

Some people might be able to afford cash transactions for certain services. But, you know, if they have something major, then likely they are not going to have the cash or chickens on hand to pay for that service.

[OldGimletEye]

Just now, Nasty LongRider said:

No, Sue Lowden's 'Chicken Insurance' wasn't better than ACA because it wouldn't fly.  

In her defense, the Chicken Plan was probably better than the current Republican healthcare bill.

[Kalbear]

2 minutes ago, Cas Stark said:

He does take regular insurance.  Please do not accuse me of lying.  It's incredibly rude and inappropriate.

He takes regular insurance.

He also has a concierge practice.

I am a self pay patient for him because he does not take my crap ACA exchange insurance.

If you're not lying, you're purposely eliding information. Having multiple practices is not a particularly common thing either. It appears he's doing this to have something of a loophole in the law, where he uses his one practice to refuse service and allow discounts for cash customers but has his other practice to accept insurance, but only insurances he gets paid enough for.

That's probably not ethically acceptable to the various boards for precisely the reasons that he's doing it. 

The problem doesn't really appear to be your ACA insurance; it appears to be this specific doctor. 

[LongRider]

The Chicken Plan might of worked, but not everyone in Nevada have chickens.  Too many coyotes, lol.  A bit of a metaphor there.

[Cas Stark]

2 minutes ago, OldGimletEye said:

But the fact of the matter, without insurance, many people won't get the medical services they need when they get sick.

Some people might be able to afford cash transactions for certain services. But, you know, if they have something major, then likely they are not going to have the cash or chickens on hand to pay for that service.

What makes you think that those same people can afford to use services when their deductable is six or seven thousand dollars?  They are in the same place they were w/out insurance only now they are paying monthly premiums for insurance but still can't afford to access actual care beyond a yearly doctor visit.

[Gareth]

11 minutes ago, Cas Stark said:

He does take regular insurance.  Please do not accuse me of lying.

He takes regular insurance.

He also has a concierge practice.

I am a self pay patient for him because he does not take my crap ACA exchange insurance.

So he has a hybrid system.  What a  mess.  He can't bill your insurance for concierge copay (i.e. the monthly or annual fee).  That's illegal.  He could bill your insurance only for things not covered under the concierge plan, only certain labs (not labs done for annual exams or labs required for your routine care, etc.).  Its really complicated what he could bill your insurance for (if he accepted your insurance).  So I'm not sure why he wouldn't accept your "crap ACA exchange insurance" since majority of time, he wouldn't be billing it anyway.  

BTW, if you are going to a concierge provider but not opting for the concierge services, you are choosing to pay for the higher cost.  Concierge providers tend to be more expensive unless you opt for the concierge services. Concierge providers make sense for someone who routinely see their physician because the higher cost even out through the year.

[kairparavel]

1 minute ago, OldGimletEye said:

But the fact of the matter, without insurance, many people won't get the medical services they need when they get sick.

Some people might be able to afford cash transactions for certain services. But, you know, if they have something major, then likely they are not going to have the cash or chickens on hand to pay for that service.

Clearly poors should have planned better, not gotten sick, and not bought an iPhone. All disposable income beyond food, clothing and shelter should have gone into savings to sit around in case of illness. I mean you can't have it all the way the non-poors do. It's not up to us to help the poors out. Sheesh.

[Cas Stark]

1 minute ago, Kalbear said:

If you're not lying, you're purposely eliding information. Having multiple practices is not a particularly common thing either. It appears he's doing this to have something of a loophole in the law, where he uses his one practice to refuse service and allow discounts for cash customers but has his other practice to accept insurance, but only insurances he gets paid enough for.

That's probably not ethically acceptable to the various boards for precisely the reasons that he's doing it. 

The problem doesn't really appear to be your ACA insurance; it appears to be this specific doctor. 

LMAO.  It's all one practice, the waiting room is divided.  It's right out there in open.  There is a huge sign for 'concierge patients'.

 I am afraid that maybe you simply don't know as much as you seem to think you do.  

All I did was give my personal story of not having insurance v. ACA insurance and everyone jumped on me, and my doctor, calling him a criminal and me a taxpayer sponge.  It's not very pretty.

[LongRider]

Damn it, kairparavel is right, it's not up to us be sure the poors have chickens.  It's there own fault if they let the coyotes get the darn chickens.

 

 

[DMC]

4 minutes ago, Cas Stark said:

What makes you think that those same people can afford to use services when their deductable is six or seven thousand dollars?  They are in the same place they were w/out insurance only now they are paying monthly premiums for insurance but still can't afford to access actual care beyond a yearly doctor visit.

The ACA subsidizes such people in order to get quality care more so than any time in the history of the United States.

Also, I thought you were "done with this" like three pages ago.

[LongRider]

"their"  damn it, I can't even edit my own silly mistakes.   span data-node-flag="true">a

[Cas Stark]

3 minutes ago, Gareth said:

So he has a hybrid system.  What a  mess.  He can't bill your insurance for concierge copay (i.e. the monthly or annual fee).  That's illegal.  He could bill your insurance only for things not covered under the concierge plan, only certain labs (not labs done for annual exams or labs required for your routine care, etc.).  Its really complicated what he could bill your insurance for (if he accepted your insurance).  So I'm not sure why he wouldn't accept your "crap ACA exchange insurance" since majority of time, he wouldn't be billing it anyway.  

Why is it a mess?  It seems like a pretty smart thing to do if your patient base is such that you can support a concierge practice, why would you not do it as it's more lucrative and less restrictive, no paperwork or adminstrative BS, just practicing medicine.  It's an adjunct to the regular practice which takes regular insurance--I started going to him when I had employer corporate insurance, which I no longer have.  To my knowledge they don't take Medicaid and they don't take the ACA exchange insurances.  He can't bill my insurance for anything because his office doesn't accept it, that is why I am self pay there.

[Kalbear]

Just now, Cas Stark said:

LMAO.  It's all one practice, the waiting room is divided.  It's right out there in open.  There is a huge sign for 'concierge patients'.

Again, you're deliberately eliding information to make yourself seem more sympathetic. You get that the overwhelming majority of situations aren't remotely like yours, right?

Just now, Cas Stark said:

 I am afraid that maybe you simply don't know as much as you seem to think you do.  

I'm sure that's true. At the same time, I know when someone is deliberately hiding information.

Just now, Cas Stark said:

All I did was give my personal story of not having insurance v. ACA insurance and everyone jumped on me, and my doctor, calling him a criminal and me a taxpayer sponge.  It's not very pretty.

Well, you are a taxpayer sponge. Especially if your doctor is using insurance moneys to allow for you to get a discount. That's simply a statement of fact. I'm sorry you don't like it, but it's absolutely accurate. You getting a discount means the money gets charged elsewhere. 

As @Gareth says, the situation is a mess and quite possibly illegal. And it's also quite bizarre, as him taking or not taking ACA patients doesn't make much sense since, well, he wouldn't be billing the ACA insurance anyway. My suspicion based on reading up on concierge doctors is that he refuses to take ACA patients simply because he knows he won't bill their insurance due to the law, and doesn't want the hassle of having to explain to them that. It's not that the ACA wouldn't cover normal things; it's that they won't cover the retainer fees. 

But again, you get that you wanting to go to a concierge doctor and purposely having to pay out of pocket isn't exactly what you'd call a typical situation, right? And that you, personally, could change most of the problems simply by not being quite so picky?