Guest guest Posted October 23, 2008 Report Share Posted October 23, 2008 in JAMA this week an article on Uninsured Adults Presenting to US Emergency Deparments- Assumptions vs data-do the uninsured present with non urgent problems? not supported by the data they reveiwed - do they lack access to primary ca re-yes -is it more expensive for these folks to be seen in t he er than elsewhere -yes - do they delay getting, and get less care? yesnow what I want to know is about the comments " no primary care care clinicans will accept new uninsured patients " well the uninsured=cash payWe will not accept cash pay? SInce when? Isn't that what we take flak FOR ? Expecting people to pay us?MAny institutions of course I understand want insurers becasue they WILL pay despite paying only some percetnage some weeks later after submitting detailed forms that often must be sent back and redone but there is some guarantee of payment However AM I naiive to think that many uninsured would make some attempt to pay- and without nearly as much out of pocket costs for the billing details as to insurers?Remember that I am talking ER visits here- I am not talking to 300,000 heart valve replacement in hospital bill which no one can pay. -- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 31, 2008 Report Share Posted October 31, 2008 We have some self-pay patients. When we referred them to a specialist, I have not had 1 yet refuse to see them if they were going to pay. And they pay us. I have started having discussions with self-pay patients on their first visit after Alice sees them. During that discussion, I explain that yes, they do pay more than their insured brothers. I also explain that we realize that they are our Premium patients. Just like when you pay extra for flying "first class" and less for coach. Well, I inform them they are our First Class patients and they will get different service than the "coach" patients. I only started this last week when we had 2 self-pays. Man you should have seen the happy grin on their faces. They actually talked about being treated worse previously. Who would treat their highest paying customers worse?? uninsur-ance in JAMA this week an article on Uninsured Adults Presenting to US Emergency Deparments- Assumptions vs data-do the uninsured present with non urgent problems? not supported by the data they reveiwed - do they lack access to primary ca re-yes -is it more expensive for these folks to be seen in t he er than elsewhere -yes - do they delay getting, and get less care? yesnow what I want to know is about the comments "no primary care care clinicans will accept new uninsured patients" well the uninsured=cash payWe will not accept cash pay? SInce when? Isn't that what we take flak FOR ? Expecting people to pay us?MAny institutions of course I understand want insurers becasue they WILL pay despite paying only some percetnage some weeks later after submitting detailed forms that often must be sent back and redone but there is some guarantee of paymentHowever AM I naiive to think that many uninsured would make some attempt to pay- and without nearly as much out of pocket costs for the billing details as to insurers?Remember that I am talking ER visits here- I am not talking to 300,000 heart valve replacement in hospital bill which no one can pay.-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 31, 2008 Report Share Posted October 31, 2008 I also see self pay patients, more of them all the time because established folks are losing their insurance right and left. But in our community most clinics won't let the uninsured in the door. I suspect many of the doctors would see the patients and write off much or all of the standard fee, but they have insulated themselves with staff who prevent that from happening. I think a big part of the reason behind this is that, in the past at least, the uninsured tended to be mostly the socially maladjusted, n'er-do-well, drug seeking sort of patient. So not taking self pay patients was more a way to avoid seeing that crowd than it was a desire not to take cash on the barrel head. There is also a strong tendency for those folks, if they don't pay on the way in, not to pay at all. Now, though, most of my self pay folks are nice, regular people who just don't happen to work for the state or one of the big factories... They aren't my " best paying " patients, because I give them a 25% discount for paying at time of service, which puts them pretty close to what insurance pays. OTOH, no billing to fool with is a bit plus in my mind. Annie We have some self-pay patients. When we referred them to a specialist, I have not had 1 yet refuse to see them if they were going to pay. And they pay us. I have started having discussions with self-pay patients on their first visit after Alice sees them. During that discussion, I explain that yes, they do pay more than their insured brothers. I also explain that we realize that they are our Premium patients. Just like when you pay extra for flying " first class " and less for coach. Well, I inform them they are our First Class patients and they will get different service than the " coach " patients. I only started this last week when we had 2 self-pays. Man you should have seen the happy grin on their faces. They actually talked about being treated worse previously. Who would treat their highest paying customers worse?? uninsur-ance in JAMA this week an article on Uninsured Adults Presenting to US Emergency Deparments- Assumptions vs data-do the uninsured present with non urgent problems? not supported by the data they reveiwed - do they lack access to primary ca re-yes -is it more expensive for these folks to be seen in t he er than elsewhere -yes - do they delay getting, and get less care? yesnow what I want to know is about the comments " no primary care care clinicans will accept new uninsured patients " well the uninsured=cash payWe will not accept cash pay? SInce when? Isn't that what we take flak FOR ? Expecting people to pay us?MAny institutions of course I understand want insurers becasue they WILL pay despite paying only some percetnage some weeks later after submitting detailed forms that often must be sent back and redone but there is some guarantee of paymentHowever AM I naiive to think that many uninsured would make some attempt to pay- and without nearly as much out of pocket costs for the billing details as to insurers?Remember that I am talking ER visits here- I am not talking to 300,000 heart valve replacement in hospital bill which no one can pay. -- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax -- Annie SkaggsLexington, KY Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 3, 2008 Report Share Posted November 3, 2008 They legally cannot accept self pay?? tell me more? At least in NY, some clinics are classified differently and legally cannot accept self pay patients. To: Sent: Friday, October 31, 2008 12:01:14 PMSubject: Re: uninsur-ance I also see self pay patients, more of them all the time because established folks are losing their insurance right and left. But in our community most clinics won't let the uninsured in the door. I suspect many of the doctors would see the patients and write off much or all of the standard fee, but they have insulated themselves with staff who prevent that from happening. I think a big part of the reason behind this is that, in the past at least, the uninsured tended to be mostly the socially maladjusted, n'er-do-well, drug seeking sort of patient. So not taking self pay patients was more a way to avoid seeing that crowd than it was a desire not to take cash on the barrel head. There is also a strong tendency for those folks, if they don't pay on the way in, not to pay at all. Now, though, most of my self pay folks are nice, regular people who just don't happen to work for the state or one of the big factories... They aren't my " best paying " patients, because I give them a 25% discount for paying at time of service, which puts them pretty close to what insurance pays. OTOH, no billing to fool with is a bit plus in my mind. Annie On Thu, Oct 30, 2008 at 9:22 PM, Wayne Coghill <cwayne59verizon (DOT) net> wrote: We have some self-pay patients. When we referred them to a specialist, I have not had 1 yet refuse to see them if they were going to pay. And they pay us. I have started having discussions with self-pay patients on their first visit after Alice sees them. During that discussion, I explain that yes, they do pay more than their insured brothers. I also explain that we realize that they are our Premium patients. Just like when you pay extra for flying " first class " and less for coach. Well, I inform them they are our First Class patients and they will get different service than the " coach " patients. I only started this last week when we had 2 self-pays. Man you should have seen the happy grin on their faces. They actually talked about being treated worse previously. Who would treat their highest paying customers worse?? [Practiceimprovemen t1] uninsur-ance in JAMA this week an article on Uninsured Adults Presenting to US Emergency Deparments- Assumptions vs data-do the uninsured present with non urgent problems? not supported by the data they reveiwed - do they lack access to primary ca re-yes -is it more expensive for these folks to be seen in t he er than elsewhere -yes - do they delay getting, and get less care? yesnow what I want to know is about the comments " no primary care care clinicans will accept new uninsured patients " well the uninsured=cash payWe will not accept cash pay? SInce when? Isn't that what we take flak FOR ? Expecting people to pay us?MAny institutions of course I understand want insurers becasue they WILL pay despite paying only some percetnage some weeks later after submitting detailed forms that often must be sent back and redone but there is some guarantee of paymentHowever AM I naiive to think that many uninsured would make some attempt to pay- and without nearly as much out of pocket costs for the billing details as to insurers?Remember that I am talking ER visits here- I am not talking to 300,000 heart valve replacement in hospital bill which no one can pay. -- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax -- Annie SkaggsLexington, KY -- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 3, 2008 Report Share Posted November 3, 2008 I can't remember the term, something like they are a "Section 54" or something like that. They are basically Medicaid clinics who have to follow certain rules to qualify as a nonprofit agency. They have to accept certain insurances and not others. I bet they CAN accept self pay but the paperwork must be abyssmal (does that have one "s" or 2?). I wish I could remember the details, I'm sure the rules are out there somewhere. I do know they must accept any Medcaid product, they get state funding, blah blah blah... To: Sent: Monday, November 3, 2008 8:44:51 AMSubject: Re: uninsur-ance They legally cannot accept self pay?? tell me more? On Mon, Nov 3, 2008 at 8:43 AM, nancy blake <nancycblake@ yahoo.com> wrote: At least in NY, some clinics are classified differently and legally cannot accept self pay patients. From: Skaggs <andrea.skaggs@ gmail.com>To: Practiceimprovement 1yahoogroups (DOT) comSent: Friday, October 31, 2008 12:01:14 PMSubject: Re: [Practiceimprovemen t1] uninsur-ance I also see self pay patients, more of them all the time because established folks are losing their insurance right and left. But in our community most clinics won't let the uninsured in the door. I suspect many of the doctors would see the patients and write off much or all of the standard fee, but they have insulated themselves with staff who prevent that from happening. I think a big part of the reason behind this is that, in the past at least, the uninsured tended to be mostly the socially maladjusted, n'er-do-well, drug seeking sort of patient. So not taking self pay patients was more a way to avoid seeing that crowd than it was a desire not to take cash on the barrel head. There is also a strong tendency for those folks, if they don't pay on the way in, not to pay at all.Now, though, most of my self pay folks are nice, regular people who just don't happen to work for the state or one of the big factories... They aren't my "best paying" patients, because I give them a 25% discount for paying at time of service, which puts them pretty close to what insurance pays. OTOH, no billing to fool with is a bit plus in my mind.Annie On Thu, Oct 30, 2008 at 9:22 PM, Wayne Coghill <cwayne59verizon (DOT) net> wrote: We have some self-pay patients. When we referred them to a specialist, I have not had 1 yet refuse to see them if they were going to pay. And they pay us. I have started having discussions with self-pay patients on their first visit after Alice sees them. During that discussion, I explain that yes, they do pay more than their insured brothers. I also explain that we realize that they are our Premium patients. Just like when you pay extra for flying "first class" and less for coach. Well, I inform them they are our First Class patients and they will get different service than the "coach" patients. I only started this last week when we had 2 self-pays. Man you should have seen the happy grin on their faces. They actually talked about being treated worse previously. Who would treat their highest paying customers worse?? [Practiceimprovemen t1] uninsur-ance in JAMA this week an article on Uninsured Adults Presenting to US Emergency Deparments- Assumptions vs data-do the uninsured present with non urgent problems? not supported by the data they reveiwed - do they lack access to primary ca re-yes -is it more expensive for these folks to be seen in t he er than elsewhere -yes - do they delay getting, and get less care? yesnow what I want to know is about the comments "no primary care care clinicans will accept new uninsured patients" well the uninsured=cash payWe will not accept cash pay? SInce when? Isn't that what we take flak FOR ? Expecting people to pay us?MAny institutions of course I understand want insurers becasue they WILL pay despite paying only some percetnage some weeks later after submitting detailed forms that often must be sent back and redone but there is some guarantee of paymentHowever AM I naiive to think that many uninsured would make some attempt to pay- and without nearly as much out of pocket costs for the billing details as to insurers?Remember that I am talking ER visits here- I am not talking to 300,000 heart valve replacement in hospital bill which no one can pay.-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax -- Annie SkaggsLexington, KY-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 3, 2008 Report Share Posted November 3, 2008 Are you referring to the " Article 28 " clinics? I know they are hospital-based and always take Medicaid (although they get paid more to do so than private docs). I hadn't heard that they couldn't take self-pay. ---Sharlene > > We have some self-pay patients. When we referred them to a specialist, I have not had 1 yet refuse to see them if they were going to pay. And they pay us. > > I have started having discussions with self-pay patients on their first visit after Alice sees them. During that discussion, I explain that yes, they do pay more than their insured brothers. I also explain that we realize that they are our Premium patients. Just like when you pay extra for flying " first class " and less for coach. Well, I inform them they are our First Class patients and they will get different service than the " coach " patients. > > I only started this last week when we had 2 self-pays. Man you should have seen the happy grin on their faces. They actually talked about being treated worse previously. Who would treat their highest paying customers worse?? > > > > [Practiceimprovemen t1] uninsur-ance > > > in JAMA this week an article on Uninsured Adults Presenting to US Emergency Deparments- Assumptions vs data > > > -do the uninsured present with non urgent problems? not supported by the data they reveiwed > - do they lack access to primary ca re-yes > -is it more expensive for these folks to be seen in t he er than elsewhere -yes > - do they delay getting, and get less care? yes > > now what I want to know is about the comments " no primary care care clinicans will accept new uninsured patients " > > well the uninsured=cash pay > > We will not accept cash pay? SInce when? Isn't that what we take flak FOR ? Expecting people to pay us? > MAny institutions of course I understand want insurers becasue they WILL pay despite paying only some percetnage some weeks later after submitting detailed forms that often must be sent back and redone but there is some guarantee of payment > However AM I naiive to think that many uninsured would make some attempt to pay- and without nearly as much out of pocket costs for the billing details as to insurers?Remember that I am talking ER visits here- I am not talking to 300,000 heart valve replacement in hospital bill which no one can pay. > > > > -- > If you are a patient please allow up to 12 hours for a reply by email/ > please note the new email address. > Remember that e-mail may not be entirely secure/ > MD > > > ph fax > > > > > -- > Annie Skaggs > Lexington, KY > > > > > -- > If you are a patient please allow up to 12 hours for a reply by email/ > please note the new email address. > Remember that e-mail may not be entirely secure/ > MD > > > ph fax > Quote Link to comment Share on other sites More sharing options...
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