Do you not accept... cash?
September 28, 2017 9:02 AM   Subscribe

Why would a doctor refuse immediate payment? The one doctor that was recommended to me in a sub-sub-specialty (scuba ENT, if it matters) takes a long list of insurances, but not mine. I called them up and they don't take "self-pay" (aka non-insurance) patients. Why?

I've heard many times about the "Arab sheik problem" where uninsured poor people pay higher rates. And some "concierge medicine" doctors won't take insurance because it's such a pain and reimburses poorly. But why would someone turn down a patient with credit card in hand? I'm aware that this is a first-world problem.

This particular doctor is part of the Sutter Health network. I ended up finding a less well-recommended doctor whose receptionist cheerfully quoted me a price over the phone ($250 for an exam!). It's just inexplicable to me that, in an era with strict diagnosis codes, high-deductible health plans, and "narrow" networks, any physician can afford not to take what seem like the easiest patients, but obviously I'm missing something.
posted by wnissen to Work & Money (9 answers total) 1 user marked this as a favorite
If they are part of a health system then it's not up to the individual providers, it's determined by contract in the C-suite.
posted by headnsouth at 9:05 AM on September 28, 2017 [2 favorites]

What sort of services does the doctor perform? I could imagine not wanting to see self-pay patients for a consult (a few hundred bucks) if that consult could lead to something far more expensive later that the patient wouldn’t be able to afford.

The admin of self-pay also needs to be airtight- if there’s any chance you’re not set up technologically to get every dollar while the patient is in the office (there are programs that can give you TOS payments immediately but not every office uses them), you might be better off not doing it at all, because it’ll be super hard to collect after the fact.
posted by ThePinkSuperhero at 9:14 AM on September 28, 2017 [1 favorite]

Why would a doctor refuse immediate payment?

This doctor isn't refusing payment, they are refusing uninsured patients. They may literally not have a price set for a procedure outside of the price insurance sets or they may not have a mechanism for collecting payment if the credit card you have in hand somehow does not pay for the procedure that you're receiving. You say "cash" but you're not actually talking about cash. They may not be able to refer patients who are not insured.

In short, they do not because they do not have to and even though arriving with cash-in-hand really does seem like it would be the simplest way to receive and compensate services. My local experience is also that ENTs and other specialists are fairly high demand so they can probably set whatever terms work the best for them.
posted by jessamyn at 9:40 AM on September 28, 2017 [1 favorite]

The doctor works for Sutter and gets paid by Sutter. The doctor doesn't work for you or get paid by you and can't take money directly from you because his actual employer, Sutter, would receive nothing from it.
posted by jesourie at 10:41 AM on September 28, 2017 [2 favorites]

If he's employed by Sutter, he's probably bound by his agreement with them as to what forms of payment he can take.

If he's in private practice and only affiliated with Sutter and he's a surgeon, it may just not be financially viable for him to see self-pay patients in consultation that then wouldn't be able to afford to have their surgical procedure done with him.
posted by The Elusive Architeuthis at 1:54 PM on September 28, 2017

Arab sheik problem

The what?
posted by standardasparagus at 3:14 PM on September 28, 2017 [2 favorites]

Response by poster: The sheik problem refers to wealthy international patients who travel to the U.S. for top of the line care. You want to set prices such that you take advantage of that person's ability to pay, even though they don't have insurance. At the same time you don't want to make care completely unaffordable for a truly uninsured person. Google for "charge book" for more info on the fascinating process of setting prices.
posted by wnissen at 4:29 PM on September 28, 2017

Just wondering it might be helpful to try again with the doctor's office and see if you can escalate the question to someone who might be either more knowledgable about payment options or in a position to either make an exception or explain why not. Try the billing office, the billing person's supervisor and then the patient's ombudsman, if there is one.
posted by metahawk at 9:35 PM on September 28, 2017

If you are “credit card in hand”, you aren’t paying cash.
posted by sideshow at 7:16 PM on September 30, 2017

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