Doctor stops accepting insurance

RainRain Posts: 8,960 ✭✭✭
A family practice doctor in Maine is refusing all forms of health insurance, including Medicare, in order, he says, to provide better service to his patients. Dr. Michael Ciampi told the Bangor Daily News that he wants to practice medicine without being dictated to by insurance companies. On April 1, Ciampi lowered his prices and posted the costs online. For example, an office visit in which patients discuss "one issue of moderate complexity or 2-3 simple issues" costs $75. When Ciampi accepted insurance, the visit would run $160, according to the Bangor Daily News. The fact that Ciampi lists the prices, he says, means no surprises for his patients. Say you're an established patient who can't make it to the doctor's office but wish to speak to him over the phone? A 10-minute conversation will run you $20. Each additional five-minute block will cost you $10. A minor surgery, like the draining of a boil will cost between $100 and $150. Dr. Ciampi told the paper that some patients have left his practice, but that all seem to understand what motivated him to make the change. Via the Banger Daily News: Insurance companies no longer dictate how much he charges. He can offer discounts to patients struggling with their medical bills. He can make house calls. "I’m freed up to do what I think is right for the patients," Ciampi said. "If I’m providing them a service that they value, they can pay me, and we cut the insurance out as the middleman and cut out a lot of the expense." Ciampi told the paper that he collects payment at the end of each session (he doesn't send bills), and he sees each patient himself. Patients with insurance can submit their receipts for reimbursement, if the insurance company allows for that, according to Ciampi's family practice site. http://news.yahoo.com/blogs/sideshow/doctor-stops-accepting-insurance-lowers-prices-posts-costs-194405203.html

Comments

  • macs-smokesmacs-smokes Posts: 587
    Finally, a Dr. who is in medicine to help people, not the business of medicine.

  • Amos_UmwhatAmos_Umwhat West TNPosts: 5,022 ✭✭✭✭✭
    God bless him
    WARNING:  The above post may contain thoughts or ideas known to the State of Caliphornia to cause seething rage, confusion, distemper, nausea, perspiration, sphincter release, or cranial implosion to persons who implicitly trust only one news source, or find themselves at either the left or right political extreme.  Proceed at your own risk.  

    "There is nothing so in need of reforming as someone else's bad habits."   Mark Twain
  • perkinkeperkinke Posts: 1,575 ✭✭✭
    Back to the good old days of medicine, curious to know what his peers think.
  • Ken_LightKen_Light Posts: 3,539 ✭✭✭
    I get it and in theory it sounds great. But it's crap in practice because, for the patient, the visit wasn't $160 before, it was a $10-$20 copay and now it's $75.
    ^Troll: DO NOT FEED.
  • RhamlinRhamlin WVPosts: 7,397 ✭✭✭✭✭
    Ken Light:
    I get it and in theory it sounds great. But it's crap in practice because, for the patient, the visit wasn't $160 before, it was a $10-$20 copay and now it's $75.
    Depends on what your deductible is. Mines like 1000$ before copayment kicks in.
  • kuzi16kuzi16 Posts: 14,616 ✭✭✭✭
    that frees his patients up to get catastrophic insurance only probably lowering their annual insurance/medical cost. this doctor gets it. if there were more doctors like this people would realize how good it is and we wouldnt have to regulate the medicine and insurance fields as much. insurance would be cheaper because it would be back to being a risk pool not a guaranteed paid-out pool.
  • webmostwebmost Dull-AwarePosts: 5,880 ✭✭✭✭✭
    Rhamlin:
    Ken Light:
    I get it and in theory it sounds great. But it's crap in practice because, for the patient, the visit wasn't $160 before, it was a $10-$20 copay and now it's $75.
    Depends on what your deductible is. Mines like 1000$ before copayment kicks in.
    My handball partner goes to exactly such a doctor in Merryland, for exactly that same reason. He has a $1,500 deductible. When he bumped into a prostate problem three years ago, he paid the deductible and went the other route. Otherwise, he uses a general practitioner who wants cash on the barrelhead. That doc is full up, too. Cannot accept new patients.

    Guy across the street was talking with the wife last weekend. His old lady works I dunno where. They have Blue Cross. Her latest prescription cost them $1,200 co-pay.

    “It has been a source of great pain to me to have met with so many among [my] opponents who had not the liberality to distinguish between political and social opposition; who transferred at once to the person, the hatred they bore to his political opinions.” —Thomas Jefferson (1808)


  • raisindotraisindot BostonPosts: 1,308 ✭✭✭
    Rhamlin:
    Ken Light:
    I get it and in theory it sounds great. But it's crap in practice because, for the patient, the visit wasn't $160 before, it was a $10-$20 copay and now it's $75.
    Depends on what your deductible is. Mines like 1000$ before copayment kicks in.
    Aye, there's the rub. I woiuldn't go to him because my health insurance policy has no deductible and only $20 co-pays. Looks like for him I'd need to spend over $100 cash for a physical. And it's not made clear how much I'd pay out of pocket for blood tests if I needed them.

    But even if my health plan had a deductible, it isn't clear whether what you pay out of pocket for this guy can be applied to a deductible since he wouldn't be covered by any health insurance.

    And it's not quite clear whether he takes Medicaire or not.

    His model is great and all the power to him, but his market is most likely people who either don't have employer health insurance or are wealthy enough to pay out of pocket. He's certainly a much nobler medical alternative to the new breed of "boutique" doctors who charge patients $5,000 a year or more out of pocket just for the privilege of being able to make appointments with them.
  • Gray4linesGray4lines KentuckyPosts: 4,502 ✭✭✭✭✭
    I like how this pay-up-front plan removes the curtain from healthcare pricing... No one knows what doctors and hospitals really charge (or they don't care) because insurance covers it and you only look at deductibles and co-pays. This kind of "mysterious" pricing, I think, leaves a lot of room for let's call it "artificial" prices.

    I'm just thinking out loud so to speak... Medical costs is a weird field. Anywhere else a consumer looks at price and decides if they want that good or not; if it gives them enough value. But, in healthcare it is kind-of taboo to imagine someone being "priced out" of a service. It's almost like price doesn't matter here (as things are now).

    And to make things worse, if you do not have insurance you are billed (in the case of hospitals) an inflated number that is arbitrarily calculated. The bills become enormous very quickly and can bankrupt anyone, even in "small" slip and fall injuries or "possible" heart attacks. It's almost too scary to NOT have insurance.

    If more practices were no-insurance, maybe it would 1. bring actual prices into light. and 2. ease the fear of going insurance-less. As I see it for my wife and I, insurance is not a choice, it is absolutely necessary because not having it is potential financial ruin for the rest of our lives.
    LLA - Lancero Lovers of America
  • jgibvjgibv John G.Posts: 9,263 ✭✭✭✭✭
    Gray4lines:
    I like how this pay-up-front plan removes the curtain from healthcare pricing... No one knows what doctors and hospitals really charge (or they don't care) because insurance covers it and you only look at deductibles and co-pays. This kind of "mysterious" pricing, I think, leaves a lot of room for let's call it "artificial" prices.

    100% agree.
    Not sure how smaller doctor's offices negotiate rates ..... I'd assume it's similar but this is a pretty interesting post that describes how hospitals come up with their prices
    (As with any "anonymous" internet post take it FWIW.)


    Gray4lines:
    If more practices were no-insurance, maybe it would 1. bring actual prices into light. and 2. ease the fear of going insurance-less.
    Wishful thinking there, Gray.


    * I have a new address as of 3/24/18 *

  • MartelMartel Somewhere in PAPosts: 3,304 ✭✭✭✭
    Gray4lines:
    I like how this pay-up-front plan removes the curtain from healthcare pricing... No one knows what doctors and hospitals really charge (or they don't care) because insurance covers it and you only look at deductibles and co-pays. This kind of "mysterious" pricing, I think, leaves a lot of room for let's call it "artificial" prices.

    I'm just thinking out loud so to speak... Medical costs is a weird field. Anywhere else a consumer looks at price and decides if they want that good or not; if it gives them enough value. But, in healthcare it is kind-of taboo to imagine someone being "priced out" of a service. It's almost like price doesn't matter here (as things are now).

    And to make things worse, if you do not have insurance you are billed (in the case of hospitals) an inflated number that is arbitrarily calculated. The bills become enormous very quickly and can bankrupt anyone, even in "small" slip and fall injuries or "possible" heart attacks. It's almost too scary to NOT have insurance.

    If more practices were no-insurance, maybe it would 1. bring actual prices into light. and 2. ease the fear of going insurance-less. As I see it for my wife and I, insurance is not a choice, it is absolutely necessary because not having it is potential financial ruin for the rest of our lives.

    I think what you've stated in the first paragraph would be the single most responsible healthcare reform anyone could sign into practice...transparent and up-front pricing. Allow competition, even with insurance picking up the bill. Allow patients to know what is being done and decide on the cost without being surprised by later bills that have mysterious charges. My last trip to the ER had so many bills coming from so many separate billing agencies (and it was a workers comp) that one fell through the cracks until it showed up on our credit report. Now we're having a heck of a time getting it paid for. I'm pretty sure it got submitted to the employers insurance at the time, but I have no way of confirming it. Examining the bill (which the credit report says is close to $500) actually shows charges of a couple of thousand and it is incomprehensible as to what is actually being charged. Seriously, hospitals should also be required to run all their billing for equipment, tests, and doctors through one central facility, too. One, clearly itemized bill at the time of treatment would have allowed the hospital to get paid on time easily. Multiple bills for x-ray, reading the x-ray, doctors, hospital itself, ortho supplies and treatment, and medication, all of which happened on a single visit to the ER, seems intended to confuse and distract patients from knowing what was done to them and whether or not they should pay.

    Perhaps I'm cynical from a time my wife needed a visit from the local paramedics and we got a bill for using an oxygen tank which I saw them carry to our room but never use, and she didn't go for a ride in the ambulance, so I was present the whole time.
    Intelligence is knowing that a tomato is a fruit; wisdom is knowing not to put it in a fruit salad.

    I like Oliva and Quesada (including Regius) a lot.  I will smoke anything, though.
  • Gray4linesGray4lines KentuckyPosts: 4,502 ✭✭✭✭✭
    jgibv:
    Gray4lines:
    I like how this pay-up-front plan removes the curtain from healthcare pricing... No one knows what doctors and hospitals really charge (or they don't care) because insurance covers it and you only look at deductibles and co-pays. This kind of "mysterious" pricing, I think, leaves a lot of room for let's call it "artificial" prices.

    100% agree.
    Not sure how smaller doctor's offices negotiate rates ..... I'd assume it's similar but this is a pretty interesting post that describes how hospitals come up with their prices
    (As with any "anonymous" internet post take it FWIW.)


    Gray4lines:
    If more practices were no-insurance, maybe it would 1. bring actual prices into light. and 2. ease the fear of going insurance-less.
    Wishful thinking there, Gray.

    Yeah, it is wishful...

    Steven Brill's article for TIME, "The Bitter Pill -- Why Medical Costs Are Killing Us" goes into great detail about hospital "pricing" and what's called a "chargemaster" price list.

    It's basically a list with made up prices that was created some decades ago in some instances. It is a starting point for negotiating prices with insurance companies (who NEVER pay the figures you see on a hospital bill). And from Brill's article, double, triple, and even quadruple + billing for the same item is common. As martel mentioned about the oxygen tank... they will just stick **** on your bill to see if you will pay, and will insurance know that you didn't actually use the tank? nope. So they'll pay it.

    I do believe that some of Brill's article is a little bit of a stretch, such as when he goes into hospital profitability (I'm not sure how he measures it). But, much of his article is very informative and at least gets you thinking about problems and issues in healthcare costs.
    LLA - Lancero Lovers of America
  • brianetz1brianetz1 St. Louis, MOPosts: 4,135 ✭✭✭
    raisindot:
    Rhamlin:
    Ken Light:
    I get it and in theory it sounds great. But it's crap in practice because, for the patient, the visit wasn't $160 before, it was a $10-$20 copay and now it's $75.
    Depends on what your deductible is. Mines like 1000$ before copayment kicks in.
    Aye, there's the rub. I woiuldn't go to him because my health insurance policy has no deductible and only $20 co-pays. Looks like for him I'd need to spend over $100 cash for a physical. And it's not made clear how much I'd pay out of pocket for blood tests if I needed them.

    But even if my health plan had a deductible, it isn't clear whether what you pay out of pocket for this guy can be applied to a deductible since he wouldn't be covered by any health insurance.

    And it's not quite clear whether he takes Medicaire or not.

    His model is great and all the power to him, but his market is most likely people who either don't have employer health insurance or are wealthy enough to pay out of pocket. He's certainly a much nobler medical alternative to the new breed of "boutique" doctors who charge patients $5,000 a year or more out of pocket just for the privilege of being able to make appointments with them.
    can we get back to this? $20 copay and no no deductible? What is this 1980? Where do you work and are they hiring?
  • Ken_LightKen_Light Posts: 3,539 ✭✭✭
    brianetz1:
    raisindot:
    Rhamlin:
    Ken Light:
    I get it and in theory it sounds great. But it's crap in practice because, for the patient, the visit wasn't $160 before, it was a $10-$20 copay and now it's $75.
    Depends on what your deductible is. Mines like 1000$ before copayment kicks in.
    Aye, there's the rub. I woiuldn't go to him because my health insurance policy has no deductible and only $20 co-pays. Looks like for him I'd need to spend over $100 cash for a physical. And it's not made clear how much I'd pay out of pocket for blood tests if I needed them.

    But even if my health plan had a deductible, it isn't clear whether what you pay out of pocket for this guy can be applied to a deductible since he wouldn't be covered by any health insurance.

    And it's not quite clear whether he takes Medicaire or not.

    His model is great and all the power to him, but his market is most likely people who either don't have employer health insurance or are wealthy enough to pay out of pocket. He's certainly a much nobler medical alternative to the new breed of "boutique" doctors who charge patients $5,000 a year or more out of pocket just for the privilege of being able to make appointments with them.
    can we get back to this? $20 copay and no no deductible? What is this 1980? Where do you work and are they hiring?
    It's my wife's insurance, she's a teacher in NJ. Mine would probably be at least nearly as good in academia. I'm really not sure where you guys get your insurance, though, even working for Borders in the late 90s I had a comparable plan...
    ^Troll: DO NOT FEED.
  • phobicsquirrelphobicsquirrel Posts: 7,349
    I have a few friends that are doctors and they HATE dealing with insurance companies. They actually have people at their office that are just there to deal with them. Talk about waste of money. There should be no money made in health care other than the health care providers those actually doing the work. There should be no middlemen (woman) getting rich off of it. I'm glad someone is staying F you to these mobsters though even though he might be cheaper or more expensive (depending) it doesn't help someone that needs a surgery. I mean 3000 dollar detectable or not, that's a lot cheaper than paying for it. So we all are by the balls in this.
  • raisindotraisindot BostonPosts: 1,308 ✭✭✭
    Healthcare costs have absolutely no relation to the reality of the marketplace at all.

    For example, my wife (a cancer survivor) goes for a mammogram at least once a year. We pay just the co-pay, but on the itemized list its price is $2,000. Explain to me how a procedure that takes, at most, a half hour, accrues perhaps $100 in electrical, machine wear, printed materials and other 'tangible' costs, and requires no more than a total of an hour of combined time (technician, nurse, doctor) can cost this much. And they do 20 of these a day!

    And it's not like this hospital has a competitive edge--it's a second tier hospital in the Boston area, home of the largest concentration of great hospitals in the entire world. Can't even imagine what these same things cost at some of the better hospitals in town.
  • phobicsquirrelphobicsquirrel Posts: 7,349
    Yeah a lot of costs in other countries are much less for the same procedures. Some estimates are around 8 to 15 times the cost of it here. And really it is just due to the lack of restrictions on these companies to charges these ab-scene rates. Maybe one day people will wise up.
  • Gray4linesGray4lines KentuckyPosts: 4,502 ✭✭✭✭✭
    raisindot:
    Healthcare costs have absolutely no relation to the reality of the marketplace at all.

    For example, my wife (a cancer survivor) goes for a mammogram at least once a year. We pay just the co-pay, but on the itemized list its price is $2,000. Explain to me how a procedure that takes, at most, a half hour, accrues perhaps $100 in electrical, machine wear, printed materials and other 'tangible' costs, and requires no more than a total of an hour of combined time (technician, nurse, doctor) can cost this much. And they do 20 of these a day!

    And it's not like this hospital has a competitive edge--it's a second tier hospital in the Boston area, home of the largest concentration of great hospitals in the entire world. Can't even imagine what these same things cost at some of the better hospitals in town.
    They essentially make up the cost. They also like to allocate other fixed costs to every procedure. And after that machine breaks even, it's essentially all profit. One thing is for sure... hospitals dont need as much charity as some would believe!
    LLA - Lancero Lovers of America
  • perkinkeperkinke Posts: 1,575 ✭✭✭
    A large part of the problem is that insurance companies are exempt from anti-trust and consumer protection laws, they are also allowed their own accounting rules so they can skew their information so it looks like they break even or lose money each year, even though simple arithmetic would show they are rolling in cash.

    Same is somewhat true of hospitals, most are granted "non-profit" status which in reality means that while the organization isn't showing a profit they can pay their executives and board members some pretty astounding salaries. I have little problem paying talented surgeons, effective doctors and nurses, or prolific researchers hefty salaries, but the moneymen? the folks who haven't even seen let alone treated a patient in 20 years? Nope.

    These two tie to Gray's point because the costs listed on your bill are not what your insurance company pays, but its what is reported on organization income statements and the cost accounting for insurance companies, even though they only part with a fraction of that amount of money.

    One of the things that made me think that the ACA was on the right track, whatever you think of it now, was that the insurance companies initially offered to spend hundreds of millions of dollars to help the administration implement it....until their lapdogs in Congress could get organized to oppose it. the fact that they OFFERED to part with that much money told me that they were scared, and insurance companies scared for their bottom line meant something good for customers.
  • Amos_UmwhatAmos_Umwhat West TNPosts: 5,022 ✭✭✭✭✭
    Steven Brill covered most or all of this in "Bitter Pill", as Gray4lines pointed out. He's supposed to be working on a follow up article, (or maybe a book, it's early & I can't remember right now) which should be interesting. Considering that he's exposing corruption at the highest level of our government, ie. the Insurance Industry, I'm hoping he doesn't "meet with an accident".

    As far as the American people "waking up"

    well, I've said for years that after the protests in the late '60s the education system in the U.S. changed dramatically. The message "Question Authority" was removed from the curriculum, as was all incentive to take action at the grass-roots level. We're all fascinated by the shiny baubles and lurid tales, too caught up to feel the hands of industry & govt slipping our wallets out of our pockets, and if we notice

    Who would we tell?
    WARNING:  The above post may contain thoughts or ideas known to the State of Caliphornia to cause seething rage, confusion, distemper, nausea, perspiration, sphincter release, or cranial implosion to persons who implicitly trust only one news source, or find themselves at either the left or right political extreme.  Proceed at your own risk.  

    "There is nothing so in need of reforming as someone else's bad habits."   Mark Twain
  • VulchorVulchor FloridaPosts: 4,806 ✭✭✭
    Amos Umwhat:
    We're all fascinated by the shiny baubles and lurid tales, too caught up to feel the hands of industry & govt slipping our wallets out of our pockets
    Well said. Not just govt. either. Apple and every other corporation has us my the balls as our consumerist and mindless culture contines to destroy everything our past generations worked towards.
  • phobicsquirrelphobicsquirrel Posts: 7,349
    Vulchor:
    Amos Umwhat:
    We're all fascinated by the shiny baubles and lurid tales, too caught up to feel the hands of industry & govt slipping our wallets out of our pockets
    Well said. Not just govt. either. Apple and every other corporation has us my the balls as our consumerist and mindless culture contines to destroy everything our past generations worked towards.
    Yeah you guys hit it right there. I can't remember what I was listening too, or who it was but the gist of it is what you all are saying. Seems as though if a people are so pre-occupied with either working (trying to survive), what's the newest shiny thing (tablets, smart phones, hd tv ...), and mindless entertainment they will get their eye off of what is really going on. Add to that there are no real journalists working for NEWS channels anymore. Where is the dan rather and other people like him from years past? Now we get these cable shows that say they are news but are not. Even the national or local "news" channels don't really do news. Sure they cover spin stories, talking points or when/if a cop saves a kitten but nothing really news worthy.

    What was it, CNN had the whole chick who shot her boyfriend thing on 24-7. Now that's not news. It isn't just that you have this no news thing, you have a few corporations that run all of them. Now there's the problem. These same companies get together and know what they want so we as viewers get it toned down and just enough to satisfy.
  • jadeltjadelt Posts: 766
    Health care..... My MIL just got a letter from her DR. It said he is no longer accepting any Medicare patients.

    Feel free to blame whoever you want
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