More doctors are switching to cash-only practices

The numbers are still small but rising, creating both cost savings and some new headaches.

By Bruce Kennedy Jun 13, 2013 3:11PM

Medical doctor (© tetra images/Getty Images/Getty Images)Earlier this year, Dr. Michael Ciampi sent a letter to patients at his family practice in South Portland, Maine, telling them he would no longer accept any form of health insurance. He now posts prices on his office website and asks patients to pay for services out of pocket.

Ciampi is part of a small but growing number of physicians who are switching  to a cash-only model (not strictly cash -- most also accept payments by check and credit or debit cards) in order to streamline their costs.

CNNMoney says about 4% of respondents to a survey conducted last year by the American Academy of Family Physicians said they took only cash at their practices, up from 3% in 2010. And a physician compensation report by WebMD site Medscape found 6% of doctors had a concierge or cash-only practice this year, compared with 4% in 2012.

Doctors who go the cash-only route get some very tangible advantages. "This arrangement generally enables much lower overhead because claims processing, patient billing and countless hassles related to managed care can be eliminated," the AAFP noted several years ago.

The cash-only approach also creates challenges. According to the AAFP, some health insurance companies prohibit patients from seeing physicians who terminate their contacts, if only for a limited amount of time. Doctors who switch to cash-only practices are also considered out of network by many insurance groups. And patients who want to stay with a cash-only doctor but need to be reimbursed have to file their own insurance claims.

There's also the argument that only healthy and wealthy patients benefit from the cash-only system and that such practices reduce a doctor's range of care because patients with long-term, acute and costly problems will most likely seek out physicians who accept insurance.

Ciampi says his decision to go cash-only cost him several hundred of his 2,000 or so patients.

"It's been almost unanimous that patients have expressed understanding at why I’m doing what I'm doing," he told the Bangor Daily News, "although I've had many people leave the practice because they want to be covered by insurance, which is understandable."

But going to a cash-only system also means Ciampi can practice a more flexible form of medicine. The insurance companies no longer tell him what to charge. He can also offer discounts to financially struggling patients and even make house calls.

"I'm freed up to do what I think is right for the patients," he 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."

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Jun 13, 2013 3:51PM
Wow one for the good guys. Drs will no longer be in a choke hold by the insurance companies and real doctoring can be performed. No more regulations or non payment because the wrong codes are put in. I hope more Drs follow suit and force these monopolies in healthcare out of business.
Jun 13, 2013 3:57PM
This will become the norm for many doctors, cut out the insurance companies and just sit back and watch how this turns out, sounds like a good plan to me.  The insurance companies will be scrambling if we all would just say "NO MORE".........
Jun 13, 2013 4:07PM
A   physician   in   my   city   has   started   having   yearly   workshops   for   suicide   prevention  for   doctors.  There   were   over  400  suicides   last   year   in  the  U.S.   by   physicians   exhausted   at   having   so  little  time   to  spend   with   patients,   and   the   enormous   hassle   of   dealing   with   insurance  companies.   They   say   what  they   want   is  to  love  medicine   again   the  way  they  did   when   they   were  early   in   their  years  of  practice.   As  a  nurse,  I've   seen   physician   burn-out   first   hand,   with  many  going   to   just   part-time   practices.   Good   for   doctors   for   thinking  outside   the   box.
Jun 13, 2013 4:00PM

I think that more and more doctors are going to do this.  In fact, instead of Obummer care, why not expect patients to pay for most routine care out of pocket, and pick and choose the health insurance coverages they most need, which includes catastrophic care.  That would bring health care costs down for everyone and make the health care marketplace more competitive. 


 Instead, we are forced to take policies with more coverage than we need (not everyone needs maternity coverage, free birth control, mental health services, etc.)   Why not be able to pick and choose the coverages that we DO need, and shop across state lines among many insurance companies for competitive pricing for the services that we need? I'll take the free market approach any day of the week over the government run bureaucracy. 

Jun 13, 2013 4:17PM
CASH is fine by me.
Just don't ask for personal information like my Social Security Number.

Jun 13, 2013 3:57PM
Wait until you need surgery, then this will not work.
Jun 13, 2013 3:55PM
This is very interesting.  I don't have medical insurance, as I'm from the group considered the "working poor", as I make too much to qualify for Medicaid or low cost insurance, but with all my living expenses (I live in NY so its very costly), I cannot afford private medical insurance at prices ranging from  $1,000 per month or more for a single individual.  However, I have a thyroid condition that must be monitered every 6 months so I go to an endrocronoligist and he charges me out of pocket only $75.00 for a full check up. My bloodwork is sent to a lab that participates in a "coupon" program for individuals without insurance and gives a significant discount to me.  Now, I had private med insurance when I was married under my x husband, however, when we got divorced I was no longer covered and when I had insurance they would send a statement  as to what they paid the dr. and it would be much more than $75.00, it was more like $200 for the same services.  My GYN does the same thing. when insurance was paying him, it was upwards of $300 to $500 for an annual check up, then I paid $150 out of pocket to him for the same services.  I don't get how that works. Why do drs. charge you less if you don't have insurance?  I'm happy with this for now as I cannot afford to pay them the high rates the insurance was paying them, however, I never understood it.
Jun 13, 2013 5:36PM
My Deductible is $1700.00 a year, than a Co-pay after that applies. I have never used up more than $600.00 TOTAL in any of the previous 8 YEARS COMBINED, but certainly have paid well in excess of $12,000 in premiums. My company has paid 2x's that, or more, I think in Premiums. Has anyone BUT the insurance company benefited? I think not. I have spent several years in Thailand where cost for medical is what the Service REALY costs, not inflated by Insurance Costs.The Western World's medical System is inflated to the point of Bloating. Glad some Doctors are seeing this and acting in Their own interests.      
Jun 13, 2013 5:16PM
Now if we can get rid of malpractice premiums, health care costs would really go down. 
Jun 13, 2013 6:12PM
One key to this new system (and after many years of practice I am about to drop all insurers) is the AMOUNT I will charge and who gets to pay less than my new fees. I am a specialist, Board certified Orthopedic Surgeon. I am limiting this discussion for the present to office visits to make a point.

Here's what I've come up with - I will charge $25 for a brief consultation (typically about 5 minutes of my time) and $15 for a small joint x-ray if one is needed. The average "one problem" visit charge will be $50, take 12 minutes of my time. 

Now, here is why it will work and all my patients (I have seen more than 200,000 of them) will not balk at my dropping the insurance companies - they are ALREADY paying on average $35 "co-pay" each time they see me! (That's with their insurance "coverage").

Also, I know my patients and my community. I already see uninsured patients and most frequently charge little to nothing. My pleasure. 

Tell me what I am missing, please.

Jun 13, 2013 3:50PM
This would be how I would do things if I was a Doctor and the same kind I would see myself,if any were around where I live.Makes good  sense to me.A doctor can choose how much to charge,does not have to deal with insurance and can basically decide who he/she will have for pt's.Doctor's having  a company or worse the government decide how much they can charge for their time just does not seem right.Imagine going to a Dr's office or having him come to where to you and actually getting to see him on time..A novel idea whose time should have come a long time ago.
Jun 13, 2013 5:34PM
It has been my position for years that if health insurance went away the cost of medical care would fall to reasonable levels. Reason is way too many middle men with their fingers in the pot. Glad the Doctors themselves are taking the bull by the horns..
Jun 13, 2013 4:52PM

The unemployed are still a market and growing more every day. 

My niece is a medical biller and she gets 10 calls a day from people who say, "I don't have insurance and I will be paying cash; how much for a doctor's visit?"


F**k you and your co-pays; cash is still king.

Jun 13, 2013 5:33PM
That's the best way to do it. Get catastophic health coverage and go cash on everything else. You'll save a bundle!
Jun 13, 2013 5:22PM
You go cash! Hope you can also afford to pay for major medical services. Cash is great for the young and healthy.
Jun 13, 2013 4:09PM
I can see the good purpose for this however, since I  already pay for health insurance, I would not go to this doctor and then have to file my own claim or pay out of pocket. The cause is in the right place but it will take time to figure this one out. If I had no health insurance, then yes, I would love this kind of doctor!
Jun 13, 2013 4:24PM
EXCELLENT...!!! It is so refreshing to hear god news...  Our healthcare system has become a self feeding monster that knows no end.  I love the reason they provide for charging so much money...  " You are paying for the people that don't pay".  That is a lie they tell you to justify charging you so much for nothing.  Hospitals charge 25.00 for 2 over the counter tylenols.  They charge you 15 or 20.00 for a ziploc bag of ice it is criminal.  This Obama Care thing is just a method of control and manipulation of the masses.  Oh yeah and it is pay the insurance or pay the penalty.  That is against everything America stands for.  Honestly, I believe they just want you on their government insurance program so they can let you die.  That 47 year old who has paid into SS all his life and gets cancer or has a heart attack, HE WILL DIE...    THEY JUST WANT TO KILL US WHEN IT SUITS THEM...  IT IS THE ONLY WAY THEY CAN HOPE TO PERPETUATE THIS HORRIBLY FLAWED GOVERNMENT STIMULUS CENTRAL BANKING FIAT MONETARY SYSTEM THEY HAVE IN PLACE.  I CAN NOT BELIEVE WE THE PEOPLE ARE ALLOWING THE CRIMINAL ACTS OF THE GOVERNMENT.  THEY ALWAYS SAY THEY ARE KEEPING US SAFE.  IF YOU BELIEVE THAT YOU DESERVE TO DIE IN LINE WAITING FOR YOUR GOVT. HEALTH CARE.  OH YEAH THEY WANT TO TAKE GUNS AWAY TOO...  HMMM...  WHY WOULD THAT BE???  PEOPLE NEED TO WAKE UP... 
Jun 13, 2013 4:33PM

My physician operates this way and the practice(he has another doc working with him), also do not take medicare or medicaid patients.

I pay cash or use my HSA, and submit to my insurance co.


Jun 13, 2013 5:18PM
I do hope you drum beaters that think this is a great idea understand that the doctor is small change in the cost of health care.  What the doctor decides to do has nothing to do with lab charges or hospital charges.  What the doctor decides to do with insurance, to accept or not, will not change your need for medical insurance nor will it significantly change the cost of your medical care.  It may be good for him but won't do squat for you.
Jun 13, 2013 3:52PM
What if you can't afford your fees.  I'll get another physician who accepts my health insurance.
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