One Day in the Life of a Private Payer

The Backstory

We were in between insurance plans.  My husband had changed jobs and his new insurance would kick in on May 1st.  By the time we realized all of this, we had about 14 days to go.  We were faced with a decision – pay $1,800 for COBRA or take the risk and hope our family’s care for two weeks would cost less.  We took the risk.

With seven days to go, I developed a really ugly cough and fever.  I’ve had pneumonia a couple of times and the intensity seemed similar.  I had to go in.  We decided on Care Now, a “doc in a box” clinic which does Urgent Care.  I knew their fees would be standard and up front while my doctor’s office’s would be based upone many variables.

I have visited Care Now in the past for treatment on a weekend or during the evening when I didn’t want to miss work.  With insurance, they normally cost about $75 ( co-pay flat rate) and are able to do x-rays, blood work, urinalysis on site.  This is an affordable way to get rapid care for more intense illnesses – Pneumonia, Kidney Infections, Bronchitis, Pertussis – without having to do a stop at the doctor, then a lab, then an x-ray technician and wait for results.  Additionally, in the latter scenario, I often get a co-insurance bill from the x-ray tech and the lab for the cost of the testing.  This isn’t the case with Care Now.  One price to the patient — if you have insurance.


One Day as a Private Payer

Returning back to my day as a private payer, I used the mobile app to call ahead.  They usually call you back and let you know your wait will be 1 1/2 to 2 hours and they’ll call you when they are almost ready.  When they called me and I explained that I was going to be a private payer, they told me it would be about an hour or so.  Within 5 minutes they called me back and told me they were ready to see me.

Normally, even though they call you when they’re “ready” they’re not really ready.  I expect to spend a half hour sitting in their lobby with sick kids watching Moana on repeat anytime I want to see a doctor at Care Now.  I even brought my phone charger.  Within 5 minutes I had checked in, filled out their questionnaire and was called back to a room to be seen.  I was blown away.

My nurse was unexpectedly prompt as well, popping into the room to assess my condition.  She took basic vitals and then told me the doctor would see me soon.  She wasn’t kidding.  Within 3 minutes, the doctor was in my room to listen to my lungs and talk about my symptoms.

After she finished with the stethoscope, I asked what she thought.  She said, “well, I would recommed blood work and an x-ray to check for any possible infection – just to be safe.”  Then she looked down at the chart.  “But I see you’re a private payer, so I’ll leave that decision up to you.”

I think my jaw fell on the floor.  I have never had a healthcare professional let me make my own testing decisions.  I said, “well, you listened to my lungs…how did they sound?”

She thought for a moment.  “They sounded a little strained.  But that could be because you weren’t breathing all the way in – probably because it hurts.  Because of that, I wasn’t able to tell how well they were functioning.”

Jaw-on-floor-again.  “I could try harder, if you want to listen again?”

She agreed and we repeated the breathe-in breathe-out routine.

“Your lungs actually sound pretty clear.  It seems to me that you have sinusitis and it isn’t infecting your lungs yet.”

Excited by the new medical conversation I’m able to have I ask, “so then why am I coughing so hard?”

“Because the drainage from your sinuses is irritating your throat.  Its hard to tell.  Your lungs could be a problem.  I can never know for sure without testing.”

“But as it stands right now, you would be willing to treat me for sinusitis and then, if it didn’t improve in a couple days, we could explore doing the blood work and x-ray?”

“Absolutely.  If that’s the course you decide to go, I think I would also prescribe you a cough syrup to help as we fight off the sinus infection.”

“Sold.”

I sailed out of Care Now within 5 minutes of that moment paying only $150 for the visit.  I left with an antibiotic and a cough syrup.

Next up was Walgreens.  Certainly this would hurt, right?  Prescriptions with ZERO coverage have gotta be EXPENSIVE.  I dropped the scripts off and explained again that I would be a private payer.  She took the time to give me an estimate of my prescriptions before I left the window so I would know what they were going to cost.  $116.41 for my antibiotic and syrup combined.  Not too bad.

When they were ready for pick up, I walked up to the window.  The clerk said “I noticed you’re a private payer, so I hope you don’t mind, but I looked up some coupons for you.  Instead of $116.41, your total is $68.42.”  I thanked her and collected my medicine in awe.  Since when has Walgreens tried to save me money?

The doctor was right.  I was better within 48 hours of treatment and had spent a total of $218.42.


The Takeaway

 

If I had used insurance on that day in April the total bill paid by my insurance company would have been higher than what I paid as a private payer.  They would have charged for the visit, the blood work and the xray.  In addition, my copay would have been subject to The Clawback.  All of these costs would have resulted in a net cost increase for the coverage across the board.

This is the long term result of allowing doctors and pharmacies to bill our insurance companies whatever they think could be necessary.  While the cost to patient appears less with insurance, the cost to the system is greater due to the freedom afforded to perform tests and prescribe at will.  If we begin to work with our doctors as collaborators on our health instead of as flat-rate consumers, we can decrease costs to the system and lower the burden on the flawed American insurance system.

Think of it like managing data on a cellular plan.  If we all agree to only stream netflix when we are on wifi, there’s more to go around for everyone.  Hell, with collective cost savings in mind, we could make single payer dreams affordable for our nation without sacrificing quality or skyrocketing cost.  We just need doctors to join us in our fight.

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