Why full price for cash payers but then a break for managed care?

LETTER — Posted March 7, 2005

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Regarding "Health savings accounts make impressive strides" (Article, Jan. 31) and "With HSAs, expect calls to cut fees" (Letters, Jan. 31):

The recent article on health savings accounts, as well as the letter by Olgard Dabbert, MD, San Diego, was interesting. Frankly, I am tired of reading articles in AMNews about the draconian practices of managed care while the acts of physicians toward cash-pay patients, which are equally egregious, seem to get no press coverage whatsoever. I am a cash-pay patient because I have chosen a high-deductible insurance plan designed to cover catastrophic needs only.

In the last two years, I have yet to encounter a physician office that gives a discount to the cash-pay patient. I am charged full price. I am unable to understand why physicians will give a deep discount to a managed care corporation, with which they have to do battle and wait months to get paid, but give no break to the person standing there with a credit card in hand, whose money they will collect almost immediately.

Do physicians not realize that the road back to control of medicine runs straight through the encouragement of cash-paying patients? The cash-pay patient should be getting the best price, not the highest. I would appreciate a response from some physicians who can provide me with a principled and rational explanation for this practice. This current practice just encourages me to join a managed care organization, which seems to be just the opposite of what physicians should be promoting.

Michael R. Cavenee, MD, Plano, Texas

Note: This item originally appeared at http://www.ama-assn.org/amednews/2005/03/07/edlt0307.htm.

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