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Paying out-of-pocket for health care in 2014


Despite what we hear and read in the mainstream media, not all health care is billed through insurance.

Many people in this country are electing to spend money on out-of-pocket treatments; as of 2010, more than $360 billion is spent each year by the public on health care not covered by insurance. Of that total more than 83 million adults are spending $33 billion a year out-of-pocket on alternative health care--services such as chiropractic, acupuncture and massage. In addition, the annual market for nutritional supplements is $55 billion, another large market of out-of-pocket spending.

Why would someone willingly choose a treatment that is not covered by insurance? What advantage is there to going around insurance companies and simply paying a fair price for health care?

First I should introduce myself. I am a natural medicine doctor at Red Mountain Natural Medicine in Boise. During the past 24 months, Red Mountain has grown from a small, one-room operation into a full-size clinic serving hundreds of patients each month. All of this growth occurred without ever receiving a single dollar from an insurance company.

It may seem strange that a doctor would voluntarily avoid taking insurance, but viewed from inside the professional landscape it makes perfect sense. When a doctor signs up with an insurance company, he or she in essence no longer works for the patient. Legally and in order to get paid, doctors must follow rigid treatment guidelines set by insurance companies, which may or may not be the best option for the patient. For example, even though research has shown that diet and lifestyle are the keys to preventing and reversing chronic disease, most insurance will only cover nutritional coaching for a few specific diagnoses--thus only covering a fraction of the people who actually need this type of care. Often they don't fit a traditional diagnosis, or receive a diagnosis where only drugs or surgery are offered as treatments. Some have tried those remedies and are looking for more options.

In fact there may be many treatments and protocols that could help the patient, such as nutritional supplements, nutritional counseling, and diet and lifestyle education, among others. Despite thousands of research studies, which prove they work, these are still deemed radical and experimental approaches by most insurance companies and, as such, are not covered services. Instead of a system where doctors are able to treat the cause of patients' health problems, practitioners are limited by what insurance contracts reimburse for. In other words, insurance companies control which treatments are used; and, remember, their main objective is to increase profits.

When doctors are not restricted by third-party contracts, costs come down. In the out-of-pocket model, doctors are free to spend more time with each patient. Consider that the average doctor visit is only about seven minutes long. Meanwhile, dealing with insurance consumes anywhere from 30-60 percent of a medical office's time and money, forcing some insurance-based practices to see four times as many patients as a comparable cash-based practice. It takes a small army of staff to ensure doctors get fairly reimbursed for the care they provide. If more people paid cash for their care, hospitals, clinics and insurance companies could provide more reasonably priced services.

While there is certainly a time and place for insurance in health care--and even as more Americans will have insurance coverage--some, like myself, will still choose high deductible plans and choose to use the savings to focus on wellness and prevention. After all, nothing is as costly, even with good insurance, as chronic disease.