Getting out of the Insurance Game

Not everyone is comfortable with the arrangement, and some patients opt not to make an appointment when they find out that they will have to cover the cost of the visit. In some cases, Dr. Gianoli will decrease his fee for patients who have a hard time paying, but patients do not know this up front.

Without insurance paperwork to deal with, the doctors have decreased the number of staff people they have in the office. At the peak, they had ten staff members. Now they are down to five, with a part-time office manager, two front office assistants, one audiologist, and one medical office assistant.

Change in Fees

The team increased their fees by approximately 10% for a standard office visit after switching to a cash-only system but simultaneously reduced their surgical fees substantially. For example, for a surgery that was previously listed at $5,000, they now charge $2,000 or $2,500. Notably, that is still above the reimbursement rate they would have gotten from an insurance company. The volume of surgery dropped off initially, but seems to be climbing again for the office.

The financial benefits are the obvious changes, but the other thing that is interesting is that the patient population is different than what we had before, said Dr. Gianoli. They are much more compliant with medical therapy, more serious about getting better, and don’t come in for silly complaints. They only come in if they have a problem and want to get better. Frankly it has made practicing medicine a lot more fun.

Additionally, he is able to devote the time he needs to a patient, rather than being on a set clock. In a recent case, he spent an hour and a half with a woman who came in with sudden hearing loss. After giving her a complete exam and taking an extensive history, he found that she had renal insufficiency and several other problems that are probably related to her hearing loss. Now I know the referring doc couldn’t have spent that much time with her, because he didn’t have it, Dr. Gianoli said.

Can any physician do this? The bottom line is that anyone can do it-it’s just a matter of whether they want to do it, he said. Laying it on the line and saying, this is how much my services are worth, is a little scary. But patients are willing to pay for services if they think they are valuable.

A Clean Start in Phoenix

Michael J. Robb, MD, finished his training in oto-neurology in 2003, specializing in tinnitus and vertigo. He opted to set up his own practice and to work on a cash-only basis. That meant not signing any insurance contracts and opting out of Medicare.