[thoraway1010]

No insurance hassles - I did medical billing for a bit. The insurance co's basically just run around doctors because they KNOW folks give up. You could absolutely force the $40 extra payment if dr + patient etc proved it out / appealed it - but often not worth it. Also govt billing into central county system for the poor - ugh - the bureaucracy / overhead was a nightmare (always having to recertify to financial need / paperwork this and that - 50% of time was on stuff I'd consider no value add).

For a while I had individual insurance (prior to obamacare). Because it had pretty high deductibles, I would just do a private pay / cash doctor for primary care etc.

Some big wins:

NO discussion about whether something was covered or not! You want to get service, just call.

No crazy surprise bills - yes - I once tried to go to urgent care for something at the main hospital, but NO ONE would tell me what I would be charged as a cash pay client. Yes, it can be expensive to do cash pay, but with a doctor billing by the time you can basically predict / know your cost.

Service - you are paying by the hour. I never felt pressured out the door (no surprise). The service is good to great.

Convenience - I got someone close who used his downstairs as his office. Have a problem, go in and get checked out. Because you don't need the huge billing infrastructure I think you can get away with smaller office sizes. To pay for a full time biller you need a few doctors, who then need a receptionist etc etc.

[gen220]

Yep! There are a large number of benefits for both the provider and the patient, for purchasing elective procedures without involving insurance. It's kind of like how when you get a minor fender bender, it can be easier to settle things directly than to go through insurance. No overhead, like you suggest.

However, it's hard to replace insurance for nonelective/emergency procedures (heart attack, stroke, aggressive cancers).

Insurance-tailored billing systems are really geared towards non-elective procedures (that's where all the money is). When they encroach on the "normal" stuff, it feels invasive.

Advocating for the insurance infrastructure, there is a preponderance of medical waste out there. Doctors prescribe blood tests, urine samples, or MRI scans even though they aren't medically-necessary, just because the hospital group needs to make some money. When the patient is paying, they are on the lookout for medical waste, because they don't want to pay.

Of course, this means that there will be false negatives from the insurance carrier, when they try to clamp down on medical waste. The only loser in this game is the patient.