Private Pay

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Those two little words on a patient’s chart in the ER, or elsewhere in the medical provider business, tell any provider who is curious all they think they want to know about the patient. If the space labeled Insurance on the admission form says Blue Cross, Aetna, Medicare, or Medicaid, that’s fine, but Private Pay is anathema. Expect to be treated accordingly.

Old-timers retired from the provider business have complained about state interference since the nightmare of Medicare commenced in 1965. The monumental growth in payment bureaucracies goes unheralded, largely because they are state contractors on one side, like Blue Cross, and provider employees on the other; the fact remains that most of the medical dollar is wasted on bureaucracy mandated by the state.

Youngsters coming up through this system are not likely to see it as something imposed by fiat, and are more likely to see it as simply the way things are. Yet the chronic annoyance of interference inevitably affects their attitude toward patient care.

After I retired I went to live in a small commercial fishing port. I was looking for stories to write, and within a month I had made good contacts among the daring and brave men and women who work the sea. On a cold January night during a gale, I stupidly ventured out of my snug dwelling, and was immediately blown off my feet. I landed on the edge of a concrete slab. It shattered my left radius at the wrist joint.

I knew I was in big trouble before I even picked myself up. No Insurance. Due to an inherited heart problem, I hadn’t had health insurance for years, but now I had to face Private Pay in my old environment, the hospital.

Sure enough, they politely slid me onto the bum track. Frankly I’d never seen a hospital break so many federally mandated rules, which may be why the hospital never billed me. The surgeon I paid in full, despite the fact that he ignored a post-op staph infection that ultimately destroyed the wrist joint, and left me crippled.

From a provider’s point of view, Private Pay means No Pay, whether or not it’s a fact or a fantasy. A hospital can recover costs from the state for indigent write-offs anyway, so it’s no big deal to them. They even refunded what I had paid for the ER doc.

I lost a year of productivity during this misadventure, but when I finally recovered enough to hunt for a doctor who might help, I went to Google and found www.simplecare.com, which lists Cash Only providers. Here the customer is king, and the provider will attend to the patient, and even help, for Private Pay.

Robert Klassen [send him mail] retired from a forty-year career in critical-care respiratory therapy. He is the author of five books, including Atlantis: A Novel about Economic Government, and Economic Government, which describe a solution to the problem of political government. Here’s his web site.

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