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Cash only, please

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During some downtime on a recent shift, the docs were gathered around the nurses station discussing insurance and patients.

The general consensus among the OBs present was that the current system of insurance reimbursement was not working for them, and that possibly going to a cash-only system was a good solution to the problem. Apparently in a close-by city, all the OBs have banded together and only take cash for deliveries–making insurance obsolete in the area. Patients who don’t have up-front cash (in the amount of $10K-$20K per the docs I was speaking with) are forced to go outside the city for their care, go on payment-plans if accepted, or use government aid and find a new provider. According to the CDC, 11% of docs have resorted to a cash-only system, and that percentage is growing!

Am I the only nurse freaked out by this idea? I am already seeing substandard care of clinic/medicaid patients by physicians. And now insured patients are being turned away? One OB doc even stated, “If you don’t have 20 grand cash up-front to pay for your delivery, you shouldn’t be having a baby, anyway.” Kinda a shocking statement, right?

I know that insurance companies cause all kinds of problems for docs. And docs who use the cash-only system have less overhead, lighter work loads, can spend more office time with patients, etc. And benefiting the patients, especially the uninsured, is more access to care. Yet those same unemployed, uninsured persons are going to really struggle to pay out-of-pocket for their care. So the benefit to the patient doesn’t seem to add up.

For patients with health insurance–and we pay a lot for our insurance!–our pockets also would have to be pretty deep to pay for healthcare in a cash only system. Office visits and tests can cost hundreds of dollars at a time. Inpatient fees are exorbitant. In all, I just don’t see how cash-only is the solution to the healthcare crisis?

More and more the financial aspect of the healthcare crisis is impacting the patients and doctors around me in the workplace–and yes, it is having an effect on care. I have witnessed how patients who have preferential payment receive preferential care, and as a nurse, I just cannot be part of this problem. I have to somehow be part of the solution–if only there was one!

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Amy Bozeman

Amy is many things: a blogger, a nurse, a wife, a mom, a childbirth educator. She started her journey towards a career in nursing when she got pregnant with her first child. After nursing school and studying "like she has never studied before" she entered the nursing profession eager to get her feet wet. The first years provided her with much exposure to sadness, joy and other complex human emotions. She feels that blogging is a wonderful outlet and a way for nurse bloggers to further build their community. Traditionally, midwives have handed down their skill set from midwife to apprentice midwife. She believes nurses have this same opportunity: to pass from nurse to new nurse the rich traditions of this profession.

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3 Responses to Cash only, please

  1. txnurse2go

    This is bologna. I wish those docs good luck paying their student loans back with the few patients they have that can pay cash. I guess a doc would have to answer did they go into medicine to make a difference in the health of humans rich AND poor or were they going into it for the Audi sports car and MD title. Hands off my child and family, cash only doc. There are a plenty others to choose from.

  2. SteelNurse

    I kind of agree with the doc who says that if you dn’t have the cash don’t have a kid. Far too many people who have no money are having kids, thus keeping them very poor. If you don’t have the money to support your kids you shouldn’t be having them!

  3. DD

    I know several docs who played the student loan deferral game for so long they literally became experts in dodging it, even when they HAD the money to satisfy the loans. None of them have paid a single cent of it back and somehow managed also not be “wage garnished” as well – quite the deal for them and the shaft for a lender. But they pulled it off, I promise it’s the truth! I personally know 3 doctors who have done this and they are now in their late 50’s ready to hang it all up anyway and retire. From those 3, each knows at least one other that pulled it off and never repaid their student loans.