Go to the doctor and the first thing you're usually asked is not what's wrong but what kind of insurance do you have? Well, in some offices you won't hear that question because they don't take insurance. That means you don't have to fill out insurance forms or get approval from your HMO for a test or treatment. But it also means you have to pay the entire bill out of your own pocket. HealthWeek's Andrew Holtz visited two clinics to hear what patients have to say.
ANDREW HOLTZ: For his job, Mark Skakel spends most of his days deep in the Vermont woods. Occasionally he takes a break from his work and visits what looks like a typical New England bed and breakfast.
Inside, though, you won't find room rates behind the counter, but prices for blood draws, IVS and bandages. It's a parts-and-labor list for a different kind of medical practice.
LISA GRIGG, MD, SIMPLY MEDICINE: "I don't take any insurance, not even Medicaid, and I charge you $2.00 a minute.
ANDREW HOLTZ: After the pleasantries, Dr. Lisa Grigg, who started the clinic, punches a time clock and gets down to work, tending to Mark's aching ears.
Mark has insurance to cover serious illness or injury. But he says Dr. Grigg's cash-and-carry care is just right for the little things.
MARK SKAKEL: It's convenient. I mean, she's local. You just walk in the door and you're seeing the doctor within 5 or 10 minutes.
ANDREW HOLTZ: Dr. Grigg says she tried to work within the standard insurance system but eventually gave up.
LISA GRIGG, MD: The patients weren't happy and were often in some kind of contentious discussions with their insurance companies. I wasn't happy and was often also in some kind of contentious discussion with their insurance companies. And I was looking for a simpler, more equitable way to practice.
ANDREW HOLTZ: This approach is no different from what you'd find, say, at an auto mechanics shop. They do the repairs, you get your bill, and you plunk down cash, check or credit card before you leave. No insurance. No hassles. And as frustration with managed care grows, some people expect more doctors to do business this way.
In Denver, Dr. Jonathan Sheldon runs a clinic he calls HMNo. In addition to basic services like Dr. Grigg, he offers high-tech tests. You can get an EKG for $70, or a lung capacity test for $50. An hour with the doctor runs $240.
JONATHAN SHELDON, MD, HMNo: The wait is zero to five minutes. Call and you get us right away, even in the middle of the night. But even with that level of service our patients are telling us that our labs are less and our time is less.
ANDREW HOLTZ: Without HMO patients, Dr. Sheldon at first wondered whether he'd be able to stay in business. But he says an ad campaign helped bring in 30 to 50 new patients a month. Claire Pieterek was one of them. She has insurance, but decided it was worth it to pay out of pocket. Now, instead of the doctor dealing with her insurance company, she does, to get reimbursed for a portion of her expenses.
CLAIRE PIETEREK: The problem I've had with HMO's and PPO's is that doctors in those practices don't want to take time with you to figure out what the problem really is, and what needs to be done.
ANDREW HOLTZ: As medical director of a managed care practice, physician John Sbarbaro knows many patients are frustrated.
JOHN SBARBARO, MD, UNIV. OF COLORADO, PHYSICIANS, INC.: There's going to be some folks that say, enough of this rot, I want to go back to the Fifties, I want to pay for what I want, I'm willing to pay it. And fortunately there are some physicians who are willing to take that risk.
ANDREW HOLTZ: But Sbarbaro thinks there's only a small market for cash-only medicine, and turning back the clock has some risks.
JOHN SBARBARO, MD: Is the doctor going to order more things because they're going to gain more money from it, and is the patient going to say no to more things because it's going to be expensive?
ANDREW HOLTZ: Other critics say the cash-only trend could create a two-tier health care system. But Sheldon says he sees no evidence of that, at least in his practice.
JONATHAN SHELDON, MD: People said, oh, it's going to be a boutique practice just for rich people. And it's been very gratifying and important to us that we have patients who are exceedingly wealthy and patients who are exceedingly poor, and of course many in between.
ANDREW HOLTZ: Back in Vermont, Dr. Grigg says she's making health care more affordable for everyone. On this day, Mark Skakel's bill is 16 bucks.
MARK SKAKEL: I think two dollars a minute is really cheap, and it's a heck of a lot cheaper than insurance.
ANDREW HOLTZ: For those like Mark who are sold on medical care for cash, it's a ticket to a simpler system, but the question remains...just how many will buy into it?
SHARYL ATTKISSON: Well, even the strongest supporters of the cash-only system recommend keeping some sort of health insurance. You'll probably need it to pay the bills if you're hurt in an accident or come down with a major illness.