Doctor in Maine stopped taking insurance, cut prices 50%

Chris emailed me an interesting story about a doctor in Maine, Dr. Michael Ciampi, who has stopped taking any insurance, only takes cash, but has lowered his prices, in some cases, in half.

And he’s willing to give people who need a further break even bigger price cuts.

He’s even posted his price list online.  Here are a few of the charges:

Dr-Ciampi-Maine-no-insurance

Chris pointed out to me that while the doctor visits range from $50 to $100, he still pays only 23 euros (about $30) for his doctor in Paris, whose office is in a rented apartment in Chris’ building.  The prices are so lower because the French government regulates them. Oh, and that’s the price you’d pay as a foreign without insurance.  The French get most of that fee reimbursed from their national insurance plan.

The arbitrariness, and exorbitance, of American medical fees has always bothered me.  It was only in the past few years that I finally understood the “non-allowed” portion of my insurance receipt.  Basically, what happens is that my doctor submits the bill to the insurance company, and the insurance company says “oh, no, we’re not going to pay $14,000 for the facility charge for your cataract surgery – we’re only going to pay $5,000.”  And the doctors says, okay.

doctor health care obamacare

Doctor via Shutterstock.

Well, the doctor says okay if you have insurance and he accepts your insurance plan.  If you don’t have any insurance at all, the hospital socks you for the full $14,000, which you can attempt to negotiate on your own (good luck with that).

Why should cataract surgery cost me nearly 1/3 the price of what they charge someone who has no insurance at all?  You’d think that if someone didn’t have insurance, especially if they couldn’t afford it, you might want them to pay less, not more, than someone who can afford insurance.

The only thing that worries me is that while the doctor in Maine is cutting his prices in half, my insurance company often seems to cut them to one-third.  Though, if you have insurance, you could still submit the bill to your insurance company and hopefully get half or more back.

Such is America’s goofy medical system.  Best in the world!  If you can afford it.


Follow me on Twitter: @aravosis | @americablog | @americabloggay | Facebook | Google+ | LinkedIn. John Aravosis is the editor of AMERICAblog, which he founded in 2004. He has a joint law degree (JD) and masters in Foreign Service from Georgetown (1989); and worked in the US Senate, World Bank, Children's Defense Fund, and as a stringer for the Economist. Frequent TV pundit: O'Reilly Factor, Hardball, World News Tonight, Nightline & Reliable Sources. Bio, .

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  • ehmkec

    Remember the good ol’days, just before Nixon signed the Public Health Service Act creating HMOs. It worked for awhile but then… What the hill happened?

  • FUFatherEisenman

    My chiropractor does not accept insurance. Her fee is $10 less than what my co-pay is for a Chiro visit.

  • ComradeRutherford

    And his prices are still too high for the not-obscenely-wealthy to afford.

  • http://www.theangryfag.com/ TheAngryFag

    When I was doing my undergraduate degree I once asked the university clinic staff why I had to pay out-of-pocket and get reimbursed by my insurance (I was covered under my mother’s Union-provided insurance which kicked ass and covered everything pretty much). It was rather cumbersome to have them print a receipt, me to get money put into my bank account by my mother, and she then seek money from the insurance (they would only pay her directly because she was the primary name). The pharmacy and lab could bill insurance but the clinic side would not.

    The receptionist responded that if they had an insurance billing department they cost of seeing someone at the clinic (most were nurse practitioners but there were one or two doctors too) would sky rocket.

    The cost? At the time it was $25 per visit. When I needed to see the doctor, the cost jumped to $33.

    The thing is, like every good thing in this nation, we went and poisoned medicine with profit. Why keep people better when they can make more money treating people for diseases?

  • lynchie

    John: what you did not mention re the cataract surgery is that the hospital tries to charge $14,000 and the insurance pays $5,000. The hospital then charges you $9,000. The insurance company sends you a notice that they paid $5,000 and to expect a bill from the hospital for $9,000. Most people simply pay it. When my wife was dying of cancer her chemo cost $15,000 a session (ever two weeks), the insurance paid $7,000 and i got a bill for $8,000 when I tried to fight it they simply denied my wife the chemo. She passed on October 18 yet on February 11 i got a bill from the hospital for $15,000 for a chemo treatment for January 25. I phoned to ask the hospital what the confusion was and they claimed they treated her. When i mentioned she had passed away the woman in the hospital asked me if i was sure. I did nothing and the hospital eventually turned me over to collections and even after I sent a copy of the death certificate they screwed my credit rating and refused to take the debt off their books. So having insurance is one thing, but what does it cover, how much is your deductible. The company i work for changed insurance companies. My deductible goes up to $6,000 before they pay a dime. Then they only pay 70%. My monthly premium is now $390 and if you average in the $6000 deductible I am paying $890 a month, what I deal but wait it is not that simply. I must use their doctors. My family doctor and my heart surgeon are not in the network. So if i want to stay with the family doctor who i have had for 15 years i pay full price same applies to the heart surgeon. None of the doctors in my area are covered and when I asked the new insurance company they said to drive to Pittsburgh (65 miles one way). Everything requires pre approval even landing in the emergency room. They will pay the ambulance but require approval before I can be treated because if the ER doc is out of network they won’t pay. Is this health care? It is a joke and companies keep cutting benefits, increasing deductibles, giving shitty choices. How does one even know who is approved and if they are approved is it because they are lousy at their jobs and can’t get covered by the big insurance companies. Obama’s plan throws everyone to the wolves and all the whining by companies is a smokescreen. The companies don’t want to provide any benefits and the sooner they get rid of SS and Medicare and put it all on the backs of the workers the better. Oh sure the executive level will have pension, gold medical etc. but the rest, screw them, there are lots of people who will work for less. That is also why they are pushing to get rid of minimum pay so they can lower their costs even more.

  • newbroom

    Eggsackly! My General Physician is nothing more than a pivot man for the growing list of specialists I go to to try to maintain my aging body.

  • AZ2CR

    Health care was one reason my husband and I moved to Costa Rica three years ago. We have a private doctor (who studied in the US and speaks excellent English) and he charges us roughly $20 a visit — no matter how long, no matter how many topics we cover. Since getting our official residency we are also members of national health care. For that we pay the equivalent of $100 a month, which covers what would be Rx meds in the US. For the both of us. I’m 65 and hubby is 75. We feel we are really stretching our retirement dollars down here! — AND getting excellent medical and dental care. And eating healthier foods, t’boot! (Oh — the $100/month — we’re about to “challenge” that — seems we’re overpaying per other ex-pats down here!)

  • NowinHaverhill

    Loved Kaiser in Oregon.

  • http://www.americablog.com/ Naja pallida

    You’re not alone there… my deductible at this point is where any time I go into the doctor for routine things nowadays, I just tell them I don’t have insurance. Because I don’t want them to bother even trying to get the insurance company involved, when I know they won’t cover it anyway. It’s just one extra step that is a waste of mine and their time. Plus, I need my insurance to be there if for some reason I end up hospitalized, or some other major expense. I’m hoping there will be something more sensible with the federal exchange.

  • http://parkandbark.wordpress.com/ Houndentenor

    I have a PPO. I pay for it 100% myself. There was something that my insurance finally decided they weren’t going to pay for from about 9 months ago. Last month I received in the mail not a bill but a notice from a collection agency. When I called the doctor’s office they admitted that they would not be sending me the bill for a few more days. Why then had it been sent to collections. It was for $40. I paid it right then. (I also told them I’d be finding a new doctor.) What kind of business operates this way. Why does it take nine months to find out what I owe and what my insurance will pay for (btw, this was part of my “free” annual physical which wasn’t free at all). Seriously, this is a mess and ACA didn’t really fix it. We need serious health care reform. The only thing I got from ACA is less paperwork. (I used to have to fill out over a dozen pages every time I went to an ENT because once a few years ago I used an asthma inhaler so for until ACA kicked in they tried to make every ENT visit a pre-existing condition.)

  • UncleBucky

    I am going to have to have a $6000 deductible and pay like $395/mo. I don’t even know what else to say… This has to change.

  • emjayay

    We were typing about Kaiser at the same time. The one stop shopping was indeed convenient. Primary care, pharmacy, blood test, specialist, minor surgery all in one place. And the doctor had all your info on a screen years ago.

  • emjayay

    Maybe everyone already knows this stuff.

    But anyway, my current insurance in NYC is called an HMO (my second one in NYC) but is nothing like for example Kaiser in California and Hawaii and DC (places I lived when I had Kaiser – obviously I liked it and liked the basic idea). It’s not even like a PPO. The doctor’s computer knows what copay to charge me as does Rite Aid or CVS etc. But a lot of providers are not on that HMO plan. Each provider is on some plans and not others, depending on which ones pay the most or is the least hassle. To join and therefore get those customers they have to agree to the schedule that plan pays, which can be as little as maybe 20% of an individual service on a bill but is usually a third to a half. But the provider already knows that. I guess they are hoping for a mistake or to make out like theives if they score a rich uninsured patient or something. For my laser retina treatments (just like you had) I only paid the usual specialist copay of $25 or whatever for each appointment and they paid the rest.

    So payment wise to me it’s just like Kaiser, only all the providers and pharmacies and hospitals are independent and take other kinds of plans as well. Kaiser docs are on salary and it’s their pharmacy also, all in one big Socialist Realist National Health Care building. In DC I went to the one in Kensington on Connecticut Avenue. There are three or four more centrally located ones there. One time I had to go to an emergency room somewhere out of Kaiserland and they paid for that. Well, of course, about half of what they charged. It still cost me the same copay as if I was in their emergency room.

    This means that every provider gets paid different amounts for the same service for different patients. And what service or appliance or drug their plan will pay for or not for each patient is often different. And they have to talk to and sometimes argue with a bunch of different companies with different criteria. And every insurer has to negotiate with various hospitals and pharmacy chains and figure out what to pay providers in various markets, all for a million different services and products, and meanwhile plans and hospitals pay CEO’s many millions a year. These are the basic reasons why we pay a lot more for health care and prescriptions than the rest of the world.
    Also those doctors in Paris went to medical school for free (I think).

    I certainly wouldn’t want to be an uninsured person needing any kind of medical care in the US. If they know it, apparently they can take the bill to the hospital or doctor and say “Um, how about a third? Half?” And they have no idea what any insurers would pay. At the drug store they just have to pay whatever they charge. It’s like workers without a union: an individual participating in a market with a virtual monopoly and no information or market power.

  • cole3244

    if it is necessary to live and not a luxury it should be socialized, no exceptions.

  • SkippyFlipjack

    I’m liking Kaiser Permanente more and more. It’s great to have any necessary specialists available in the same building or group of buildings; I used to have to run around the city getting recommendations from my primary care guy and visiting specialists. They have one centralized database so all your meds are tracked. (There are still a few bugs in this system but it’s a good idea and should get more reliable in time.) I also like their 24-hour advice nurse line; I imagine it really cuts down on office visits because you can have someone tell you how urgent your issue is. I don’t know where their monthly premium falls on the pricing scale, but the model overall seems great.

  • bkmn

    America is paying to educate too many specialists and not enough primary care doctors. The result is too many people go to specialists for care, which costs a lot more.

    http://www.washingtonmonthly.com/political-animal-a/2013_06/how_medical_schools_fail_to_pr045374.php

  • http://www.rebeccamorn.com/mind BeccaM

    Once, while in India, I became very ill. It started with some throat pain, then went up into laryngitis. My wife and I were in town, staying at a hotel, on one of our regular resupply shopping trips.

    The hotel staff, who never failed to take very good care of us, offered to go fetch a doctor, but said that if I was ambulatory (I was, at that particular moment), I could walk halfway around the block and see one right away. One of the bell-men even walked me over and made sure I was taken care of. I saw a lady doctor literally as soon as I walked in the door, because she maintained her own appointments and was free at the time. She examined me, said I should drink fluids, have soup, and as much bed rest as I could manage, plus gave me a prescription for a truly awful-tasting cough syrup.

    Total cost for the visit: 150 rupees. At the exchange rate then, around $3.50 US. The cough syrup was another 50 rupees.

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