Why would people pay cash?

Dr. Tea:     0:01
Owners of a direct care practice are more likely to experience higher job satisfaction than the insurance based practice. And it's no wonder why direct care is independent of insurance. Patients pay the doctor directly for their expertise. The doctor gets full autonomy in how they care for patients and how they get paid. We've chosen this path for the love of medicine. This is the direct care way.

Dr. Tea:     0:26
By listening to this podcast, you may even start to believe you too can have a successful direct care practice. Come listen with an open mind as I share my personal journey on how I pivoted from an insurance based practice to direct care right in the middle of a pandemic, and the valuable lessons along the way. This podcast may be the very thing you need to revitalize your medical practice on your host owner of a direct care podiatry practice, Dr. Tea Nguyen. 

Dr. Tea:     0:55
Hey, welcome back. I was just thinking about this question that I get asked pretty regularly by colleagues, like who would pay for their medical care if they have health insurance. So I got to thinking about the list of patients who recently saw me within the past couple of weeks, and I created this list, I think it's like less than 10 reasons why people choose to pay cash for their medical care. And I wanted to share that with you, because maybe you have a friend who's asking the same questions. Or maybe you're looking into transitioning from insurance base into a cash model, or maybe a hybrid, some version of that. And you kind of want to know, is it really true? Do people actually pay out of pocket for their medical care? And why would they?

Dr. Tea:     1:41
So I'll share some of those cases with you today. So the first one number one uninsured, this is a whole pocket of people that I think a lot of us have forgotten that there are still people in the United States who either choose to be uninsured, or are uninsured. Because they're seasonal worker, they only get the benefits while they're working, or for a variety of other reasons. Now, being uninsured doesn't mean you're low income or incapable of paying out of pocket, those are very different things. So the people who have seen me, because they were uninsured range from small business owners, who are healthy enough to know that if they need medical care, they can just pay out of pocket to the laborers who lost her job and they're uninsured. But they suffered an injury that required for medical attention.

Dr. Tea:     2:38
So I have a case that I might have shared in a different podcast, and I'll share it again here. I had a patient who had a dislocated toe fracture, that required surgical intervention. He had gone to another provider he went, he went through the system of community health clinic who then referred the patient to another specialist in the specialists offered the patient surgery. But the specialists also had to get some quotes from the facility they were going to go at and that never came to bear fruit. They never got the the patient never got the answer on how much it's going to cost. So in between that time, his primary doctor knew about me and said that I had price transparency available cash prices, and set the patient to me.

Dr. Tea:     3:29
So that was word of mouth. By letting people know that I am pro price transparency. So if people want to know the price of things that can either look up my website or call me directly, and I try to provide that, that way they are financially prepared to pay. And they can have the freedom to choose if they don't feel that it's in their budget, or be able to make it in their budget and save for that procedure or care. So the patient saw me I got to evaluate the patient. This was a pretty bad dislocated closed fracture. It was about six weeks old. And I told him, I can do a procedure for him the following day. And this is the price. And he said, Great. I want this problem fixed. And I want it fixed fast. And just tell me what the cost is. And we worked it out.

Dr. Tea:     4:22
So my surgery prices, I do it as a bundle. It's one price and I take care of the patients for six months thereafter. And so if things that come up X ray bandaging, shoes, all the things related to that surgery, it's all inclusive, even the casting I had to do for the patient. So that gave the patient peace of mind to know that his care was inclusive for six months. And it also gave him the confidence to choose me as his doctor because I was able to provide him a clear pricing option that he can then budget for. And as far as payment goes, he obviously needed the surgery, but it's not in my position. to judge the patient on their ability to pay, which is why I have my prices online, so patients can see it, and then they can decide for themselves if this is something they want to invest in. 

Dr. Tea:     5:12
For a lot of us specialists where our services are more expensive than routine evaluations, you can have Care Credit, which is a financing option. It's like another credit card to pay for medical services. And I've seen this pretty common in dental offices, plastic surgery offices. And I think it's a really wonderful option, just another way to pay for those services. 

Dr. Tea:     5:38
Number two, people come to me for a second opinion. So some people, maybe they did use their health insurance provider. And maybe they were unsure of the solution or felt uneasy and just wanted to have a second opinion, to either given other option, or just reinforced that the decision that was made is the correct choice. Because don't forget the public, they don't have the medical background to really understand the intricacies of medical care or even surgery. And so sometimes they just have to sit with information, and sift through all of the things that was said in their appointment. And sometimes they can get a little confused. And that happens to me all the time, when people give me more information than I can absorb. It can feel that can feel a little bit frustrating. And so sometimes they're just looking for a peace of mind. 

Dr. Tea:     6:29
Second Opinion, or maybe another option. And I want to make this analogy, very similar to therapists, counselors, coaching, these are services that is less tangible, like there's no hands on touching of the patient, manipulating correcting certain, you know, surgery correction. For me, I'm a very tangible person I see like something broken, I want to fix it. And then there's mental health services providers who work on the mind and the brain. That is not very tangible, like you can't put a finger on it, but it's just as valuable. And so being that second opinion to reinforce what they saw with their primary doctor, to reiterate to clarify, to give peace of mind, that's worth something to a lot of people out there. And especially in those second opinions. I do have a comment about second opinions. Somebody had reached out to me through social media saying that when doctors promote themselves as a second opinion, that brings up a whole like litigation issue. And I thought to myself, does it I mean, what is the damage of providing a second opinion to a patient who's actually looking for it? 

Dr. Tea:     7:45
There's so much value to giving people peace of mind, I think that's something we overlook. So if you're looking at a second opinion as a threat to your own ego, you might want to check yourself, you might want to think about why you feel that way. This is a small mindset. And if you want to run a direct care practice, you really have to have a growth mindset. Because we are working against the way we are working against the norm, we have to think a little bit differently, which means you can't look at every instance, a second opinion, you can't look at that as a threat. It is a resource for a patient in indirect care. It is 100% about the patient, and 0% about the insurance and all of the administrative burdens that we had to go through as doctors. So second opinion is very valuable. I always encourage it, it's doesn't bother me one bit.

Dr. Tea:     8:44
Number three unique services. So this is where podiatrists or other specialist can really position themselves in a cash practice that is highly profitable. And it is in providing a unique service. So if everyone is doing insurance, look out what is paying cash. So a lot of people are starting to incorporate more cash services into their practice. It's it's what people are already looking for. You don't have to like reinvent the wheel and try to imagine like what crazy new thing you can develop and make money from. Now there's like laser therapy. There's shockwave therapy, there's foot filler injections, there's even custom orthotics like you can be like the one person that does just these one things. And the magic in making these things work is really marketing. It's not really taking another course getting another certificate or a board certification. Those things are important. But mind you when the public looks to you for medical advice, they're not looking to see how many certifications you have. They already expect you to be the best in your field. That's the expectation. 

Dr. Tea:     9:54
So another course like get it if you want it, but really if If you have the time, and if you have the growth mindset to do so, learn the language of marketing, that means learning how to speak to your potential patients pain points, so that they can hear you. If you're speaking to somebody, and you're consumed with talking about yourself how your fellowship training, you did three years of surgical residencies, you treated X, Y, and Z, you wrote this paper, you're the most, you do the most of these things, like you're talking about yourself, and they're not hearing you.

Dr. Tea:     10:30
They just hear you brag about yourself, and you have not yet tapped into their mind, you have not gotten into their brain, you have not talked to their pain points for them to listen. So once you start learning the language of marketing, and marketing is not being sleazy about what you're doing what you're offering, what you're selling, you're not taking, you're not giving empty promises. As a doctor, you're giving them the best options to heal, to get better to not have pain to not have a amputation, those are things that you offer. So what you offer is valuable, you're not selling a used car, and trying to upsell it. Okay, so let's just get that out of the way, you have something valuable to give. Now you need to learn how to speak that language in delivering it so that the patient understands and want your service. So it comes down to the unique service you provide and how you message that unique service. You can buy a fancy machine, and think people will come to you. 

Dr. Tea:     11:27
And that's not how it works. People don't care about your machine, they care about their problem. So learning how to speak that language is going to position you ahead of what everyone else is doing. Now everyone else right now is doing insurance. So they're not maybe really focused on their messaging as much because patients want to use their insurance, it's kind of like it sells itself. But when your accounting practice, do you do have to learn marketing in this way, so that what you have to sell, or what you have to offer is going to reach the right ears. And it works much better when you have something unique that nobody else has. What I like to tell friends who are asking me about the direct care path is find a need in your community find that thing that people are already asking for. And think about offering that. 

Dr. Tea:     12:17
So in my community, they were asking for non surgical options for heel pain. And so that's something that I offer, I offer a non surgical thing for a heel pain. And so you're gonna have to find what works in your market. Okay, the next one, I lost count. But this is a word that I just learned that I think it's really, it really describes the situation. So functionally uninsured, that means a person has health insurance, but their deductible is so incredibly high. That it doesn't matter if they have insurance, nothing's covered, you have to pay out of pocket up to that deductible Number. And oftentimes people these days are having $5,000 $10,000 deductibles. And so it's not like they're having access to, you know, the things that they need in their medical care anyway. And so when people know that they know that their deductible is high, they might be more willing to pay out of pocket. And I certainly had patients who know that. And so they want quicker access to a doctor. And so they just pay out of pocket for that. Which brings me to a point just because I'm a direct care practice doesn't mean I'm against health insurance. 

Dr. Tea:     13:23
People still need health insurance for catastrophic reasons, things that we can't predict car accidents, heart attacks, you know, the strokes, these types of things, even cancer, health insurance plays an important role. And that's what it should be reserved for. And then everything else should be paid out of pocket to get that quality care. And not a lot of people know this. But we offer a lot of valuable things that isn't covered by health insurance. So in podiatry, routine, foot care flatfeet evaluation, custom orthotics are none of these are covered by Medicare. And that's fine.

Dr. Tea:     14:01
I mean, no, it's not fine, because you know, we're paying into this program. But that's besides the point I have no control over what the government wants to do. I'm just here trying to make my business run. And so being able to offer patients in immediate solution that they need, without any of the hassles of getting prior authorizations and getting it paid for and so on. It just really eases the pain of a private practice. In it, it really helps out patients because you're giving them transparent fees, a quick solution and people pay for that. And the last one I want to put on this list why people pay cash for their medical care is because they know you I put this on the bottom because I know a lot of people who are able and are capable of paying out of pocket but they just won't because they want to use their health insurance and I have no issues about that. But for me when I choose my medical care, I'm choosing my friends, my colleagues, people that I trust and I want to support worth their small businesses.

Dr. Tea:     15:01
So it's on top of knowing that they're really good. Plus, I know them. Plus, I want to support their business so they can continue seeing more patients helping the community. That's the reason I chose to pay out of pocket. And what would you give us what you get, and I really, I don't want to be that person that's always cheap. I want to be able to give more than I get, because I believe that it comes back around one way or another. So I never want to be the person who's penny pinching who's trying to do things on the cheap all the time, I can't, I personally cannot stand that type of mentality. And look, I grew up poor to my parents are immigrants we came over, they came over to the US in the 80s, they had nothing didn't know English, we slept on people's floors, on a flat mat together as a family. I ate rice and soy sauce predominantly growing up, I was probably malnourished in a lot of ways. I know what it's like to be poor.

Dr. Tea:     15:58
And so in the back of my mind, I still have that poor mentality where I have to Penny pinch and bargain hunt. And just be mindful about spending. But that's in regards to commodities, to things that I can easily purchase online on Amazon and have it delivered to my house the following day. That's the commodity that is the thing that's replaceable. If the thing is busted and gets broken, I can easily replace it. Medical care is not the same way. I mean, can you imagine if you're shopping around for legal advice, and you're picking the cheapest one, like what, what are you getting in return, if you're picking the cheapest lawyer, you know, there's cheapest servers that they have, you may not get what you need, you may not have your problem solved. In my practice, I approach it the same way I have like a very standard rate for my surgeries.
 
Dr. Tea:     16:50
And so when patients asked me to discount the surgery rate so that it matches the insurance rate, I have to think about that for a second. Like why would you want a discounted version of the surgery? Right? If I'm paying if I'm being reimbursed for a fraction of my actual price? How does that motivate me to really give you the best. And by giving you the best that could mean giving you undivided attention around the clock. And that's what I want to give. But I want to give it at this particular rate to make it work. Otherwise, I'm, I'm kind of shortchanging everybody, if I'm being cheap with this one person, instead of being very ethical in within the standard of care. I don't know if I want to be that surgeon I don't. When you market yourself as the cheapest, like Walmart, nobody wins, you get cheap stuff, you get cheap outcomes. And you know how saying you get what you pay for. And so there you have it, don't be cheap about your medical care, the way you give it or the way you get it. Okay, I already hear it now. Okay.
 
Dr. Tea:     17:58
Some people are saying, but I didn't go into medicine to make millions and millions of dollars. And let me break it to you. I am not making millions of dollars in my private practice. Nope, that's not the point of my practice, my private practice, my direct care practice was meant to be completely invested in the individual patient sitting right in front of me without any insurance interference, which means I see fewer people, which means I'm not going to make millions in this model. And that's not really my intention in this practice. So if you ever flown on an airplane, and the flight attendant tells you, you know, if we happen to have a faulty landing and the mask comes down, please be sure to put your oxygen mask on first before you put it on the child next to you. Building a business is the exact same analogy, it's the same thing.
 
Dr. Tea:     18:48
You have to make a profit in your business before you start giving out stuff for free before you start giving people things that you don't have. So when you pour from an empty cup, it's just more empty cups you're pouring, that makes no logical sense. But when your cup is full, when your business is profitable, then you can choose how to spend that time you can choose to spend that time in volunteering or giving out free care. You have to allocate your time so that it makes sense not just for you and your business but also for the family members who are supporting you on the backside and are waiting for you to come home and not bring your junk home not bring home your work stress. And that was me that was in the insurance model I was bringing home I work stressed. I wasn't really there for my family. I wasn't really focused work was always on my mind around the clock and I just hated that version of myself. So I realized I'm now walking on tangent Boulevard. This topic was about why people chose or choose to pay cash for their medical care. And there you have it. These are the reasons people see me.
 
Dr. Tea:     19:50
They are paying out of pocket. They are more invested in their health, they value their health, they value what I have to offer, and those are the people that I'm speaking to Do and then there's gonna be a bunch of people who say like, oh my gosh, she's only doing it for the money and so on, which is fine, they can say what they have to say I have no control over that. But I know what my intentions are. And it gets reflected in the people who come through my office. And that's what I want to focus on. So I'm curious, what do you want to focus on? Do you want to focus on people who say, I will never pay cash for your medical care? Or are you going to speak to the people who are waiting for you willing and able to pay for your medical expertise? You get to decide.
 
Dr. Tea:     20:33
Thank you so much for being here with me today. If you enjoyed this episode and want to hear more, please like, share and subscribe. So more people like you can have access to another way of practicing medicine, that direct care way. Let's connect by my info in the show notes and send me your questions. It might be the topic for future episodes.

Dr. Tea:     20:53
And lastly, if you remember nothing else, remember this. You are in control of your life. See you next time.