Posted by: notdeaddinosaur | January 24, 2017

Positioning for the Future

As you may have heard, the United States has a new president. From where I sit, things do not bode well for me — that is to say my patients — over the next few years. In addition to the virtual certainty of massive changes in health insurance, I fear a significant overall economic downturn similar to the last time a Republican held office. Until the outgoing president managed to turn around the Great Recession, my income tanked. In fact, it’s only now beginning to come back to where it was seven years ago. Talk about nipping it in the bud!

As I say, though, this is more about my patients than about me personally. Just as my practice enjoyed a nice uptick as more people acquired insurance through the ACA, I anticipate that large numbers of patients will now be losing that insurance. So to the about-to-be newly-uninsured, along with everyone kicked off the all-but-certain-to-contract Medicaid, please listen:

Medical care as I am able to provide it is NOT EXPENSIVE. Primary care for minor illness and injury, evaluation of new symptoms, management of chronic conditions, and preventive care is not free, but not break-the-bank expensive either.

I take cash. (Including checks of course, and all credit cards.)

Here’s a price list reflecting my cash discount*:

  • Truly brief visit (up to 15 minutes): $50
  • Minor illness (up to 30 minutes): $75
  • More complicated (up to 45 minutes): $100
  • Very complex (more than 45 minutes): $125
  • New patients: Add $25 to each of the above
  • Tdap shot: $50
  • Flu shot: $30
  • EKG: $25
  • Urinalysis: $10
  • Urine pregnancy test: $10
  • Strep test: $20

Obviously this isn’t everything, but it covers the most common services I provide. I can’t provide the same kind of 24/7 coverage as Urgent Care, but without insurance, I’m told those places can get expensive.

If you feel you need medical attention, PLEASE don’t hesitate to come see me because of money. Although I do need to keep the lights on, I’m not interested in picking your pocket. I just want to help.


*As of the date of this post. Subject to change.
This is NOT my regular fee schedule for insurance billing, but rather the discount offered for cash payment at time of service. 



  1. I have been told by more than one doctor that if they give a discount for cash, that they could be charged with insurance fraud. Is this correct or does it depend on the type of agreement that the doctor has signed?
    Love the way you run your practice!

  2. This is cash payment for service. As she mentioned above this is for people who are UNINSURED. It’s called direct primary care and is perfectly legal.

  3. Thanks Mamadoc but I have had doctors on KevinMD say multiple times that they could not do this (that is, charge a lesser fee to the un or under-insured for a cash payment) legally. Hence my question?
    There is just so much wrong with out current system. It will take a Herculean effort to even begin to try to change anything!

  4. From my understanding, if you participate in Medicare you cannot charge less to a self-pay patient.
    Your fee is your fee. You may then have contracts with various insurers where you accept less than your fee, but your fee is your fee.
    If you publicly list your fee as $50 for a 99213(the simple visit you list above) and don’t charge all your patients that you are in violation of your contract with Medicare and probably several insurers as well.
    If you have a self pay discount than that is more gray. Be careful with your wording and I hope CMS doesn’t happen to read your blog.

  5. I think your rates are very reasonable, but you need to understand that even reasonable rates are unaffordable for many people. The minimum wage in Pennsylvania is $7.25 an hour. When you account for taxes and FICA deductions, a moderately complicated new patient appointment ($125) is almost 3 days of work. That doesn’t even account for lab tests and prescriptions. Plus they have to take time off work to go to the visit.

  6. To address some previous comments–offering a discount for payment at the time of service is perfectly legal and doesn’t run afoul of insurance contracts if you offer the discount to anyone paying at the time of service. That includes insurance companies. Of course insurance companies never in practice pay at the time of service, but the fact that you offer them the same discount is a perfectly legal way to circumvent contract rules about charging all patients the same

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