Announcing our new Non-Testifying Consulting Service
Is a Private Physician The Answer?

Is a Private Physician The Answer?

Is a Private Physician the Answer?

As we all know, health care has made a lot of changes in the last few years. The everyday consumer has been hit with higher rates along with higher deductibles and we all know that salaries and benefits have not increased accordingly. As we see more people covered by medical insurance, we actually see less people in certain groups using it.

Let’s talk….. 

Most working families carry health insurance and always have. Where their annual deductibles or “out of pocket expenses “used to be $2500, they are now often $10,000. These families are probably paying twice what they were paying 5 years ago for what is essentially catastrophic insurance. If they are lucky, they will never have to meet that deductible but in the meantime, similar to house and car insurance, they are paying for insurance they will hopefully never use.

If you are a reasonably healthy individual, you may want to have a catastrophic insurance plan for emergencies but take control of the rest of your health care. You pick your physician, you decide what tests you are willing to pay for and you negotiate how much you are willing to pay.

Another option, if you have a high deductible, is to use your health insurance for your yearly physicals and preventative medicine and pick and choose for your specialists and high cost tests. This will almost always cost less money and you are seeing who you want, and making your own decisions on treatment without insurance involvement.

For example, a consult with a specialist would be billed to your insurance company. If the physician was a provider, the insurance would have a negotiated rate for a consult. Depending on the policy, you would probably owe a co-pay and a percentage of this. If they were not a provider, you could be responsible for the whole amount or a large percentage of the whole amount. No matter what, you will still be paying the bulk of the bill.

Your physician would have to get approval for any tests from your insurance company and you would also pay the negotiated amount for them. Treatment would have to wait while all this is going on.

At ShimSpine, we have cut out the “middleman”. By you paying at the time of service, we are able to keep costs low by not having to spend time billing insurance claims and fighting appeals.  Since no insurance is involved, we do not have to obtain a pre-authorization for any tests such as an MRI, which also saves you time.  You get a price for your whole visit up front and we negotiate your other costs for you.  You still have the flexibility to use your health insurance for testing and treatments, including surgery, if you wish.

In answer to the question “is a private physician the answer?” the answer is, sometimes. If the price is reasonable, if you get the care you need, and if you leave feeling like you did the right thing for both your health and peace of mind, then a private physician is the answer for you.


Article by Catherine Nicholson based on over 30 years as a Registered Nurse and 15 years as a practice manager in a spine practice.

Last modified: December 11, 2020

Leave a Reply

Your email address will not be published. Required fields are marked *