Self Pay Health Care

Self-pay is the basis upon which the healthcare financing system began. Patients paid physicians a fee-for-service. In its purest sense, the self-pay model includes only the physician and patient in the exchange of compensation for medical care provided. Over the years as healthcare financing arrangements have changed, entities paying a fee-for-service includes all payers-public and private. Some in the healthcare industry has referred to physician practices that do not accept health insurance as cash-only practices or self-pay patients. Self pay vastly reduces the traditional overhead expenses by not having to bill and abide by contractual requirements of third party payers. Further, collection rates may be higher with fewer bad debt expenses. Physicians in a pure self-pay practice may want to continue to see patients with private insurance who are willing to pay cash and submit their own claims. Before charging privately insured patients on a cash basis, the physician should determine that there are no contractual or legal restrictions on doing so. This will necessitate a review of existing contracts and state insurance regulations. Certain states protect enrollee’s in particular private insurance plans from being billed for any sums beyond what the insurance company pays, except for co-pays and deductibles. Some physicians have found the self-pay model a way to regain meaning in and control over their practices, as well as to reestablish a physician-patient relationship in which there is time to care. Another option to consider in not accepting health insurance is to combine a self-pay model with a retainer practice. This hybrid practice would allow patients who could not afford a monthly retainer fee, to still receive care in their personal medical home and only pay for the medical care provided. For more information on retainer fees, see the discussion paper on retainer practices.

Retinoids Topical Acne Treatment

Retinoids are a group of medications that normalize the follicle cell lifecycle. There are topical retinoids such as tretinoin (brand name Retin-A), adapalene (brand name Differin) and tazarotene (brand name Tazorac). Like isotretinoin, these medications are similar to vitamin A, but they are topical treatments and generally have much milder side effects. However, they can cause significant irritation of the skin. The retinoids appear to influence the creation and death lifecycle of cells in the follicle lining. This helps prevent the hyper-keratinization of these cells that can create a blockage. Retinol, a form of vitamin A, has similar but milder effects and doctors prescribe because it also contains moisturizers. Doctors have prescribed topical retinoids for over 30 years, but are not available over the counter, so they are not as widely used as other topical treatments. Topical retinoids often cause an initial flare up of acne and facial flushing.

Fat Loss Surgeon

A fat loss surgeon performs bariatric surgery, bypass surgery, gastric banding and obesity surgery. Surgical weight control is an option for very overweight who cannot lose pounds with only a healthy diet and exercise. Weight loss surgery limits the amount of food a person can intake. Some operations also restrict the amount of food the stomach can digest. Many people who have fat loss surgery lose weight quickly. If patients follow all diet and exercise recommendations, most can keep the weight off. Like all surgeries, fat loss surgery has risks and complications, including infections, hernias and blood clots. Men who are at least 100 pounds overweight and women who are at least 80 pounds overweight are eligible for this surgery. If candidates somewhat less overweight, surgery still might be an option if they also have diabetes, heart disease or sleep apnea. Bariatric surgery, or weight loss surgery, is a type of procedure that doctors perform on people who are dangerously obese. This procedure achieves weight loss by surgical reduction of the size of the stomach by means of an implanted gastric banding device, through removal of a portion of the stomach or by re-sectioning and re-routing the small intestines to a small stomach pouch as gastric bypass surgery. Long-term studies show that fat loss surgery procedures result in significant long-term loss of weight, recovery from diabetes, improvement in cardiovascular risk factors, and a reduction in mortality of 23 percent to 40 percent. The U.S. National Institutes of Health recommends bariatric surgery for obese people with a body mass index (BMI) of at least 40. When a patient ingests just a small amount of food, the first response is a stretching of the wall of the stomach pouch, stimulating nerves, which tell the brain that the stomach is full. The patient feels a sensation of fullness, as if they had just eaten a large meal—but with just a thumb-full of food.