Providers' collection policies adapt to economic slump

With the recession still hitting many Americans hard, and near-universal healthcare years away, providers continue to seek alternative ways to get paid for their services. For some, it means skipping the middleman--insurers--and collecting cash directly from patients. For other, it means bartering for goods and services straight from patients.

For example, more than 2,000 medical and dental providers who accept reduced procedure fees now advertise their rates on Seattle-based, a searchable database that is free to patients.

Typical users are uninsured, underinsured or seeking elective procedures, reports NBC News. Consumers can also submit bids for services to multiple providers.

For some specialties, such as plastic surgery, negotiating for cash is not new. "We've always quoted cash prices, or self-pay prices, for our procedures because they've never been covered by insurance," commented Charles Wallace, a Texas plastic surgeon.

Other practices, prompted by worries over health reform, have opted to forgo the insurance model entirely and operate concierge practices where patients pay a premium to have near round-the-clock access to their physicians, notes the Fort Collins Colorodian.

The recession has also spurred a resurgence of bartering for medical care. While some physicians negotiate the value of such services as Web design directly with patients, others do so through Craigslist or Web-based trade exchanges such as ITEX Corp., both of which have seen dramatic increases in healthcare business since the economy began to dip, the Associated Press reports.

As with those paying cash, most barterers offer up organic vegetables, plumbing services or similar to supplement their insurance. And providers who can successfully barter with patients are generally limited to specialties like dentistry or smaller doctor practices that are less bureaucratic, said Andrew Whinston, a University of Texas at Austin professor who has studied bartering. Further, the fair market value of all property or services received must be reported as income on providers' tax returns.

To learn more:
- read this coverage by NBC News
- read this Associated Press report via Clear Politics
- check out this report on