PCP Visit – Cash Only

This picture was taken this morning on the way to Starbucks in Brownsville. The location is on the frontage road of Highway 77. According to the sign in the window, total charge for an office visit is $35 – cash or credit card only. No appointment necessary.

So the question is, if I have an insurance policy with a $20 office visit co-pay, do I go to this clinic and pay $35 or go to a PPO doctor down the street and only pay $20?  What is interesting is that the PPO network fee is probably a multiplier of 2008 RBRVS (Medicare), say 100% of Medicare for example. In that case, the PPO doctor down the street gets paid $80-$145 for the office visit, which the employer’s health plan pays for. This makes no economic sense at all – pay $35 cash or as much as $145 or 400% more  with insurance – for an office visit?

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