Baskets and cash: Amish working with hospitals

Following up our discussion on how Amish choose hospitals, a regular reader has shared observations of how his Amish friends choose and pay for conventional care.  You’ll see that sometimes creativity is involved.

Per request I’ve changed the names of the locations, substituting generic names for the actual town names.  The Amish community in question is a small one and quite conservative:

Amish HospitalsMy friends prefer coming to Smithfield rather than the hospital in Plymouth which is much closer. They will go to Plymouth in a dire emergency but only under those circumstances. However, any follow up is taken care of here in Smithfield. The reason is the hospital and local physicians will “deal” with them.

For instance, I know of one situation where a $20K bill was paid with about $8K. When my friend came to Smithfield he told the billing department he had 8K and they said fine and dandy, we’ll take it. In another instance a friend had to have a colonoscopy and the physician knew he made baskets. So the doctor told him he needed a very large laundry basket so the deal was done. That said, I wish I could make very large laundry baskets and get such a bargain.

Another service I know they have used is the Shriners Hospital for Children. Samuel, the 13 year old son of my buddy Ephraim, cut all of his fingers and most of his thumb off his left hand in a sawmill accident. (Don’t get me started on allowing a 13 year old to run a 28 foot capacity band saw mill as I have a real but privately held issue with such things.) He was immediately taken to the closer Plymouth hospital where the reattachment surgery failed. His follow up care was at the Shriners’ Hospital which is at little or no cost to patients.

Not that Smithfield’s hospital is an independent, autonomous entity but rather a part of a much, much larger corporation than the hospital in Plymouth. I know the bigger a corporation gets the harder it is to bend the rules. However, the hospital here seems to be much more lenient and forgiving for those who don’t have insurance and who are willing to fork over cash. Unfortunately it seems my friends have far more serious mishaps than most folks which is most certainly due to their work activity level and exposure to dangerous farm equipment and shop tools.

A few observations I had after reading the above comments:

1. I think a dire emergency for Amish is different from a dire emergency for English. My eyes were first opened to this on reading House Calls and Hitching Posts about a doctor working in the Holmes County community.  Later I saw other examples that confirmed this.  As the doctor’s quote from An Amish Paradox had it: “They don’t come in every time they sneeze.”

2. Missing fingers are the way things go with Amish, many of whom work with saws and power tools.  We’re not used to seeing missing digits and limbs nowadays.  During times of large-scale military conflicts, and when more people were working manual trades, they were more common.  Among Amish, even young guys lose fingers.

3. Would non-Amish be able to pay $20,000 bills with $8,000, if they only tried?  From what Kerry writes, it sounds like Pomerene Hospital in Millersburg, for instance, offers the same packages for non-Amish self-pay patients as they do Amish.  Amish have negotiating power, as well as sympathy for a fairly well-known religious stance on their side, however.

Band-aid image: barky/sxc.hu

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    16 Comments

    1. Ed

      The Amish are also known for their honesty – they won’t sneak out leaving a bill unpaid. I’m glad that some hospitals and individual doctors will “deal” with them, even accepting payment in baskets.

      From my observation there are many hospitals that offer discounts for self-paying patients who pay in advance, esp. for procedures like childbirth. It does require a lot of preparation work, however, as these days often a doctor’s own staff have no idea what a procedure will cost — they just send bills on to the patient’s insurance company. It is little wonder that medical care has become so expensive, when both providers and patients are out of the loop about pricing.

    2. Naomi Wilson

      Paying in cash

      In my experience, if you pay for medical procedures with cash, you can often negotiate a much lower price than if you go on a payment plan or have insurance. We have a number of friends who don’t take out medical insurance, in part for religious reasons, although they are not Amish. They will save up for years if a certain procedure is needed, but they always pay a much lower amount when they finally go in with cash in hand.

    3. SharonR

      Amish and Hospitals

      I think that is very resourceful, in how the Amish will pay for their medical needs! This was done MANY MOONS ago, before there was anything such as “insurance”….I remember reading about doctors “trading” items, for their services.

      I do know that there are “foundations” and other organizations that will help, (at least in Florida), that may need expensive procedures/surgeries, etc. One place, being my husband’s oncologist; I happened to be behind a client who was receiving treatments, and overheard the lady to say, “I can’t afford any more treatments”. The receptionist told her to fill out some paperwork and there were many foundations and organizations “out there” that will help out anyone, that are in “dire straits”, with medical issues. So, aside from the Amish ways, in dealing with medical expense, there is also other alternatives, that doctors and hospitals can provide for the ones who just cannot come up with the payments. It is not publicized, however, and you kind of have to learn about it, when the time arises.

      I just wonder if the word “insurance” has crippled the medical industry, driving up fees, etc, where ordinary people cannot even afford an office visit, now……who knows? But I think the Amish have the perfect idea of “trading” their talents for an unexpected hospital or doctor’s visit. Of course, it wouldn’t work for everyone.

      I do respect the Amish for their principals of taking care of their own, in all situations, plus they are living by their faith in God, to help them through any crisis they meet. Bless them!
      SharonR

    4. Richard from Amish Stories

      Most folks that I know including myself can not afford to pay for most medical bills unless its for something very minor, so health insurance is not an option but a necessity to have for myself.

      I also wonder Erik if the Amish only go to see a doctor when something goes wrong, or do they go for preventive check-ups to catch something that could be more serous and find it early. Health costs are really out of hand in many ways and in paying cash it just shows you that a hospital or doctor is willing to accept at times much less money and is able to still make some kind of profit.

      Lets face it trying to just “live” can be a struggle sometimes and when one gets really sick the last thing on your mind should be ” will I be covered and will the insurance company drop me”. To have someone die because the insurance company decides your no longer profitable as a customer is not only sad, its inhumane! Richard. http://www.Amishstories.net

      1. Judy

        Richard from Amish Stories

        Richard, this is more of a general comment: I am always interested in your comments, but cannot seem to sign on to your site. Is it restricted somehow? Thank you. Judy from MN

        1. Richard from Amish Stories

          Hi Judy...............

          I’m sorry that you have issues posting on my blog Judy, and I’m pretty sure that your talking about posting a comment. I have no restrictions and in fact I dont use those spam number codes that some use before posting a comment on their own blogs.

          If you would like to post your comment just click where it says “comments” then type in what you would like to say, then when your all done and if you dont have a Google account then where you see “anonymous” click that box and click “publish your comment” Judy. I hope this helps and I would very much enjoy reading what’s on your mind. Richard. http://www.Amishstories.net

    5. OldKat

      It has.

      Re: “I just wonder if the word “insurance” has crippled the medical industry, driving up fees, etc, where ordinary people cannot even afford an office visit, now……who knows?” the answer is it absolutely has. Private insurance – United Health Care, etc and government insurance – Medicare, Medicaid and the abomination that leads to (fiscal) desolation; Obamacare … have and will lead to a huge disconnect in personal accountability.

      People, in general, don’t care what their health care costs because they are paying the premium (or pat of it)and don’t really care what is being billed to the insurance company. Regardless what the insurance company is paying out their premium remains the same; UNTIL the next year when they jack the premiums up. Do that thirty or forty years in a row and you get to where we are now.

    6. Laura

      In my experience, a lot of hospitals will settle a bill for what they know they can get rather than holding out for the full amount — or even write off a bill under some circumstances. My daughter, for instance, had a bill with her local hospital of close to $2,000; she went in to the billing office to offer to work out a payment arrangement, and they told her that they’d just written it off and she didn’t need to worry about it. She lives in a very small town, though, where everyone is known; I’m sure her reputation for honest dealings with local merchants preceded her. That’s the key word for the Amish, too, I suspect — honesty. Organizations like hospitals are far more willing to work with people when they know they’re being dealt with honestly. It’s a precious commodity in today’s world!

    7. Lee Ann

      Baskets and Cash

      Yes, insurance has caused medical bills to soar. I work in the medical area with billing, and I have seen what happens with many bills. Most people do not look at their bills and just pay what is there.any times there are errors and if looking closely one can spot an error easy. I have spotted two huge errors with bills on my husband and contacted the Clinic or Dr. that wrongly charged us and got that taken care of and they also reduced our bill by 30%.

      Most hospitals are required by law to give so much in free medical care. This is how the Amish are able to reduce their bills. Also if you pay upfront your bills, they reduce your total by 20-30% right off the top. Going in to work out payments will also reduce one’s medical bills. Everyone but the ambulance companies will work with you to reduce your bills and make them more affordable.

      We had over 90k in bills four years ago,no insurance and we were able to work with the hospital, Dr’s and trauma team to reduce the bills and allow us to make payments until we were paid up! The Amish have figured all of this out to their benefit and it helps them a great deal. Could help others as well.

      Many country Dr’s will still barter their services. ie: the Amish with the baskets, or a quilt or something. Not all country Dr’s will but most country Dr’s will still barter with you, so that they can build up their practice and gain your trust.

    8. I dont do doctors much, but recently had a checkup at the Parochial Medical Center at New Holland. I found it quite interesting that they had a sign there that said (not exact quote): “No insurance payments of any kind accepted.”
      I suppose that is a quick way to filter out most people from the non-Plain community. The chance of lawsuits drops tremendously if you only work with Plain folks, so I am sure that helps the prices a doctor would have to charge. And knowing that the people you serve will make an honest attempt to pay helps in extending credit for the big bills.
      Moral? Honesty pays!

      1. Matt from CT

        There is a small segment of the medical community that is called “Direct Pay Practices” — they do away with taking insurance in exchange for significantly lower operating costs and pass on the savings.

        http://health.usnews.com/health-news/managing-your-healthcare/healthcare/articles/2009/07/17/is-a-cash-only-or-direct-pay-medical-practice-for-you

        There is an ENORMOUS amount of bureaucratic friction involved with “medical coding” and both sides trying to assure the right codes are applied and they fit the patient’s coverage(s).

        The largest hospital chain in the U.S. is currently crowing about record profits due to more aggressive “coding” practices. Not efficiency, better outcomes, etc. — just they’re better at gaming the system then others.

        http://www.nytimes.com/2012/08/15/business/hca-giant-hospital-chain-creates-a-windfall-for-private-equity.html?pagewanted=all

    9. Valerie

      Bartering and Insurance Alternatives

      Recently I learned of a Christian company where it works like insurance but is not insurance, that you make a monthly payment to and when a medical need arises, the company takes care of it by pooling all the money together from the members. The monthly payment was not that much, and reduced under certain criteria. It would also, if I understood it correctly, enable you to be exempt from Obama Care.

      Couple of years ago, an Amish woman in our county told me she paid a large bill of her own with a quilt. I had never heard of such a thing and wondered if the doctor really wanted a quilt or was being kind-I couldn’t help also but to be curious whose idea that was but either way, was glad to hear of such an arrangement.

    10. John

      With the high birthrates in the Amish community I wonder how payments work out. Do most Amish use mid-wives or go to a hospital to give birth?

    11. Lowell

      The hospital I work for has an agreement with Immergrun Ihttp://www.immergrun.org/ whose stated mission is “Immergrün, Inc. is a non-profit organization directed by a majority of Anabaptists. Our goals are to negotiate quality health care at affordable prices for Anabaptists who don’t have health insurance and to promote wellness”
      Amish and other plain groups pay $5.00 to join. A staff member at Immergrun will review the hospital bill of a member and reduce the bill by identifying what is a reasonable charge for that illness and the accompanying DRG. The Amish will then agree to pay cash within 30 days in exchange for a reduction of 30-50%. This has helped to reduce large bills but as you can imagine a serous illness can cost 400,000-500,000 very quickly. In our area the Amish borrow the money and then have the community come together to assist them in paying the bill.

      I can only imagine how healthcare would look is it was always negotiated that way.

      In speaking with Dr. Byler who runs the birthing center in Ohio he indicates costs can be contained as he is not spending money for staff to bill and manage accounts as over 95% of his patients pay cash up front.

      Lowell

    12. Katya

      I am behind in reading…has been a tremendously busy month!

      My Amish friend had a baby two years ago in July. The baby was born prematurely, weighing one pound, fourteen ounces.

      Throughout the baby’s stay in a university hospital in a large nearby city, I learned much about not only the Amish are looked upon as a community, but also about how my friend felt, going through this ordeal.

      The baby was kept in the hospital for about two months and her bill came to $364,000.00. Of course (said sarcastically) a discount would be considered if the bill was paid in full within three months.

      This community is very small and from the looks of the homes, it is certainly not a flourishing, wealthy community. Indeed, the folks work hard and live extremely modestly. Because I came to know not only my friend, but her extended family, I know that there were some money struggles for the family.

      The husband, preachers, and Bishop went to talk with the financial department of the hospital. They said they might be able to get together $100,000.00 and asked if that would be acceptable. They were declined.

      Knowing my husband is a hard-nosed negotiator, he gathered information from the family and went to bat. No go. The hospital was inflexible and non-negotiating. I still have a conversation from the lady my husband dealt with…it is disturbing.

      There is a service that will pay huge Amish/Mennonite hospital bills with the promise of communities paying them back, but they also found the hospital inflexible.

      Time has passed. My friends send a small portion each month. The lady my husband talked to said they would eventually be turned over to collections at some point. My husband and I laughed, asking if they would come for the couple’s horses and cow?

      My husband did get his feathers a bit ruffled, though, in thinking that when we pay our property taxes, we are actually paying into Medicare. He cannot understand why the Amish refuse to have Medicare/Medicaid help with enormous bills. We were told by the aforementioned service that in many cases, Amish couples will actually accept the Medicare/Medicaid, but not tell their church. If bills are paid by Medicare/Medicaid, the remaining amount is generally then paid through charities.

      Tough ball of wax and at some point, I think the Amish will have to become “more modern”. As times change and the world gets crazier, it is harder and harder for the Amish to hold tightly to their age-old tradition. Of course, family and community will never change and that is for sure and for certain!!!!

    13. Susan

      question

      I am a nurse at a midwestern pediatric hospital. I became close with an Amish family, and we still communicate back and forth via mail. Their child was hospitalized for an extended time, and eventually passed away. They just wrote me about finding out about help to pay their bill. They said that while they were in the hospital, someone came and spoke with them about an organization that helps the Amish pay their hospital bills. However, they are from Michigan, which is a different state than the hospital is in. They were told that the state where I am could not help them, but this person would get back to them about help from Michigan. With the child dying and all, they left, and never talked to the person again. They have asked for my help to figure this out. Does anyone know of this organization or any organization that helps with these types of things??