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August 4, 2015

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Cutting the insurers out

When Dr. Kevin Petersen began offering cash-pay surgeries to uninsured patients, his friends told him he was crazy. Now, four years later, he wouldn’t work any other way

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Leila Navidi

Dr. Kevin Petersen performs hernia repair surgery at Medical District Surgery Center in Las Vegas Friday, January 21, 2011.

No-Insurance Surgery

Dr. Kevin Petersen performs hernia repair surgery at Medical District Surgery Center in Las Vegas Friday, January 21, 2011. Launch slideshow »

Dr. Kevin Petersen’s peers thought he was crazy when he started offering cash-pay surgery to uninsured patients about four years ago.

But about 700 no-insurance surgeries later, he’s opting out of all of his remaining insurance contracts.

Petersen went to medical school at Tufts University, has been licensed in Nevada since 2000, and has performed about 25,000 surgeries. He says his booming niche business is a sign of the times in American health care, as many patients are uninsured and have few good options for their surgical needs.

The interview with Petersen was edited for clarity.

How did you get started doing no-insurance surgery?

In 2005 a plastic surgeon friend suggested I should do it like they do. They do cash-pay surgery every day, hiring an anesthesiologist and renting an operating room, then putting it together as a package for the patient. We hire the anesthesia and rent the OR.

I pay the anesthesiologists by the minute, and I’m a pretty fast surgeon. I do a hernia in 20 minutes and that saves the patient a huge amount of money. I do most of my surgery at Medical District Surgery Center.

Who are most of your patients?

There’s a particular demographic: in their 50s or older, self-employed, too old to get inexpensive insurance and too young to get Medicare. Most of my patients are from out of town: Florida, Maine, Alaska, Hawaii and every now and then a Canadian who doesn’t want to wait for his national health service.

What procedures do you perform?

Hernia repair is my most common procedure. My package price is $5,000. I hear hospitals would charge $10,000 to $15,000 for it. Gall bladder removal is my second most common procedure. That’s $6,900, which is also a very good price.

The way I look at it, I charge everybody, regardless their ability to pay, the best price. I want to be able to honestly tell anybody who asks that I charge everybody the same fee.

These two types of surgery work well because they’re low risk for the patient and me. And they’re outpatient procedures, so I can keep the price down. The complication rates are very low. And patients can travel soon after surgery.

The aim of health care reform is that everyone would have insurance. How will that affect your practice?

I’ll believe it when I see it. Right now the rolls of the uninsured are growing.

Personally, I have a high deductible policy. I don’t want my insurance company to pay for every doctor visit, lab work, and then take their premium out of it and charge me that plus the profit.

Do you save administrative costs by not billing insurance?

I save on stress. I save on getting rid of that grief in my life. The single biggest disappointment to me in my practice in the past 25 years has been dealing with insurance. They get in between me and my patient. They tell me when I can and can’t operate. They tell me what my service is worth. And in this way they devalue my service. They increase the inconvenience to the patient and the workload in my office. And of all the stuff I do they’ve never helped me take care of a patient.

What do your doctor friends say about your practice?

When I started it, everybody told me I was crazy. One of the other objections I heard early on: You’re going to get sued from these patients. But my uninsured patients are grateful like you wouldn’t believe. I’m treating patients who have been pushed aside by the system.

When I can work in that niche and do important work that I get paid for and get gratitude from my patients, it’s very rewarding.

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