If you think HMOs were different, just you wait

If you think HMOs were different, just you wait:
"Pay now, please

Finally, get ready to pay upfront for care.

Ten percent of insured Minnesotans already are enrolled in a high-deductible plan. But because of the idiosyncrasies of the insurance system, many don't get asked to pay a cent until long after they've left the doctors' office.

Clinics and hospitals say they are seeing a rise in bad debt from these patients.

Now some doctors are looking at installing kiosks and other devices to swipe a credit card upfront -- just like at hotels and car rental companies. The card is charged only after a service has been performed and the insurer clarifies how much is owed. Minneapolis-based mPay Gateway already has 300 customers for its Web-based software that helps doctors estimate a bill and authorize that amount."

This is the logical result of high deductibles like HSAs. Can't get service unless you pre-pay. Again, forcing the patient to use the ER or go without care.