The largest publicly run health plan in the nation, L.A. Care, will allow customers who do not have traditional bank accounts to pay their health insurance premiums with cash.

One in four Americans who were previously uninsured and eligible for federal insurance subsidies do not have a bank account, relying instead on pre-paid debit cards, money orders and cash to pay bills, according to a study by Jackson Hewitt Tax Service.

After advocates for low-income consumers raised concerns to the U.S. Department of Health and Human Services over how so-called ‘unbanked’ households would pay their monthly insurance premiums, the Obama administration ordered health plans to accept payment methods that didn’t require a credit card or checking account.

Starting Monday, customers of L.A. Care Covered, one of the health plans for sale on Covered California, the state’s insurance marketplace, can pay monthly premiums in cash at more than 680 locations, including 7-Eleven and Family Dollar Stores. At the register, customers scan a bar code sent to their smart phone and hand over their cash.   The payment posts to L.A. Care within 24 hours, and  the service is free to customers.

“It’s as quick as buying a Slurpee,” said Danny Shader, PayNearMe’s founder and CEO, the for-profit company that established the electronic cash transaction network.

L.A. Care, like most health insurers around the country, pays fees to Visa, MasterCard and banks to process debit and credit card transactions. Laura Jaramillo, Director of Commercial and Group Plan Operations at L.A. Care, said the health plan negotiated a similar surcharge to PayNearMe for cash payments.

“It should not increase our administrative costs,” Jaramillo said. L.A. Care estimates up to 25 percent of its marketplace customers mail in money orders each month. Now, members who don’t have a bank account can pay in cash, said Jaramillo, “instead of sending us money orders.”

Some low- and moderate-income households shun bank accounts, researchers find, because checking account and overdraft fees can wreak havoc on their precarious finances. These same households, however, rely heavily on cell phones—68 percent of unbanked households have mobile phones.

L.A. Care is the first health plan to use the PayNearMe network, although the company’s method of cash collection is already in use in other ways elsewhere: By Nebraska parents who owe child support, Pittsburg water customers and bike share riders in Philadelphia who can pay cash at local convenience stores to settle bills.

“What goes in is cash, and what comes out is an electronic payment,” said Shader. “We think everybody ought to do it.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Imagine walking into an emergency room with an awful rash and waiting hours to see a doctor until, finally, a physician who doesn’t have specific knowledge of your condition gives you an ointment and a referral to a dermatologist.

That could change if a technological device like Google Glass, which is a wearable computer that is smaller than an ink pen and includes a camera function, could be strapped to an emergency room doctor’s head or to his or her eyeglasses and used to beam a specialist in to see patients at the bedside. Not only would a patient get a more specific initial diagnosis and treatment, but a second visit to a dermatologist might not be necessary.

Researchers did just this for a small sample of people at the emergency room of the Rhode Island Hospital in Providence. They found during the course of the study that 93.5 percent of patients who were seen with a skin problem liked the experience, and 96.8 percent were confident in the accuracy of the video equipment and that their privacy was protected.

“There had been a lot of talk about using Glass in health care, but at the time that we designed the study, no one had actually tried it. No one knew if it would work,” said Megan Ranney, a study author and assistant professor of emergency medicine and policy at Brown University.

ER doctors normally have to page an on-call specialist – in the study, a dermatologist — to talk through the patient’s condition. With that information, the dermatologist makes a judgment call about the treatment, usually without ever seeing the patient. If there’s no dermatologist available, which can frequently be the situation, doctors do what they can but then refer the patient for follow-up dermatological care. Many rural and community hospitals do not have dermatologists on staff and it’s up to the emergency physician to care for the patient.

In the study, researchers instead had the physicians connect via Google Glass, enabling the specialist to see on his or her office iPad or computer what the ER doctor was seeing in person. The ER doctor was able to communicate with the dermatologist, and both physicians could ask questions of the patient in real time.

“You’ve rolled the first and second visit into this one visit. You have the specialist at the bedside, and if you get better, you don’t need to have follow-up,” said Paul Porter, a physician in the emergency department of Rhode Island Hospital and study author. “There’s nothing more frustrating [for the patient than] to be seen, leave with diagnostic uncertainty, and have to go somewhere else. … People don’t want that answer.”

Emergency rooms across the country may already use telemedicine technology for patients with skin or other visible conditions, but many of those machines can cost as much as to $60,000 — not to mention the expense of maintenance and support. Google Glass costs less than $2,000.

In addition, many ERs either don’t have the funds to obtain a telemedicine “cart,” or don’t use it because the size – four to six square feet – can be too large for that setting, said Edward Boyer, a professor of emergency medicine at the University of Massachusetts Medical School in Worcester, Mass.

“The crowding in emergency rooms means we physically do not have enough room to manage the patients they have in them. A dermatology cart is not a little thing, and a lot of ERs don’t have that much spare room to store and wheel around one of those things,” said Boyer, also an author.

The researchers’ next step is to study whether Google Glass or similar headset technology could be used for other ER patients, such as those showing signs of stroke or who may have been exposed to poison.

In the latter instances, poison control center toxicologists are always available, though mainly consulted via the telephone. But these patients commonly have visual symptoms such as seizures, said Peter Chai, a lead author and fellow in medical toxicology at the University of Massachusetts Medical School. And, if a person is severely ill due to poisoning, they are flown via helicopter to the closest major hospital, he added.

“If we could see them virtually, could we save the money of transport, keep them in the community intensive care unit, and give better patient care?” Chai said, noting that even if ERs in smaller or rural settings don’t have access to telemedicine, they may be able to afford this type of device.

The research surveyed 31 people with skin conditions in the Rhode Island Hospital emergency department for six months, and was published as a research letter in JAMA Dermatology April 15. Google Glass is currently not available commercially, but health care providers can get the device through health care technology companies.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.