MD dropping out of all insurance plans

[Planogirl]

Some can't afford the numbers being thrown around here. Even though for me not having to pay almost $500 a month for insurance would be helpful.

What about surgeries, tests and other procedures? Some of those, particularly some surgeries, are wildly expensive. How can most people pay out of pocket for those?

 

[M5ward]

Our PCP does not accept the Medicare assignment but still has to submit the bill to Medicare. We are reimbursed the Medicare approved amount directly and then submit to our supplemental insurance for the remainder. We usually have our reimbursement check from Medicare in about two or two and a half weeks. Our supplemental insurance is also pretty prompt.

 

[Friendly Frog]

I worked with a girl and her son was making 800.000.00 a year reading x-rays and such. I don't think all doctors are going broke from submitting insurance. Yes, I know that a family doctor make much less than a specialist, but I think it is more of not wanting to deal with insurance.

I will do my best to give my money to a MD that does file for me.

 

[Friendly Frog]

Some can't afford the numbers being thrown around here. Even though for me not having to pay almost $500 a month for insurance would be helpful.

What about surgeries, tests and other procedures? Some of those, particularly some surgeries, are wildly expensive. How can most people pay out of pocket for those?

We are paying over 1000.00 a month for the two of us and that is through DH work. The insurance is not even all that great, but the company is very small.

 

[rie'smom]

Some can't afford the numbers being thrown around here. Even though for me not having to pay almost $500 a month for insurance would be helpful.

What about surgeries, tests and other procedures? Some of those, particularly some surgeries, are wildly expensive. How can most people pay out of pocket for those?

We do see other doctors if there is a need. Our insurance does cover that. Our internist is fabulous and our first choice for other than sinus, allergies, run of the mill. He tells us if we need a specialist and then we'll go.

 

[Caradana]

Most of the best doctors where I live accept no insurance. Until I started traveling a lot for work, I actually thought that was the norm nationally. Medical insurance to me has basically always been about catastrophic care.

 

[portocall]

I pay a small fortune a year for our health insurance. If any of our doctors drop insurance then we are leaving. I have some that I really like but I can't afford both insurance and to be paying out of pocket. Both DH and I have chronic illnesses so we certainly won't risk losing our coverage for any hospital visits or surgery that is needed in the future.

 

[honugirl]

But it is going to reduce the number of doctors availabe thus making it more difficult to see a doctors. That's why you are seeing extreme waiting times in other countries.

Him not wanting to bill insurance will reduce the number of doctors available? How? It will make it worse if he is forced to accept insurance because most likely doctors like him will quit practicing forcing those of us who really need people like him to use other resources. He has a tiny office open once a week with another assistant doc and an administrative assistant. If he had to bill insurance he wouldn't be able to deal with the patient load he has now because the overhead would be too much. He provides you with a superbill and it's up to you to send it to your insurance to see if they will cover anything. At least he is an option right now, it is my choice to pay for his services. If I don't wish to pay what he's asking, I'm free to go to anyone else I choose who may or may not be able to help me.

 

[Friendly Frog]

I do not know of any doctors who sit down and do their own billing, so it does not impact the number of people the doctor can see. It does impact profitability as they must hire someone do to the paperwork.

 

[honugirl]

I do not know of any doctors who sit down and do their own billing, so it does not impact the number of people the doctor can see. It does impact profitability as they must hire someone do to the paperwork.

No, they don't do their own billing, but not all docs just run a practice. Some are also in research and also teach at local med schools. It's a different setup than most are used to. Under his current setup, he can accommodate more patients because his administrative staff is focusing on doing med refills, scheduling testing, answering emails, etc. If they have to shift to spending time billing insurance, then they will spend less time assisting patients. With less time to assist patients, they have to see less or provide a lower level of care.

In the beginning, yes, I did balk at paying OOP to see him, but once I did, it was definitely worth it.

 

[bicker]

Does anyone know what the doctor receives as payment if they are paid by the insurance company rather than the patient?

The "negotiated" fee. Indeed, it's not really negotiated... it's a take-it-or-leave it fee, and that's why some doctors are leaving it.

 

[bicker]

These statements are just plain not true. There is a federal law called EMTALA which requires that Emergency Departments screen and clear all patients who arrive for assistance. While it does not state that they have to treat chronic conditions or provide long-term care, all who arrive will be screened and stablized/treated. No hospital wants to risk an EMTALA violation....BAD things happen.

Indeed, and the folks who have health insurance or pay for medical care out-of-pocket cover the costs for those patients who invoke EMTALA. According to the Centers for Medicare & Medicaid Services, that represented $1,186 per year per family - or $43 billion total - money we pay that goes to cover the emergency care for other people, including both those who cannot afford to pay for health care (which is fair) and those who choose not to (which is not). In Massachusetts, we've very successfully started fixing this injustice, ensuring people who work and make money in the Commonwealth pay their fair share into the system, so that when they find themselves needing care, they're covered.

 

[bicker]

Some can't afford the numbers being thrown around here.

Okay, but then who do you feel should pay for the health care for folks in that situation?

 

[dhardawa]

The "negotiated" fee. Indeed, it's not really negotiated... it's a take-it-or-leave it fee, and that's why some doctors are leaving it.

I work in the contracting area of an insurance company and this is 100% false. Most providers are mailed a fee schedule, review it, and sign the contract with no negotiation, but for those who want to negotiate, the rates are not fixed. Often we see trade offs where a provider will accept much less for a service s/he rarely performs in exchange for more for regular services.

Also, for those concerned about all the doctors dropping insurance, it isn't going to happen. We have doctors beating down our doors trying to get in to our network so for each one who drops insurance, there are 10 more to take his/her place.

 

[bicker]

It is not surprising that the insurance industry and physicians disagree about the nature of the "negotiation". Thanks for providing the balancing perspective.

 

[mhsjax]

It is not surprising that the insurance industry and physicians disagree about the nature of the "negotiation". Thanks for providing the balancing perspective.

Agree with you. OUr physicians never had much wiggle room, maybe a small amount, but there were no real negotiations. The joined form the patient stand point, as in this insurance plan will bring me X number of new patients, or if I decline this insurance plan I will loose X number of patients.

Also to the pp that said she knew a radiologist making $800,000.00 a year. Check his mal practice fees, they are killing him.

 

[sbell111]

The reason I ask is that for about a year and a half (several years ago - long before I had the doctors I have now) I was without insurance.. The doctor's office I went to then (several doctors in the practice) charged me $30 per visit.. Are the doctors really receiving less than $30 per insured patient?

It depends. Depending on the lkevel of visit, a contracted provider may certainly make less than $30 per office visit. However, he also will be paid for each service that he provides during that visit.

Also to the pp that said she knew a radiologist making $800,000.00 a year. Check his mal practice fees, they are killing him.

In 2000, the average professional liability premium for radiologists was $19,000 per year. I don't know specifically how much this has increased since 2000, but I did find historical data and current data for other specialties that showed an increase of 268% since 2000. Therefore, I would guess that the average annual premium now is about $51,000. That fee probably would not 'kill' a radiologist making 800k annually.

 

[Geoff_M]

In Massachusetts, we've very successfully started fixing this injustice, ensuring people who work and make money in the Commonwealth pay their fair share into the system, so that when they find themselves needing care, they're covered.

I think its a bit premature to claim that. The "Massachusetts Medical Miracle" has plenty of its own problems, and "cost shifting" is alive and well in The Bay State as it's citizens are quickly learning how to game the system. As a kicker, Massachusetts' ERs are as busy as ever treating non-emergency conditions.

 

[bicker]

I think it's a bit premature to claim that.

No, not at all. Nothing is perfect. The issue is whether THIS is better than THAT. Living here, I can tell you with assurance that I find THIS is better.

And, of course, it is fairer. Not absolutely 100% fair - again, nothing is - but fairer than how things were, and fairer than how things are where such approaches are not used.

 

[DWGal210]

Isn't the issue WHO we feel
should cover the lions share of our healthcare costs? Should that be insurance or the consumer is certainly a hot button issue. But I guess I thnk that if we (we as a society) feel that it's unfair or not possible to pay OOP for non catastrophic medical cate, we can't be too surprised if costs go way up & doctors decide to go it on their own. Unfortunately, we can't have it all ways where costs are low, fees & premiums are low, and the majority of costs are covered by someone (federal, insurance, etc). It just can't all work. There has to be something that gives. I guess the question is, what is that give?