MD dropping out of all insurance plans

[powellrj]

Our family Dr left his practice 3 years ago to open a concierge practice in another town. We were lucky that another Dr took over his patients and we love her. A few months before he left, my OB/GYN who was a friend of his retired at the age of 38. I can't help but think the insurance situation had some part in it. Our dentist also retired at a young age and moved to Panama because he said he could work less and make more down there.

 

[Nancy]

Don't think so. I think this is going to become much more common in the near future. Honestly, when I look at the explanation of benefits that I receive from my insurance for Dr visits I often wonder how these practices survive to begin with. Often times it is pennies on the dollar.

But that is the contract they negotiated with the insurance. If they didn't like the reimbursement rate they didn't need to sign on. I have 2 doctors that bill with the same office visit code, the same amount is charged but they each have a different allowed amount.

 

[Handbag Lady]

Why can't you keep going and submit it yourself? then get the reimbursement instead of the Dr's office? That is how it used to always be. Dr's never did the insurance for you, you paid and them submitted it to your company.

Oh, sure, if you just happen to have buckets of cash sitting around. Many, many people are paying so much each month just for their health insurance, paying more out of pocket in advance just can't be done.

 

[honugirl]

Oh, sure, if you just happen to have buckets of cash sitting around. Many, many people are paying so much each month just for their health insurance, paying more out of pocket in advance just can't be done.

You do what you have to do to get it done. I had no choice but to pay OOP for my specialist because he's the best for my diseases and many of my friends are in the same boat. You scrimp and save and cut back where you can to make it happen. Many of my friends can't work due to our illness, but somehow they make it work. Many of us also have the added expense of travel since we don't live near our doc (airfare, hotel, food, etc.). I'm a college student myself (so I pay OOP for my insurance premiums too). You do what you have to do to survive and if that means paying OOP to see the best, that's what you have to do.

For emergent issues, many docs will let you pay on a payment plan if you are planning on paying cash. They will work with you.

 

[15isto2]

Our family Dr left his practice 3 years ago to open a concierge practice in another town. We were lucky that another Dr took over his patients and we love her. A few months before he left, my OB/GYN who was a friend of his retired at the age of 38. I can't help but think the insurance situation had some part in it. Our dentist also retired at a young age and moved to Panama because he said he could work less and make more down there.

RETIRED at 38!! He must have made a shedload to be able to do that

 

[Rumpus]

This will be a short lived trend for doctors when their practices plummet. I don't know of anyone who will continue to go out of pocket for a doctor. The other thing to consider is that this doctor will also not be able to admit a person to the hospital if they are not participating in the patients insurance plan. Something to keep in mind if one chooses to pay out of pocket.

Believe me..I know the paperwork is horrendous(I deal with it everyday), but the bottom line is if a doc wants patients and they choose to omit the whole Medicare population, they're going to have to look for a lot of sick millionaires!

Not so. Many physicians no longer have the time to follow their patients to the hospital and often turn their care over to hospitalists. Many have have been dropping out of Medicare for a while. With the cuts to Medicare, it actually costs physicians to see patients.

 

[Planogirl]

Do some of these physicians plan to only see the rich? What about perscribed drugs? I have to take certain things and they must be perscribed by an in-plan physician. I couldn't afford to buy these drugs out of pocket.

 

[LuvOrlando]

I'm waiting for hospitals to open up along side the casinos on Indian reservations. As more & more states open up to gambling the reservations will lose income and look for the next big cash cow, I think this will be it. its just a matter of time before medical co-ops pop up

 

[wvjules]

So when all of the good doctors stop accepting Medicare, what happens to the elderly?

 

[mhsjax]

But that is the contract they negotiated with the insurance. If they didn't like the reimbursement rate they didn't need to sign on. I have 2 doctors that bill with the same office visit code, the same amount is charged but they each have a different allowed amount.

This is why they are now leaving. In the past Dr's did it so they could keep patients, I think now they have had enough. None of the Insurance companies pay that much more than the other when it comes to negotiated rates.

Now the Dr's are saying they won't sign on, and this is what is happening, they refuse to bill and the patients must pay.

 

[Octoberbride03]

But that is the contract they negotiated with the insurance. If they didn't like the reimbursement rate they didn't need to sign on. I have 2 doctors that bill with the same office visit code, the same amount is charged but they each have a different allowed amount.

I can't imagine they had much of a choice in reimbursement rates. But I'll be able to compare shortly as Aetna kicks in for me on Sat. till then its Anthem. But I don't see the reimbursement to Drs going up all that much when the idea of insurance is to save employers/employees money.

So when all of the good doctors stop accepting Medicare, what happens to the elderly?

I don't know what happens then. But I am 37 going on 38 and I don't believe that Medicare will even exist when I get to 65. Or Social security for that matter. My DH and I are working at clearing all of our CC debts and have stopped using them so that we can build savings for when we need it, because we cannot count on the govt. We can only count on ourselves.

 

[bicker]

Do some of these physicians plan to only see the rich?

The best ones surely could do that. They have to make the decisions that are best for their family, just like you and I make our decisions based on what's best for our families.

So when all of the good doctors stop accepting Medicare, what happens to the elderly?

They suffer.

 

[Octoberbride03]

For emergent issues, many docs will let you pay on a payment plan if you are planning on paying cash. They will work with you.

This is true. Lots of places will work with you. When I was in my 20s and had no health insurance I had an MRI for my hearing issues, and paid cash to the MRI center. I actually wound up paying them a couple of hundred dollars for the test. And after having some CT scans and other tests done after getting insurance I suspect that what I paid actually got them a better return than co-paying insurance would have.

I'll tell you though all this insurance/healthcare stuff going on now makes me very glad that I am not smart enough to be a Dr.

 

[sbell111]

If my doc decided not to accept my insurance, I would change docs.

This isn't a complicated decision, at all. Heck, one of the qualifications that I had when I chose him to be my doctor was that he accepted my insurance.

 

[Rumpus]

If my doc decided not to accept my insurance, I would change docs.

This isn't a complicated decision, at all. Heck, one of the qualifications that I had when I chose him to be my doctor was that he accepted my insurance.

That certainly is an easy choice if your insurance isn't Medicare....or medicaid. With so many physicians dropping both of those, the choices aren't so easy.

 

[sbell111]

Do some of these physicians plan to only see the rich?

The best ones surely could do that. They have to make the decisions that are best for their family, just like you and I make our decisions based on what's best for our families.

So when all of the good doctors stop accepting Medicare, what happens to the elderly?

They suffer.

You answered those two questions as if the doctors being discussed in each question are teh same. Of course, they are not.

Could some doctors who currently see Medicare patients opt out of all insurance and only care for the rich? Sure, a very small percentage of them could. If this percentage is over 2 percent of the doctors who currently see medicare patients, it would be a huge shocker.

The remaining 98% could not do this simply because there is not enough demand. In fact, it would be VERY surprising if there was enough demand to allow even a fraction of this very small percentage of doctors to do this.

This leads us to your second answer. You are hypothesizing that all good doctors will stop accepting medicare. I have seen NO data that suggests that this will happen. In fact, it is about as likely to happen as all doctors leaving any major commercial payor's plan. It's not that it isn't likely to happen, but it is that it is almost impossible for it to happen because the payor would simply adjust its payment methodology and reporting requirements to stabilize its network.

 

[sbell111]

That certainly is an easy choice if your insurance isn't Medicare....or medicaid. With so many physicians dropping both of those, the choices aren't so easy.

You make it sound as if the majority of doctors are dropping out when this hasn't been shown to be true.

 

[bicker]

You answered those two questions as if the doctors being discussed in each question are teh same.

No, not necessarily. There is no reason to read into what I wrote that way. Each statement stands on its own.

Could some doctors who currently see Medicare patients opt out of all insurance and only care for the rich? Sure, a very small percentage of them could.

Uh, okay. I would expect that a very small percentage of physicians would be consider the "best", which is what I said.

This leads us to your second answer. You are hypothesizing that all good doctors will stop accepting medicare.

Uh, no I'm not. wvjules did that. I think you're very confused about which message you're replying to.

 

[Rumpus]

You make it sound as if the majority of doctors are dropping out when this hasn't been shown to be true.

A doc doesn't need to "drop out" to limit their financial exposure. Fewer follow up visits, limiting the number of Medicare patients per day or per week, filling only the slots that are left by those patients who have private or group health insurance or self pay. There are lots of ways to avoid losing money in a practice each day.

 

[wvjules]

You answered those two questions as if the doctors being discussed in each question are teh same. Of course, they are not.

Could some doctors who currently see Medicare patients opt out of all insurance and only care for the rich? Sure, a very small percentage of them could. If this percentage is over 2 percent of the doctors who currently see medicare patients, it would be a huge shocker.

The remaining 98% could not do this simply because there is not enough demand. In fact, it would be VERY surprising if there was enough demand to allow even a fraction of this very small percentage of doctors to do this.

This leads us to your second answer. You are hypothesizing that all good doctors will stop accepting medicare. I have seen NO data that suggests that this will happen. In fact, it is about as likely to happen as all doctors leaving any major commercial payor's plan. It's not that it isn't likely to happen, but it is that it is almost impossible for it to happen because the payor would simply adjust its payment methodology and reporting requirements to stabilize its network.

That was me. I asked bicker a direct question and he answered it. He didn't hypothize anything.