MD dropping out of all insurance plans

[southern_redhead]

And all of this will cause an even bigger burden on the ER's - because people need to go "somewhere"..
....

If this becomes a widespread trend, ER's will become a much, much bigger nightmare than they are now.

This is the absolute truth. In our small town there are TONS of people on the free state health insurance (due to job loss/poverty) but doctors aren't accepting new patients carrying this insurance so...they have to go to the ER for treatment of even small things like a child's cold or ear infection. It makes no sense.

Years ago when we first moved back "home" my DH was laid off before he could become "permanent" at work (thus eligible for benefits) and we put the kids on state insurance until he found a new job with benefits. With 3 small children, one was seemingly always sick and I would have to take them to the ER for what I knew would be an ear infection or strep throat. I spent that whole period of time apologizing each visit and saying "I'm so sorry, this isn't an emergency, but my child has an ear infection and needs medicine and with this insurance we can't get in to see a doctor." or something similar. Thank goodness the doctors were all understanding. When I went back to work the first thing I did was purchase insurance due to DH's job being one where changes companies every few years and it is always new insurance/learning curve. So glad to be done with that.

I have to say that I think good doctors are few and far between. The vast majority of them have also lost sight of being "healers" and are more worried about the bottom line (their pocketbook.) One of our local practices actually discouraged one doctor from giving the correct medicines and making a person better..."We give them steroids/decongestants so they get better for a bit and when they flare up again they come back and do another office visit." This was straight from the (p***ed off) doctor's mouth!

 

[Buckeye Princess]

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

Or saved a shedload. It is how much you save, not how much you make.

 

[bicker]

This is the absolute truth. In our small town there are TONS of people on the free state health insurance (due to job loss/poverty) but doctors aren't accepting new patients carrying this insurance so...they have to go to the ER for treatment of even small things like a child's cold or ear infection. It makes no sense.

The American taxpayer generally has a different perception of "sense" than the American consumer of health care services. (And yes, imagine how interesting that is when they are one-and-the-same person, essentially disagreeing with themselves, depending on which side of the coin they happen to be thinking about at the moment.)

There is very little chance, I suspect, of getting the American taxpayer to fund state-funded insurance for the poor that is worth sufficiently more to doctors to warrant them being more generally receptive to patients with that insurance.

I have to say that I think good doctors are few and far between. The vast majority of them have also lost sight of being "healers" and are more worried about the bottom line (their pocketbook.)

I think you've got the chicken-and-egg backwards: As long as being a physician was practically an air-tight lock on being affluent, they had the luxury to view their work as a noble calling, and project that Marcus Welby image that you seem to relish. With cost pressures coming from skyrocketing insurance rates, from HMOs and other cost-reduction measures those paying for health care imposed, as well as from other directions, that luxury is one that most doctors entering the job market today cannot afford.

 

[Disnydad]

Our dentist did this several years ago. After a couple of years we found another dentist who does take our insurance.

 

[LuvOrlando]

:

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.

I don't know about this, not because of my own feelings but because of how market forces work. The best Dr's have the highest demand and prestige in ANYTHING costs more. The top Dr's will be able to draw more people to them and statistically, the more people who want you the more likely
to have a sustainable number of affluent customers in the mix. this whole scheme is intended to make healthcare more affordable and to do that they should have just worked within the parameters already in existence. Now the applecart has been overturned and no-one can be sure of the outcome.

What I DO know is that I am steering my 2 kids away from being surgeons. NO way will I continue to encourage them to give up a decade of life, lost income and tuition debt for an uncertain outcome. I hope the people in charge have something in mind to draw kids into the profession because so far it seems more thankless than teaching with a staggeringly higher personal and financial cost. Not for my kids, maybe they should be stage hands at Lincoln Center I hear they make an average of $290k with nearly zero education or licensing.

 

[sbell111]

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

He agreed with your flawed premise. Same thing.

 

[sbell111]

This is the absolute truth. In our small town there are TONS of people on the free state health insurance (due to job loss/poverty) but doctors aren't accepting new patients carrying this insurance so...they have to go to the ER for treatment of even small things like a child's cold or ear infection. It makes no sense.

TennCare access to care standards require PCPs to be available within 30 minutes or thirty miles from the member's home. As of last month, all TennCare plans met this requirement statewide. In fact, if a plan were to be found failing at this standard, it would be required by the State to contract with additional providers regardless of the cost to the Plan.

It is much more likely that people in your area are not happy with having to travel the thirty minutes to the contracted providers and choose to instead visit the ER for care.

It should also be noted that a good number of people on TennCare are not on the free Medicaid product, but are actually on TennCare Standard which has premiums and copayments based on income.

 

[Lisa loves Pooh]

Admittedly, I am confused...

Is this refusing assingment (meaning they file and do the leg work in getting payment from insurance) or is this complete refusal in that you cannot even make a claim at all.

We saw a psychiatrist and she did not accept assignment. She was a one woman show and opted to be private practice with no employees and no time to chase down insurance companies. Our insurance still covered her, we just had to get reimbursed.

It does take work and initial hits can be huge until the reimbursements come in, but then at that point, we used our reimbursements to l
Pay for visits.

As for it being Christmas time and not a good time to make major changes....

It is common practice for things to run on a calendar year. Additionally, when one gets hired, you have a short window to make decisions...

Christmas is not an excuse to avoid life and then blame the doctors change for it.

You were notified, even if it wasn't within your timeframe. If I am not mistaken, a PCP can be changed at anytime. You aren't locked in for the year. So you can have more than 30 days. It might mean some inconveniences while you shop around. But they gave ample notice.

 

[bicker]

He agreed with your flawed premise. Same thing.

Uh, no. I responded to the scenario set out by the previous poster.

Please stop with this silliness. Thanks.

 

[arminnie]

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.

Every single one of my many doctors in California dropped out of all insurance and Medicare by 1998. Their practices are totally full. They can rarely take a new patient.

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.

And that is exactly why they are now dropping out.

And in my opinion NONE of these doctors did this for money. My internist is truly one of the best and most caring docs ever. An annual physical with her was a 2 hour appointment. She wanted to practice medicine the way she thought best for her patients not how it was dictated by the insurance companies. She limited the number of patients so it did not take 2 months to get an appointment.

I never had such excellent care. Unfortunately I will have to go on a Medicare supplement in a few months. I would love to find a concierge practice (generally about $2500 a year). My health would so be worth it.

I made 8 trips to the ER of which I think only 3 at most were really ER situations because it takes months to get an appt. when I am in Arkansas. It's actually easier to get an appt. with a doctor who does not take Medicare at all as most practices severely limit the number of patients and appts. for Medicare patients.

I had sleep apnea surgery (which worked) in 1993 from doctors who were not in my plan. I paid a lot out of pocket to go to them, but this surgery was very experimental at the time (tongue moved) and my doctors invented this surgery. I didn't want to go to someone who had to open a book to figure out to do the surgery. Most sleep apnea surgery has a dismal success rate (way less than 50%). My doctors' success rate is well over 90%. And he has never charged me again when I go for a checkup every year or two.

 

[sbell111]

Uh, no. I responded to the scenario set out by the previous poster.

Please stop with this silliness. Thanks.

I think we've all read enough of your posts to know that if you disagreed that you would throw down three or four rather condescending paragraphs explaining why the person is incorrect. You wouldn't run with the premise that you disagreed with to give a pat answer.

 

[bicker]

I would if I didn't care one way or the other, with regard to the premise, and the point I was making was served by doing so. Again: Please stop with this silliness. Let's just discuss the topic.

 

[LindaG4458]

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.

My insurance, BCBS PPO, pays NOTHING out of network. It's too late to change this year.

 

[LindaG4458]

Admittedly, I am confused...

Is this refusing assingment (meaning they file and do the leg work in getting payment from insurance) or is this complete refusal in that you cannot even make a claim at all.

This is complete refusal. My plan will not pay out of network. Although she wrote the letter 12/1. she mailed it on 12/14. With forwarding, I got it on 12/24, hardly adequate notice. Now I have to find another participating doctor. It's ok, I will find someone else, but it will be interesting to see who is accepting new patients. I aready have an appointment with a neurologist and gynecologist in FL so will ask them for recommendations. Of course, that is assuming that they are still taking the insurance and I can go to them.

As for it being Christmas time and not a good time to make major changes....

It is common practice for things to run on a calendar year. Additionally, when one gets hired, you have a short window to make decisions...

Christmas is not an excuse to avoid life and then blame the doctors change for it.

You were notified, even if it wasn't within your timeframe. If I am not mistaken, a PCP can be changed at anytime. You aren't locked in for the year. So you can have more than 30 days. It might mean some inconveniences while you shop around. But they gave ample notice.

By the way, I never blamed anything on Christmas or the holiday season. We made our 2011 insurance choice in November during the first week of selection. We don't postpone making decisions.

 

[C.Ann]

I'm curious about something.. If I understand correctly, it's not just Medicare that some doctors are no longer billing, but rather any type of insurance at all - right? The reason being that the out-of-pocket fee will be higher than the negotiated price with the various insurance programs.. Does anyone know what the doctor receives as payment if they are paid by the insurance company rather than the patient?

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?

 

[luvwinnie]

The rheumatologist I used to see in NYC did not accept any insurance. I loved him. He was the only dr. who spent enough time with me to figure out what was wrong. I could email him any time and he would reply quickly. First visit was $450, from then on they were $260. I only got reimbursed if I saw him more than 2x in a year. I switched due to cost, but I'm regretting it.

 

[Bell30012]

A doctor is a business. He/She provides a service. They have overhead and costs in running this business. When they no longer agree with the terms that insurance companies or government (in the case of medicare/medicaid) offer they have the option to refuse to take those plans.

Insurance companies and the government have forced doctors to accept lower amounts for their services for years. Now some doctors are declining to accept those patients.

 

[rie'smom]

The rheumatologist I used to see in NYC did not accept any insurance. I loved him. He was the only dr. who spent enough time with me to figure out what was wrong. I could email him any time and he would reply quickly. First visit was $450, from then on they were $260. I only got reimbursed if I saw him more than 2x in a year. I switched due to cost, but I'm regretting it.

He sounds like our internist who is worth every penny we pay out of pocket.

 

[LaraK]

only community er's, private ones refuse you at the door

,,

Unless you are Dying or require maternity assistance to save the unborn childs life

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.

 

[manning]

My endocrinologist has a booming business and does not do any insurance at all. I pay OOP to see him. Trust me, this isn't going to kill off a good docs practice. I know it's a huge choice for some that go to him, but he's the best. I don't bother billing my insurance because what they would pay me to see him is peanuts. It's just not worth the time and the effort to deal with the paperwork.

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.