State Orders Dr. John Muney to Stop Treating Patients for $79/month

http://blog.americanjusticecenter.com/2009/03/state-orders-dr-john-muney-to-stop.html

by Dave C. Jones

I was listening to Tom Sullivan yesterday and heard about Dr. John Muney of New York and his innovative method of servicing those who cannot afford health insurance. In a nutshell, he charges his patients $79 per month plus $10 per visit. In other words, for about $1,000 per year, his patients do not have to worry about routine illnesses or anything else that can be taken care of in Dr. Muney's offices.

Who could possibly have a problem with that plan? Apparently, the New York state insurance regulators do. The state told Dr. Muney that his plan is an insurance policy and he has to be licensed to sell insurance.

Give me a break. The government cries out of one side of its mouth that society has an obligation to ensure that every person has access to health care; then, out of the other side, it berates doctors who do something to make that goal a reality. What the government really wants is complete control of everything. If the government really cared about the people, New York state would have no problem with what Dr. Muney is doing. In fact, the state should be recommending that idea to doctors all over the state.

Unfortunately, the state sees money running through its fingers. Rather than Dr. Muney submitting claims to Medicare, he collects cash. Rather than paying the state insurance licensing fees, he shuns insurance, enabling his patients to pay cash. The government worries that if all doctors did this, the government would not be able to continue employing people to process insurance, doctors could cut overhead by laying off insurance billers and accounts receivable employees, and the economy as we know it would end! Good grief.

The bottom line is that what Dr. Muney is doing here is not conceptually different from what attorneys do when they allow clients to sign a retainer agreement. In essence, a retainer agreement secures the right of the client to call the attorney with any legal problems the retainer agreement says are covered and to have the attorney handle them for an agreed upon rate (either included in the retainer fee, hourly, or flat fee). The "client" may never call the attorney for advice, just as the "patient" may never come in to see Dr. Muney.

I don't know how Dr. Muney's agreements are written or structured, but any good civil attorney should be able to help Dr. Muney modify his agreements so they are essentially putting him on retainer for each of his patients. The agreement would be that Dr. Muney would see the patient within X number of hours for any of the problems he can handle in his office for a retainer fee of $79/month and a flat $10 per problem.

If the state still has problems with the arrangement, it must have a problem with attorney retainer agreements. And, if that is the case, I'm sure there are hundreds or thousands of attorneys who would step up and defend the retainer agreement in both law and medicine.

It's time that people see government for what it is—a leviathan that would rather take complete control of everything rather than fix anything. Just ask Dr. Muney's patients.

 

Wow. Just. Wow.

I don't know if I'd agree with the prices - they look low to me - but. Wow.

So, I just joined a health club. I pay $39 a month, plus $5 per class. This is, or seems, equivalent to what Dr. Muney is doing - and yet Taxachusetts has no problem with it. I believe no state does.

It's not as if every, or even any, other physician is going to follow suit - but it's brilliant, it's affordable, it fulfills an apparent need...

 

This doctor IS offering insurance - he is charging $79 of premium for an unlimited amount of "standard care" (care that can be provided by a family physician).

Dinallo is right - this is a profoundly bad idea, and should not be permitted.

First of all, insurance companies are required to maintain minimum levels of capitalization and reserves. This is so they can be relatively assured (in this current climate, nothing is certain ) of being able to meet the obligations they have incurred associated with the premium they have collected (paying out) when they become due. Although this doctor has not committed to pay out cash, common sense dictates that he could only conceivably provide a finite amount of medical care to a finite number of people in any particular period of time. What will happen when he realizes he bit off more than he can chew, particularly since his obligations is unlimited in nature? Which brings me to the second reason this is a bad idea -

Second, an insurance company is a third party payor. It relies on a regulatory scheme to determine when it should pay one party for a service that party provided to another party, and in what amount. The insurance company itself does not provide the service, and all parties rely on established rules to decide what will happen. The present situation is ripe for misunderstanding, confusion and discrimination, since the doctor here is judge of jury of what will happen.

This is nothing like a retainer agreement. A retainer agreement either provides a lump sum payment which is credited until it runs out, and then more money is due, or provides for payment at a particular rate.

In light if these and other reasons, I'm pretty sure the reason the state doesn't like this idea is NOT because insurance related clerical employees will be out of jobs!

Jane

 

OMG that is crazy!!! The insurance company needs to ****!!! greed pigs. This Dr. Is saving people money. What happend to people being able to spend there money how they want.

 

Sorry but it isn't even close to the same thing. You health club has figured out that with expenses and profit margin it costs each member whatever amount to run the health club. What the dr is doing is setting a flat rate for services no matter how much they really cost-it is an insurance policy but the simple answer is get an insurance license. It takes a couple weeks of classes and to pass a test. He would then have to form his own insurance company because you can't be licensed without being appointed by a recognized insurance company in your state, he would then have to file all of his fees with the state, etc.

The issue is the regulation of the insurance industry. People don't realize just how regulated it is and this most certainly is an insurance policy. Do it within the state laws and he is fine.

 

I hope and believe this doctor will rework this thing and be able to continue. He wants it and his patients are happy with it or they'd move on.

I wonder if he has turned people away if they start to come in too often, etc.

 

If I was him , I would just say it $89 a office vist a month. He should be able to charge whatever he wants for his office

 

The problem with this system is that insurance companies are required to have cash reserves. So lets say one month that the insurance company has a ton of expenses -everyone gets sick at once -the insurance company can still handle it.

If this guy has ALL his patients get sick at once -he may not be able to care for them in timely manner. That is why it is illegal

 

That would be fine but it isn't just the office visit he is charging for. It sounds like he is providing all of their care for that flat fee, no matter what it costs. If you go in with a broken arm, need a few x-rays and a cast it costs the same as if you went in to get your ears checked for an ear infection. The flat monthly fee covers anything.

 

He should be allowed to run his business as he sees fit. I dont see him breaking any laws here.

 

Don't you think if you own a business. You should be able to charge what prices you want. I would hate to own a business and the gov come in and tell me what I could charge

 

Yes, you can charge what you want but he isn't doing that, he is collecting a premium to cover any and all care--it is VERY different then charging someone $10 for a shirt. It costs the same if you go in for an ear check as it does to go in for an MRI and a spinal tap--THAT is why it is an insurance policy, not just someone charging what they want. There are laws about what people can charge for goods too, which is why you don't see gas stations charging 1/2 of what their competitors do or that they get fined for price gouging in various situations too.

 

I have never been to a Dr office that could do Xray. They would have to send you somewhere to get that done, I would image that this is just for his normal office visit.

 

Our dr's office has everything right there, x-ray, MRI, full lab, ultrasound, etc. We don't have to go anywhere else to get anything done (unless you have to go to the hospital for surgery, etc.). I have never been to a clinic that DIDN'T have all that there.

 

Its his business. He doesn't need a cash reserve as he is the one supplying the service and willing to take a loss if needed. An insurance co is a third party taking the responsibility of paying a service by someone else, not the same thing.

We are an A./C company and have flat fee monthly contract amounts that cover services. For this flat fee we cover basic services and anything that might come up throughout the year. Basically the same thing.

 

Ours doesn't have anything, they will send you to get all of that stuff done.

 

All members of my family have their own doctors, and each respective office is able to do on-site Xrays. They don't have to outsource a patient.

That being said, there are a myriad of reasons why a doctor who is licensed by the state in order to practice in the first place must adhere to certain business practices. There's no question that the current system is broken, but the solution must be implemented by all who practice medicine and who charge for their services.

 

Sorry, but again, not the same at all as your heating and cooling business. Health care is a vital commodity - there is a very real chance that someone could get hurt or die if this doctor overextends himself and suddenly can't provide the volume of health care to all the individuals he has collected from. If, on the other hand, he decides not to overextend his practice and engage in risky behavior, and instead tells some people, sorry, I can't treat you anymore, how do they get their money back? His prices are pretty low, and chances are he's already spent the money he's collected.

It goes back to lack of regulatory oversight, and the likely inability of one individual to ethically and safely engage in his own "system" that is far beyond the bounds of what is happening anywhere else.

Jane

 

Laws may vary state by state, because here in Massachusetts I have heard radio ads and read newspaper articles about multiple physicians doing the exact same thing. They have a set number of patients paying a certain amount per month, and they see those patients on call (even make house calls). They market it as returning to the old fashioned practice of medicine where you had a family doctor.

Maybe they went through some legal hoops that this guy in NY neglected to do, but it seemed to me like a business model that was gaining popularity at least in Massachusetts.

 

But insurance companies aren't complaining, at least not yet. The government, in the 'person' of the State of New York, is.

Do you really think this medical professional is such a bad business person that he would overextend himself, or not have a backup plan in place?

And how do you account for, or treat, people who don't HAVE insurance?

Oh, and the physicians to whom daisax refers charge a LOT more than $79 per year membership fee.