How is it possible that a residency dropout is able to get paneled with all these insurances?

[B52slinger]

Just saw an interesting ShareCare profile of an alumni of my medical school's general surgery residency who was fired in PGY-2 due to substance abuse issues. He is now practicing FM full-time in NYC, with these insurances listed on his profile:

I thought that you had to complete residency and become board certified to get paneled with all these insurances in NY state? He is not board certified or eligible as he has only completed 1.5 years of residency training. And how can he claim to be a Family Medicine doctor on all his profiles when he has zero residency training in FM? His patient reviews seem to be good though lol

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[Sushirolls]

Does it really matter?
Glad the guy is making a living in medicine and didn't get chewed up spit out just so an ARNP could fill that vacancy/demand.
Kudos to guy.

 

[B52slinger]

Does it really matter?
Glad the guy is making a living in medicine and didn't get chewed up spit out just so an ARNP could fill that vacancy/demand.
Kudos to guy.

Yeah, definitely not hating on him. Just curious and surprised because I was told that with only a license, one could only get paneled with basic medicare/medicaid. But that does not appear to be the case here?

 

[randomdoc1]

Oxford and Harvard Pilgrim are United products. So bottom of the barrel. Cigna sucks too. The others look like smaller insurance companies. So that is part of your answer. You can probably also talk your way into more panels especially if you offer to address an area of dire need and/or accept a lower fee schedule.

 

[whopper]

If he hasn't finished residency (and this would then force the answer of how do you know this? You didn't tell us when he was kicked out of residency and how long it's been. He could've completed residency at a different program), he could've lied about his credentials and somehow got away with it.

Another situation that could've happened is he might've found some exceptional clause. Some states have enacted methods for people with MDs to practice without graduating residency although these exceptions are rare and bring up several insurance questions as to whether they are covered or not by insurance. Missouri, for example, has an "Assistant Physician" status that allowed MDs or DOs to practice without finishing residency so long as they are under the supervision of a licensed MD or DO.

I haven't researched NY's laws about this, but I did read that recently they allowed NPs to practice on their own without physician supervision (Someone correct me if I'm wrong cause I didn't decide to jump down the rabbit-hole and fully read into it). Heck if that's the case maybe they'd let an MD or DO practice without finishing residency as the education training for an MD that half finished residency is more than what most NPs get.

 

[calvinhobbes]

I think in NY you only need one year of residency to practice and you can get a state license. It’s rare but people still can be self-employed or find insurance companies to cover them. This person can also have received an online NP lol, but still practice and advertise as an MD

 

[splik]

some insurance companies have a credentialing for GPs (i.e. you have a licence, no residency) and they pay you less than they would otherwise. It's really not unusual. I know several people who are credentialed as GPs and practicing psych with insurances even though they never did a psych residency, not even part of one.

 

[B52slinger]

some insurance companies have a credentialing for GPs (i.e. you have a licence, no residency) and they pay you less than they would otherwise. It's really not unusual. I know several people who are credentialed as GPs and practicing psych with insurances even though they never did a psych residency, not even part of one.

So are these people listing themselves as "psychiatrist" on ZocDoc, PsychologyToday and other websites? Even though they are credentialed as GP?

And yeah it looks like a lot of the medicare advantage plans paneled him

 

[Sushirolls]

The applications with insurance paneling are varied.
Some ask about BE/BC
Some ask about hospital privileges AND back up... I didn't bother with that one.
Some just have you list CV details of training and what not but don't really hint or draw extra attention to BC/BE.
Many have separate / different applications for the mental health side of things compared to general medical.

Really don't know until you crack open an application.