Not accepting insurance?

[brodaiga]

I don't know much about this, so no flaming. What if a physician does not take insurance and instead leaves it to the patient to get reimbursement themselves?

Now, if the patient has no way of paying for healthcare, say a cc, check, cash, whatever, then insurance will be accepted.

I just read an article about dentists doing this. Thoughts?

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[DropkickMurphy]

I know a lot of plastic surgeons, dermatologists and ophthalmologists require payment up front. I personally think this is a great idea and if I were to pursue one of these specialties this is exactly how I would operate. Granted I would also do pro bono work because I think that is just a necessary part of medical practice, but I believe those who have the money should be expected to pay.

 

[ShyRem]

There are doctors that don't take certain insurances. They bill you, you submit the bill to your insurance and pray they'll reimburse it. However, often these days if the physician doesn't take that particular insurance you'll get a runaround about a reimbursement. I am currently part of an HMO where I live - twice while traveling I had to go see a doc about a sinus infection and had to pay for it out of my own pocket. I brought the receipt back to my insurance company and they cut me a check within 7 days (the visit was "medically necessary" and I was "out of the area" and the problem "could not wait").

I do hear of doctors doing this because of the awful paperwork many insurance companies demand. In fact, there are many doctors that won't take worker's compensation for just that reason. Makes it difficult for the poor patient - I was one this happened to. I had a potentially very complicated problem and after waiting for 3 months for the appointment, the specialist in Colorado informed me two weeks before my appointment that he didn't take worker's comp insurance. Since I couldn't afford the potentially tens of thousands of dollars it would have cost, I had to find another doctor (farther away) that would take worker's comp insurance. The end result was my surgery wound up delayed by a total of 8 months and I did my own rehab. That sucked.

Bottom line: insurance requirements and restrictions are getting more and more problematic for medical professionals of all types. Not to mention the very low reimbursement rates from certain insurance companies. I see in the future more and more medical professionals becoming predominantly private pay and leaving the fighting with insurance companies to the patient.

 

[Non-TradTulsa]

I don't know much about this, so no flaming. What if a physician does not take insurance and instead leaves it to the patient to get reimbursement themselves?

Now, if the patient has no way of paying for healthcare, say a cc, check, cash, whatever, then insurance will be accepted.

I just read an article about dentists doing this. Thoughts?

Okay, no flames, just a serious answer from someone who's been on the business side of medicine for years.

You could use this business model with people who have conventional indemnity health insurance - but those patients (who are completely outside managed care) are getting quite rare and they're disappearing fast.

Health maintenance organizations and other managed care providers are not going to allow you do this - you will be obligated to bill on behalf of the patient as a condition of your contract with the payer. There is a valid business reason for this - they don't want to look at the superbill you gave to the patient - processing claims by hand is extremely expensive - they want to see a HCFA-1500 form which has all of the data required to process a claim in a standard format. (Dentistry, by the way, is not as far advanced in standardized billing as medicine is - the systems are in place for dentistry, but they're not as mandatory as they are in medicine).

I used to know a few physicians who practiced in certain specialties who refused to contract with any managed care organizations - because they were pretty much "sole providers" of their specialties within their communities. But I don't know any doc who still does this. If your patients are submitting bills from a non-contracted provider, the first thing the managed care organization is going to do is request records from the patient - they'll drive your patients and you crazy, and they know it. But - if they don't have a contract with you, they can't request records from you directly. And they will want to see records from non-contracted providers.

Medicare also frowns a great deal on "non-participating" providers who don't bill. Medicare payments to contracted providers include a "practice overhead" component which, at least in theory, is supposed to cover your expense of billing and collection.

Fortunately, the "paper blizzard" of billing is going away. Right now, smaller physician practices are exempt from electronic filing - but pretty soon, everyone will be transmitting all their bills electronically and payments/remittance advices will all come back electronically. Electronic billing was rough in the early years, but it's pretty slick these days.

 

[GoodEats]

I've heard of a family doctor who did not want to practice medicine by getting people in and out as quickly as possible, so he charges twice as much, requires patients to pay up front, but spends twice as long with each patient.

I mentioned this to one of my interviewers, and he said that it was called boutique medicine. Google churned up this for me: http://www.acponline.org/journals/news/oct01/new_model.htm

 

[DropkickMurphy]

Hmmmm.....working for a consortium of EM docs is looking better and better.....

 

[Non-TradTulsa]

I didn't want to bring up "concierge" medicine because it's so controversial - but, you're right, that's another option. I think if a physician accepts the annual retainer as full payment for services rendered - or at least if the physician requires patient payment for all services, he'll stay within bounds of what's permissible. But most "concierge" practices say that the retainer fee is for "non-covered" services they provide and they still bill insurance for "covered" medical services. I think a crack-down on that will be coming soon. Some physicians think "concierge" medicine is a great idea and others find it ethically appalling. It's an interesting discussion to watch.

 

[brodaiga]

very good stuff guys, thanks

 

[silas2642]

I don't know much about this, so no flaming. What if a physician does not take insurance and instead leaves it to the patient to get reimbursement themselves?

Now, if the patient has no way of paying for healthcare, say a cc, check, cash, whatever, then insurance will be accepted.

I just read an article about dentists doing this. Thoughts?

I know a great psychiatrist who does exactly this. He used to work at a hospital where all administration cared about was money, and he got sick of fighting with insurance companies and management about whether or not his patients were sick enough to warrant treatment. So he quit, took a huge cut in pay and went into private practice. He won't accept insurance; he'll write letters to insurance companies for reimbursement, but he won't talk to them. He's doing fine-- has no trouble getting patients, and he gets to spend the majority of time helping them instead of fighting with some dork at an insurance company who has his two year degree from his local community college over whether or not his patient can take a certain drug.

 

[deuist]

There's a program here in South Florida called MD/VIP. Patients pay $1500 a year to have unlimitd access to their physician---office visits, phone calls, email, you name it. In return, the physician keeps his patient population low---usually around 300 people---and can usually see a visitor for over an hour.

 

[CADreaming06]

I've heard of a family doctor who did not want to practice medicine by getting people in and out as quickly as possible, so he charges twice as much, requires patients to pay up front, but spends twice as long with each patient.

I mentioned this to one of my interviewers, and he said that it was called boutique medicine. Google churned up this for me: http://www.acponline.org/journals/news/oct01/new_model.htm

also heard this called concierge medicine.

 

[DropkickMurphy]

There's a program here in South Florida called MD/VIP. Patients pay $1500 a year to have unlimitd access to their physician---office visits, phone calls, email, you name it. In return, the physician keeps his patient population low---usually around 300 people---and can usually see a visitor for over an hour.

How much do the docs get out of this deal? Any stats?

 

[deuist]

I don't know how much the docs actually make, but given that 300*1500 = $450,000, I'd say that they make quite a lot of money. Only physicians that have been practicing for a long time and have an established reputation in the community can get invited to join MD/VIP. I first heard about such retainer programs a few years ago in a national news magazine. You could try some searches for it on Google and LexisNexis and let me know what you find.

 

[DropkickMurphy]

I might have to look into that.....granted, I'm not a fan of primary care, but one of the reasons for that was the lack of adequate income.

 

[DropkickMurphy]

http://www.mdvip.com/physicianIndex.asp

MDVIP affiliated physicians limit their practice to 600 patients, allowing greater focus on preventive care. Fewer patients means more control over your practice and your life.

No wonder our rapidly growing network of affiliated physicians now extends from New York to California, including the Pratt Diagnostic Center at Tufts-New England Medical Center.

http://www.mdvip.com/physicianFAQ.asp