DOs in Managed Care

[kaikai128]

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"Do managed care companies/insurance compinaies typically offer people a selection of DOs to choose from as well as MDs in their lists of approved physicians?"

One of my professors asked me this question and asked me to provide a paragraph on it. My short answer to her was that due to the fact that they have equal practicing rights, they should be offered in equal proportion. Anyone have any sources on this...I am having a bit of trouble finding it layed out in a plausible source? Any thoughts?

 

[Robz]

"Do managed care companies/insurance compinaies typically offer people a selection of DOs to choose from as well as MDs in their lists of approved physicians?"

One of my professors asked me this question and asked me to provide a paragraph on it. My short answer to her was that due to the fact that they have equal practicing rights, they should be offered in equal proportion. Anyone have any sources on this...I am having a bit of trouble finding it layed out in a plausible source? Any thoughts?

Hmmmmmmmmm. I would just call a company to see what groups they have. I know that my insurance (when I had it) offered a BOOK of physician names and practices. I am sure you would find DO's there....as for sources or literature? HMmmmmmmmmm. I am not sure, cause it just seems like another physician to me and probably to the insurance company as well.

 

[UltimateDO]

Insurance Companies don't care whether you are an MD or DO. Both of the Blue Cross network physician books (Eastern PA and Central PA) that I have include a pretty good mix of DOs and MDs in all specialties and sub-specialties.

 

[franklinthedog]

I agree...I used to work for Blue Cross. Insurance companies offer a price to doctors or groups of doctors and then the doctors either accept it (hence they are in network) or not. For example, say there is a group of ten IM docs, the insurance company will call them up and say, "Will you contract with us if we only pay you 75% of what you bill?" Then the IM group can say yes or no. The bigger the insurance company, the bigger the discount for the insurance company (i.e. a lower percentage allowed by the company compared to what the physicians bill ). And this makes sense, if I'm a doc I would be willing to get paid a little less by Blue Cross or United so I could get the added advantage of their huge patient base (more quantity coming through my practice).

Insurance companies don't care whether the docs are mds or dos...all they want is the docs to contract with them. The exception would be bad docs or those who have sketchy practice backgrounds. Insurance companies try to build their networks to be really huge, so they can say, "85% of all docs in city x are in network for us." Thus it would be their disadvantage to exclude DOs.

I hope this helps, insurance can be very confusing!

 

[DrRichardKimble]

i have never seen a list of member physicians that has been separated between MD and DO . they are all on the same alphabetical list with no noteworthy differentiation between the two. (why should there be really since they both practice "medicine") i even noticed the last time i was paging through the local highmark blue shield directory they were also listing DPM's along with the MD's and DO's, even though they are not provided the same liberties in practicing medicine (unless of course they are doing it on your feet).

ask your professor to write a one page paper explaining his thinking in the question he posed to you!

good luck

 

[(nicedream)]

"Do managed care companies/insurance compinaies typically offer people a selection of DOs to choose from as well as MDs in their lists of approved physicians?"

One of my professors asked me this question and asked me to provide a paragraph on it. My short answer to her was that due to the fact that they have equal practicing rights, they should be offered in equal proportion. Anyone have any sources on this...I am having a bit of trouble finding it layed out in a plausible source? Any thoughts?

What class is this for?

 

[skypilot]

i have never seen a list of member physicians that has been separated between MD and DO . they are all on the same alphabetical list with no noteworthy differentiation between the two. (why should there be really since they both practice "medicine") i even noticed the last time i was paging through the local highmark blue shield directory they were also listing DPM's along with the MD's and DO's, even though they are not provided the same liberties in practicing medicine (unless of course they are doing it on your feet).

Yup, docs are separated by specialty and not by degree. Sometimes they won't even list the degree awarded. You will have to infer it from the med school attended.

 

[kaikai128]

What class is this for?

This is for my senior "Capstone" project. It is kinda like a research thesis, but the paper is shorter (approx 25-30pgs). I have to present to peers, faculty, etc. Seniors have the choice between doing it on a laboratory topic or pretty much any topic you can get a faculty member to support. Mine is on "An Overview of the Past, Present, and Future of Osteopathic Medicine." 🙂

 

[JohnDO]

Sounds like a fantastic topic!

 

[kaikai128]

Sounds like a fantastic topic!

I thought so!!! I have learned a tremendous amount of information--I was planning on researching and reading books on the topic as it is, but this paper just gave me a good jump on it.

FYI: I found the JAOA: Journal of the American Osteopathic Association (I think that is the correct long hand for the acronym) to be a great source with a plethora of information about osteopathic medicine, education, and issues in America today. I now read the journal for fun every month (I know I am a huge dork). 🙂

 

[Cowboy DO]

You know I would actually like to read it, if thats a possibility. Do you need any proof readers? 😀