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Losing Patients With Insurers

We are losing patients.  Certain insurance companies are trying to “play hardball” with doctors, unwilling to negotiate with us over their outlandishly low rates.  We have lost patience.

So the signs went up in the exam rooms today:

As of the start of the year, we will only accept X, Y, and Z Medicare advantage plans, and we are presently negotiating with A and B insurance companies.  Please consider this when enrolling in plans.

It is highly likely we will drop one of the insurance plans altogether, and we are one of the last practices in our town to accept them.

Patients are distraught.  Some of them who have seen us for years are now going to have to go elsewhere, while others that just joined our practice because their previous doctors dropped out of the plan will once again have to find a new doctor.  Patients aren’t mad about this, just sad.  The conversations go like this:

“So you are dropping X insurance?”

“We will if they don’t change.  They are paying us significantly less than other plans.”

“That’s crazy.  We just left a doctor because of the same thing.  Now we have to move on.”

“Yeah, I am very sorry about that.  I just want to see patients; I don’t want to do this kind of thing.”

“Well, I don’t blame you.  They pay $1000 for an ER visit for an ear infection, and they won’t pay you what you charge?”

“Apparently not.  They have been playing hardball with primary care docs recently.  That’s why nobody is accepting it any more.”

“I don’t know what we are going to do.  I hate changing doctors again.”

“Call your employer and tell them about this situation with the insurance they’ve chosen.  The only way things will happen is if employers get mad at the insurance companies.”

There is no anger, just disappointment and frustration.  Patients are victims of the strategy insurance companies are using to cut cost.  But why cut primary care?  Why low-ball the one group of doctors who don’t cost that much and who can actually save money?  It makes no sense to me.  It certainly doesn’t make sense to my patients.

Come December, we may be putting a similar sign up:

Due to the 23% cut in our reimbursement by Medicare, we are no longer accepting new patients and may soon be forced to drop Medicare altogether.

It’s happening in a lot of offices already.  The problem is that these patients won’t have an employer to tell.  These patients won’t have a choice.  Medicare won’t come back to the table if there are no PCP’s.  They don’t negotiate their rates.

See those clouds on the horizon?  They look harmless, but they’re not.  It’s a storm that will kill a lot of people if we don’t do something soon.

Rob Lamberts, MD, is a primary care physician practicing somewhere in the southeastern United States. He blogs regularly at Musings of a Distractible Mind, where this post first appeared. For some strange reason, he is often stopped by strangers on the street who mistake him for former Atlanta Braves star John Smoltz and ask “Hey, are you John Smoltz?” He is not John Smoltz. He is not a former major league baseball player.  He is a primary care physician.

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Samuel Stenes, MDPaoloDavid H.CT IPA docMukesh Recent comment authors
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Rob
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For what it’s worth, the company that was the main focus of this is actually responding to our action and is offering us a better contract. They realize we are one of the few providers they have left.

pcp
Guest
pcp

“I can’t make Medicare patients pay cash if I am still accepting Medicare payments”
Rob, look closely at going non-participating. You’re allowed to charge a little more, the patient pays the allowed amount in full at the time of service and then is reimbursed, and your cash flow improves.

DeterminedMD
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DeterminedMD

What are you missing here, Dr Lamberts? This health care deform legislation gives insurers and pharma big breaks, continues to collude with these defenders commenting here as alleged experts that physicians are a prime cause to the health care debacle as is, and people just want to pontificate over numbers and business principles to just murky the waters of patient-physician relationships. And you all want to be civil and respectful when the profession of medicine is beyond being trashed, but being stabbed in the back by fellow colleagues and professionals who do not have equivalent training to what we commit… Read more »

pcp
Guest
pcp

1. The vast majority of insurers put in their contracts that doctors may not reveal the fees that have been negociated. This leads to situations like we see in Massachusetts, where some docs (those affiliated with large institutions) are paid twice as much as others for the same service, due to market share and reputation. 2. The assumed prohibition on doctors revealing their “non-negociated” charges seems to be a remnant of the days when insurance companies paid the doc her full fee without any discount. Of course, at that time the insurers didn’t want docs comparing fees. Whether this still… Read more »

Paolo
Guest
Paolo

Rob, I have been to a Minute Clinic once when I was in a hurry to get a vaccine. They accepted my insurance and I only had to pay the insurance co-pay of $15 (I think the list price was $30-40). Insurance-wise, it was just like any normal visit to an in-network physician’s office (it was just cheaper for my insurance). The reason these clinics post their prices is because they are very competitive, specially for those without insurance. I’m not sure a conventional medical practice with higher prices would be as motivated to post prices. As to dropping insurance,… Read more »

Margalit Gur-Arie
Guest

You are right on this one, Rob. Posting your fee schedule (i.e. the fixed amount that you bill all payers, but never get actually paid by any of them), is useless to customers and may even hurt your business. A prospective patient with a high deductible would want to know how much he has to pay out of pocket, and that is not your published fee. It is your contractual fee, which is of course lower, but you cannot disclose that amount and the patient may very well misunderstand. Here is where insurers are shooting themselves in the foot. On… Read more »

Rob
Guest

I agree with Paolo, that this is a nice heated discussion without rancor. I appreciate that from all. For me, the contractual obligations are there – I can’t tell others what I am being paid by a managed care contract. I can’t share my contracts. That would simply make me in breech of contract. That is not a big concern for me. Medicare payment schedules are published openly, so sharing what I am paid by the public plans is also not a big issue. I think that the possible difference between me and the minute clinics is the fact that… Read more »

DrWonderful
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DrWonderful

Nate- Your weak arguments have fallen the deaf ears of the people who try to work under the crushing collusive power of the insurance carriers. Let me ask you this. Why did Sen Nelson wait until the very last minute to give Reid the 60th vote for PPACA in Senate and he did so with just one ultimatum…that all health insurance carrier anti-trust exemptions must be protected in the bill. Coincidentally he was an HMO exec before becoming a Senator. The 60th Dem, who used to be an HMO exec, put his entire party on the plank over shark infested… Read more »

Samuel Stenes, MD
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Samuel Stenes, MD

The only price fixing I see is by the government. It is said price fixing that causes inflation. It is a bipartisan failure to learn from the history of the price fix on all Americans in the 1970s.

Peter
Guest
Peter

“Peter your confusing Medicare and Private Insurance. Private Insurance can’t prohibit a doctor from treating anyone or accepting any payment arrangement if they don’t have a PPO contract or some contractual relationship.”
But Rob does have a contractual agreement with the insurance carriers. Ask him, and ask him to read it. My information was gotten from the local doc here that only accepts cash. He had to take a 2 year sabbatical before setting up his cash business in order to satisfy his existing insurance contracts.

Paolo
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Paolo

First of all, congratulations to Rob and others for the many good comments on this thread that are informative and that reflect different point of views in a fair manner. Nice to see most posts stay away from politics and personal attacks. On the subject of price disclosure, the reason that most medical providers hide their prices is simply because they can. If Jiffy Lube could sell services without posting prices they would do it. But if they did it, they would lose all their customers. This is not the case with physicians and hospitals. Every action involves risk, from… Read more »

Nate
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Nate

DrWonderful, you have a number of factual misconceptions in your comment. First HMO market pentration at its best was around 25%, that means 75% of the market doesn’t even have the evil HMO contract your blaming everything on. “There is a reason why premiums, co-pays, deductibles, and denial rates climb each year but doctors fee do not.” Premiums are a product of loss ratio, if what you insinuate was even partially true then profit margins would be increasing as well, and they have not. Co-pays, deductibles, and patient cost sharing are a product of the employers insurance contract not the… Read more »

Nate
Guest
Nate

“One wrinkle as to how insurance restricts the market is if Rob did opt for a cash business he would not be allowed to see his former insurance clients as cash customers.” Peter your confusing Medicare and Private Insurance. Private Insurance can’t prohibit a doctor from treating anyone or accepting any payment arrangement if they don’t have a PPO contract or some contractual relationship. If a doctor goes cash only they are basically tearing up their insurance agreements and thus free to do whatever they want. The patient might suffer some financial penalty but that is a different story. Hospital… Read more »

DrWonderful
Guest
DrWonderful

Doctors are typically restricted from posting fee schedules per the HMO contracts that they sign. Those fees are considered the property of the carrier and docs accept all these terms when they sign the contract. Any doctors who posts them in public view, either in the office or on their web site, is not only in violation of most HMO contracts but borders on an anti-trust violation whereas they may be accused of “signaling” to their colleagues what an acceptable fee or market might be. Most HMO contracts prohibit docs from even discussing the fees, co-pays, or even terms of… Read more »

Peter
Guest
Peter

So does everyone thinking posting prices (market forces) will lower PCP charges? Does Rob really need another mechanism to lower his revenue? Would posting prices lower his costs? Do his patients really want to drive around town looking for a doc based on price, or do they want to be treated by Rob? This is the lunacy of this system. Rob wants to spend his time treating patients, not participate in auto dealer like marketing gimmicks. In single-pay Rob would negotiate through his PCP association to get fair compensation for his services, and the single payer could reduce specialist and… Read more »