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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.
Stumbled on your blog and have thoroughly enjoyed it! I had some pretty extensive surgery done 2 months ago – two different surgeons/ specialties performing the surgeries… ANYWAY. I didn’t have to pay much out of pocket at all, which was good for me. HOWEVER, I was shocked to see the Insurance carrier’s statement of what they paid out to the providers, based on the contract they have with the provider. HALF of their fee… crazy… It has given me a different perspective. It mad me feel kind of bad for the surgeons since I was a complicated case and I know that after their overhead, it is not even close, based on the work they put into me!
Brilliantly put Dr. Rob. We’re having this same issue in our office due to Cigna cutting reimbursement rates on vaccines. On some vaccines, they’re not even close to reimbursing our cost for them. Almost to the point of having our Cigna patients go to the health department for their child’s immunizations. 🙁
the only thing id add to the mix, rather than just it being the patients who have to make the noise and put themselves in situations of further stress, is to have pcp’s voice their displeasure with their own peers in the specialty areas who will not play fair with their fellow primary care doctors by agreeing to make their pay more fair to the primary doctor, but as i ve read it all along they just wont do that, …………. it sure would help you guys out if they would help you out as well……….. i dont know if im explaining it right, but i think you know what im meaning. its not fair to the pcp and mostly the patients……….. i am wondering, what do the insurance people do when doctors get angry with them in situations like this? because fr the most part if it is anything like what happens to the patient, they dont seem to care much who is mad at them or why……………..
This is understandable, yet it all seems like a game where just about everyone loses. After living in a country where health care is a right and way more accessible that the US, I advocate for a single payer system to take the gaming out of it.
You are absolutely right, Dr. Rob. If these insurances companies had anyone running them with a brain in their head, they would see it is best to cover these visits with primary care physicians. They could save themselves a bundle up the road in backing preventative medicine. Stupid to not reimburse, only to then find they will be paying more out of pocket for major issues that will result, as people begin to avoid seeing a physician until they need urgent medical intervention. Emergency Department docs will be even more inundated with things that could and should have been addressed in a primary care setting.
There is another solution that some docs in Atlanta have figured out. Charge fees for other services that are not medical treatment related. For examples if a patient comes in with insurance A (which is not really medical insurance plan but a medical payment plan – we have long ago gotten away from insurance), then charge a $30 insurance processing fee, a $20 use of office lounge, a $25 fee to write a prescription, a $15 fee to file the patients paper work, etc, etc, etc. for all patients with that coverage and no fees or reduced fees for all others like ($0.01). Whne the patient has to pay $90 in extra fees beyond insurance they realize there iinsurance plan really isn’t worth the premiums paid.
I would rather set of a “insurace plan” with my doctor for him to charge me a reasonable fee that I will pay on the spot. No deductibles or paper work for either of us. I get the care I need and can afford. If I get sick then I have to cover the cost not someone else.
In the use we currently pay about $7200 per person per year. This number is expected to rise as more portable medical devices, expensive drugs, more test options all become available. So the question is how much can a person aford before we can’t pay for the treatment. $20,000 per person, $50,000 per person?? Why should I pay higher premiums because Uncle Joe is lazy, overweight and won’t take his medication? My answer is I won’t.
Once again I ask, what is a real and legitimate way (as opposed to just sounding off) for change to be created immediately? Our elderly and highest need population on Medicare/Medicaid cannot get a primary care doctor to see them. I think it’s shameful to turn away our elderly population from care they most certainly need, and many do not have anyone to advocate for them and their health. I would beg to differ about whether they are angry when you tell them you too are closing the door on them or perhaps they’ve just lost hope. I think the issues we are facing with the healthcare crisis is not just with the insurers. I recently listened to the This American Life episode you list on your site, it sounds like everyone needs to change and has had a part in the the system’s dysfunction.