Guest guest Posted January 24, 2006 Report Share Posted January 24, 2006 Hi , insurance companies rarely negotiate with solo doctors in a city. Usually your leverage is just dropping the plan after you've been with it. Going into practice without taking insurance is a legitimate option. I think it's very hard to decide ahead of time which insurance to take and which not to take. That's why the traditional advice for doctors starting out is to take all insurance they can initially. Then at the end of a year you can make your decisions based on what what you've been paid, not just what's in writing. If you drop two or three plans at the end of the first year, some of those patients will switch insurance to stay with you. But if you start out not taking insurance X, those patients will never make the first visit. If you do take insurance, I would take all the major ones for your first year. Just my 2 cents.samanthasanfran wrote: I've just been purusing the Blue Shield contract and provider manual. It's enough to make my head spin. Have others "negotiated" changes to their contracts or did you just sign them as is? There's so much ambiguity and abdicating of responsibility on the part of the insurer I wouldn't know where to begin. And did you actually read through the enormous provider manuals? This is enough to make me seriously consider not contracting with insurance companies at all. Yahoo! Photos Got holiday prints? See all the ways to get quality prints in your hands ASAP. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 24, 2006 Report Share Posted January 24, 2006 Hi , insurance companies rarely negotiate with solo doctors in a city. Usually your leverage is just dropping the plan after you've been with it. Going into practice without taking insurance is a legitimate option. I think it's very hard to decide ahead of time which insurance to take and which not to take. That's why the traditional advice for doctors starting out is to take all insurance they can initially. Then at the end of a year you can make your decisions based on what what you've been paid, not just what's in writing. If you drop two or three plans at the end of the first year, some of those patients will switch insurance to stay with you. But if you start out not taking insurance X, those patients will never make the first visit. If you do take insurance, I would take all the major ones for your first year. Just my 2 cents.samanthasanfran wrote: I've just been purusing the Blue Shield contract and provider manual. It's enough to make my head spin. Have others "negotiated" changes to their contracts or did you just sign them as is? There's so much ambiguity and abdicating of responsibility on the part of the insurer I wouldn't know where to begin. And did you actually read through the enormous provider manuals? This is enough to make me seriously consider not contracting with insurance companies at all. Yahoo! Photos Got holiday prints? See all the ways to get quality prints in your hands ASAP. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 27, 2006 Report Share Posted January 27, 2006 , I used a medical consultant to help me with determining who to contract with (I do three - Kaiser, United, and PacifiCare) - both she and another consultant both listed them as the top 3 in my area. She also helps to negotiate with the insurance companies. I've been ready to walk on 2 of the three since I started (same 3), but have not had to - they worked with her to get me a reasonable contract(s). I took Gordon's advice not to get too many contracts, and am glad I did not. I have a large percentage of people that see me out of network (guess~ 30%). Many of these were new patients. They had heard about my practice, and wanted to join, even if it was higher cost to them. I was a known in the community prior to going solo, which undoubtedly helped. Being female and offering a great model of medicine, you have the potential for dangerous growth and quickly reaching saturation. Two and a half years into my practice, I am still trying to balance work and life... be careful. A. Eads, M.D. Pinnacle Family Medicine, PLLC phone fax P.O. Box 7275 Woodland Park, CO 80863 insurance contracts I've just been purusing the Blue Shield contract and provider manual. It's enough to make my head spin. Have others " negotiated " changes to their contracts or did you just sign them as is? There's so much ambiguity and abdicating of responsibility on the part of the insurer I wouldn't know where to begin. And did you actually read through the enormous provider manuals? This is enough to make me seriously consider not contracting with insurance companies at all. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 27, 2006 Report Share Posted January 27, 2006 , I used a medical consultant to help me with determining who to contract with (I do three - Kaiser, United, and PacifiCare) - both she and another consultant both listed them as the top 3 in my area. She also helps to negotiate with the insurance companies. I've been ready to walk on 2 of the three since I started (same 3), but have not had to - they worked with her to get me a reasonable contract(s). I took Gordon's advice not to get too many contracts, and am glad I did not. I have a large percentage of people that see me out of network (guess~ 30%). Many of these were new patients. They had heard about my practice, and wanted to join, even if it was higher cost to them. I was a known in the community prior to going solo, which undoubtedly helped. Being female and offering a great model of medicine, you have the potential for dangerous growth and quickly reaching saturation. Two and a half years into my practice, I am still trying to balance work and life... be careful. A. Eads, M.D. Pinnacle Family Medicine, PLLC phone fax P.O. Box 7275 Woodland Park, CO 80863 insurance contracts I've just been purusing the Blue Shield contract and provider manual. It's enough to make my head spin. Have others " negotiated " changes to their contracts or did you just sign them as is? There's so much ambiguity and abdicating of responsibility on the part of the insurer I wouldn't know where to begin. And did you actually read through the enormous provider manuals? This is enough to make me seriously consider not contracting with insurance companies at all. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 27, 2006 Report Share Posted January 27, 2006 Things must be different in each part of the country. Here in central Ohio if a patient sees me " out of network " that means " pay the entire bill out of pocket " about 95% of the time. Very, very few plans here offer ANY out of network benefits. They either go in network or lose all benefits, as if they did not even have the insurance coverage. insurance contracts I've just been purusing the Blue Shield contract and provider manual. It's enough to make my head spin. Have others " negotiated " changes to their contracts or did you just sign them as is? There's so much ambiguity and abdicating of responsibility on the part of the insurer I wouldn't know where to begin. And did you actually read through the enormous provider manuals? This is enough to make me seriously consider not contracting with insurance companies at all. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 27, 2006 Report Share Posted January 27, 2006 Things must be different in each part of the country. Here in central Ohio if a patient sees me " out of network " that means " pay the entire bill out of pocket " about 95% of the time. Very, very few plans here offer ANY out of network benefits. They either go in network or lose all benefits, as if they did not even have the insurance coverage. insurance contracts I've just been purusing the Blue Shield contract and provider manual. It's enough to make my head spin. Have others " negotiated " changes to their contracts or did you just sign them as is? There's so much ambiguity and abdicating of responsibility on the part of the insurer I wouldn't know where to begin. And did you actually read through the enormous provider manuals? This is enough to make me seriously consider not contracting with insurance companies at all. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 27, 2006 Report Share Posted January 27, 2006 Why do you say they lose all benefits - if you order lab work, x-rays, prescriptions, etc., won't the insurance cover those fees and expenses? I try hard to educate my patients that even though they may get nothing back for my fee, their insurance should still be good for " the expensive stuff " . Most patients don't mind paying $75 or $90 for an office visit if they feel confident that the $120 worth of lab, $200 x-ray, $60 prescription, etc., is covered by their health plan. I know we've ranted about this before on this group list, but we're living in a society where people routinely spend $60 for a hair salon treatment, $75 for dinner for two at a nice restaurant, and $120 for Rolling Stones tickets - through excellent customer service, nice physical environment, and close follow-up with personalized care, I convince my patients that their health is worth a nominal fee. --- Brock DO wrote: > Things must be different in each part of the > country. Here in central Ohio > if a patient sees me " out of network " that means > " pay the entire bill out of > pocket " about 95% of the time. Very, very few plans > here offer ANY out of > network benefits. They either go in network or lose > all benefits, as if > they did not even have the insurance coverage. > > > > insurance contracts > > I've just been purusing the Blue Shield contract and > provider manual. > It's enough to make my head spin. Have others > " negotiated " changes to > their contracts or did you just sign them as is? > There's so much > ambiguity and abdicating of responsibility on the > part of the insurer > I wouldn't know where to begin. And did you > actually read through the > enormous provider manuals? This is enough to make > me seriously > consider not contracting with insurance companies at > all. > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 27, 2006 Report Share Posted January 27, 2006 Why do you say they lose all benefits - if you order lab work, x-rays, prescriptions, etc., won't the insurance cover those fees and expenses? I try hard to educate my patients that even though they may get nothing back for my fee, their insurance should still be good for " the expensive stuff " . Most patients don't mind paying $75 or $90 for an office visit if they feel confident that the $120 worth of lab, $200 x-ray, $60 prescription, etc., is covered by their health plan. I know we've ranted about this before on this group list, but we're living in a society where people routinely spend $60 for a hair salon treatment, $75 for dinner for two at a nice restaurant, and $120 for Rolling Stones tickets - through excellent customer service, nice physical environment, and close follow-up with personalized care, I convince my patients that their health is worth a nominal fee. --- Brock DO wrote: > Things must be different in each part of the > country. Here in central Ohio > if a patient sees me " out of network " that means > " pay the entire bill out of > pocket " about 95% of the time. Very, very few plans > here offer ANY out of > network benefits. They either go in network or lose > all benefits, as if > they did not even have the insurance coverage. > > > > insurance contracts > > I've just been purusing the Blue Shield contract and > provider manual. > It's enough to make my head spin. Have others > " negotiated " changes to > their contracts or did you just sign them as is? > There's so much > ambiguity and abdicating of responsibility on the > part of the insurer > I wouldn't know where to begin. And did you > actually read through the > enormous provider manuals? This is enough to make > me seriously > consider not contracting with insurance companies at > all. > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 28, 2006 Report Share Posted January 28, 2006 Out of network does mean different things in different areas. Here in this HMO driven town - "out of network" means not covered if I'm not contracted with that health plan. Also, patients will probably not be covered for labs and radiology if I'm the ordering physician. Now, a large employer, here, the University of New Mexico, has thrown yet another twist in the system. I'm a "2nd tier" provider -I am in the United and BCBS network they offer their employees, but not a UNM hospital physician. So patients pay higher copays to see me and pay a large fee for studies I order outside the UNM hospital. Every time I think I've figured the system out, another curve ball comes along.I do think these plans are a tremendous hassle, but if I didn't take all of them, I would lose up to 25% of my patients every year, when the new contracts are negotiated with the community employers. I could replace those patients, of course, but I couldn't replace the long years of continuity in caring for them. Albuquerque Why do you say they lose all benefits - if you order lab work, x-rays, prescriptions, etc., won't the insurance cover those fees and expenses? I try hard to educate my patients that even though they may get nothing back for my fee, their insurance should still be good for "the expensive stuff". Most patients don't mind paying $75 or $90 for an office visit if they feel confident that the $120 worth of lab, $200 x-ray, $60 prescription, etc., is covered by their health plan. I know we've ranted about this before on this group list, but we're living in a society where people routinely spend $60 for a hair salon treatment, $75 for dinner for two at a nice restaurant, and $120 for Rolling Stones tickets - through excellent customer service, nice physical environment, and close follow-up with personalized care, I convince my patients that their health is worth a nominal fee. --- Brock DO wrote: > Things must be different in each part of the > country. Here in central Ohio > if a patient sees me "out of network" that means > "pay the entire bill out of > pocket" about 95% of the time. Very, very few plans > here offer ANY out of > network benefits. They either go in network or lose > all benefits, as if > they did not even have the insurance coverage. > > > > insurance contracts > > I've just been purusing the Blue Shield contract and > provider manual. > It's enough to make my head spin. Have others > "negotiated" changes to > their contracts or did you just sign them as is? > There's so much > ambiguity and abdicating of responsibility on the > part of the insurer > I wouldn't know where to begin. And did you > actually read through the > enormous provider manuals? This is enough to make > me seriously > consider not contracting with insurance companies at > all. > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 28, 2006 Report Share Posted January 28, 2006 Out of network does mean different things in different areas. Here in this HMO driven town - "out of network" means not covered if I'm not contracted with that health plan. Also, patients will probably not be covered for labs and radiology if I'm the ordering physician. Now, a large employer, here, the University of New Mexico, has thrown yet another twist in the system. I'm a "2nd tier" provider -I am in the United and BCBS network they offer their employees, but not a UNM hospital physician. So patients pay higher copays to see me and pay a large fee for studies I order outside the UNM hospital. Every time I think I've figured the system out, another curve ball comes along.I do think these plans are a tremendous hassle, but if I didn't take all of them, I would lose up to 25% of my patients every year, when the new contracts are negotiated with the community employers. I could replace those patients, of course, but I couldn't replace the long years of continuity in caring for them. Albuquerque Why do you say they lose all benefits - if you order lab work, x-rays, prescriptions, etc., won't the insurance cover those fees and expenses? I try hard to educate my patients that even though they may get nothing back for my fee, their insurance should still be good for "the expensive stuff". Most patients don't mind paying $75 or $90 for an office visit if they feel confident that the $120 worth of lab, $200 x-ray, $60 prescription, etc., is covered by their health plan. I know we've ranted about this before on this group list, but we're living in a society where people routinely spend $60 for a hair salon treatment, $75 for dinner for two at a nice restaurant, and $120 for Rolling Stones tickets - through excellent customer service, nice physical environment, and close follow-up with personalized care, I convince my patients that their health is worth a nominal fee. --- Brock DO wrote: > Things must be different in each part of the > country. Here in central Ohio > if a patient sees me "out of network" that means > "pay the entire bill out of > pocket" about 95% of the time. Very, very few plans > here offer ANY out of > network benefits. They either go in network or lose > all benefits, as if > they did not even have the insurance coverage. > > > > insurance contracts > > I've just been purusing the Blue Shield contract and > provider manual. > It's enough to make my head spin. Have others > "negotiated" changes to > their contracts or did you just sign them as is? > There's so much > ambiguity and abdicating of responsibility on the > part of the insurer > I wouldn't know where to begin. And did you > actually read through the > enormous provider manuals? This is enough to make > me seriously > consider not contracting with insurance companies at > all. > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 28, 2006 Report Share Posted January 28, 2006 In my market, if the ordering doctor is out of network, then NOTHING is covered by UHC. And having had to face one person who got stuck with a $1200 MRI bill (even tho I did not tell them one thing or another about whether it would be paid) I am not willing to make that sort of statement to patients anymore. If UHC does it, what’s to keep every other insurer from doing the same thing. I just advise them to ask their benefits manager or the insurance company itself. Generally no one sees me out of network, even if I agree to accept an amount equal to the copay they would pay to a network doc annie. insurance contracts > > I've just been purusing the Blue Shield contract and > provider manual. > It's enough to make my head spin. Have others > " negotiated " changes to > their contracts or did you just sign them as is? > There's so much > ambiguity and abdicating of responsibility on the > part of the insurer > I wouldn't know where to begin. And did you > actually read through the > enormous provider manuals? This is enough to make > me seriously > consider not contracting with insurance companies at > all. > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2006 Report Share Posted January 29, 2006 There are a few very restrictive HMO insurance plans in my area - I saw a patient with one of these plans so I called her designated " PCP " (in my experience the plans that don't cover out-of-network ordered studies assign PCP's to control access and cost). I faxed their office my progress note and why I feel the study is warranted, and their referral coordinator took care of the rest. I didn't even have to talk to the doctor (she is probably so busy with her managed care panel she doesn't even care that I saw her patient - no money out of her pocket). It's just a reflection of the sad state of affairs in medicine that we have to make the extra effort like this. If simple stuff like meds, labwork, and x-ray isn't even covered by UHC, I think you should talk to your local congressman or representative. I think that limitation is going too far. Rancho Mirage --- Annie Skaggs wrote: > In my market, if the ordering doctor is out of > network, then NOTHING is > covered by UHC. And having had to face one person > who got stuck with a > $1200 MRI bill (even tho I did not tell them one > thing or another about > whether it would be paid) I am not willing to make > that sort of > statement to patients anymore. If UHC does it, > what's to keep every > other insurer from doing the same thing. I just > advise them to ask > their benefits manager or the insurance company > itself. Generally no > one sees me out of network, even if I agree to > accept an amount equal to > the copay they would pay to a network doc > annie. > insurance > contracts > > > > I've just been purusing the Blue Shield contract > and > > provider manual. > > It's enough to make my head spin. Have others > > " negotiated " changes to > > their contracts or did you just sign them as is? > > There's so much > > ambiguity and abdicating of responsibility on the > > part of the insurer > > I wouldn't know where to begin. And did you > > actually read through the > > enormous provider manuals? This is enough to make > > me seriously > > consider not contracting with insurance companies > at > > all. > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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