Re: Direct/ retainer option: So what do you actually plan to do this year?

[Guest guest]

RE:OHP(medicaid). My understanding is that if you are not contracted with OHP ,

then you can sign private contracts with patient, but , alas, it is true that

they will only accept referrals from the contracted PCP.

Stew

Direct/ retainer option: So what do you actually

plan to do this year?

Hey guys. Leigh here.

Have been going back through the threads re: direct primary care practices (or

parts of practice). I am opted out of Medicare/Medicaid, but have several

patients who have these insurances, and also have a $50/month " subscription "

plan with me. Naturally, they are my sickest (and therefore lowest-income)

patients, homebound for example. (Also a couple of happy healthy babies on

Medicaid whose parents like my style, housecalls again e.g.)

Local Medicaid administrators have now told their clients that they will not

cover any of my referrals, labs, imaging, or prescriptions, because I am not a

contracted Medicaid provider.

And today I see (in the threads) that the public insurances will explicitly

provide " personalized health advice " after Jan 1, so I can no longer charge any

publicly insured patient for same. (I expect private insurances - such as many

patients' $100000-deductible plans) will want to follow suit.)

I am supposing that what I will have to do is stop providing (or charging for)

services to my patients with public insurance. I can't afford to become a martyr

for the cause, and am already on the radar screen of the Oregon health Plan

(administrator of capitated Medicaid insurance here).

Is that what y'all are doing? What's your plan? --leaving aside all the

political and public-health implications, for 2011 or 2014, of this issue.

Thanks!

[Guest guest]

....But you did NOT say what your PLAN is, Stew!

p.s. I think OHP has changed some of their rules very recently. For example,

" open cards " apparently no longer exist.

>

> RE:OHP(medicaid). My understanding is that if you are not contracted with OHP

, then you can sign private contracts with patient, but , alas, it is true that

they will only accept referrals from the contracted PCP.

> Stew

>

> Direct/ retainer option: So what do you

actually plan to do this year?

>

> Hey guys. Leigh here.

>

> Have been going back through the threads re: direct primary care practices (or

parts of practice). I am opted out of Medicare/Medicaid, but have several

patients who have these insurances, and also have a $50/month " subscription "

plan with me. Naturally, they are my sickest (and therefore lowest-income)

patients, homebound for example. (Also a couple of happy healthy babies on

Medicaid whose parents like my style, housecalls again e.g.)

>

> Local Medicaid administrators have now told their clients that they will not

cover any of my referrals, labs, imaging, or prescriptions, because I am not a

contracted Medicaid provider.

>

> And today I see (in the threads) that the public insurances will explicitly

provide " personalized health advice " after Jan 1, so I can no longer charge any

publicly insured patient for same. (I expect private insurances - such as many

patients' $100000-deductible plans) will want to follow suit.)

>

> I am supposing that what I will have to do is stop providing (or charging for)

services to my patients with public insurance. I can't afford to become a martyr

for the cause, and am already on the radar screen of the Oregon health Plan

(administrator of capitated Medicaid insurance here).

>

> Is that what y'all are doing? What's your plan? --leaving aside all the

political and public-health implications, for 2011 or 2014, of this issue.

>

> Thanks!

>