Insurance industry goes after docs who help the uninsured
by Doc Gurley
SFGate.com
Doc Gurley is a board-certified internist physician, with UCSF residency training, and as a Robert Wood Johnson Fellow in the Stanford/UCSF program. Her scientific publications cover areas of lab/basic science, cost-effectiveness, and health services research. She sees patients (for which she's paid an hourly wage) in a public health clinic for the homeless. Her health writing has appeared in Salon, and the L.A. Times, among others. She's been called "the Dave Barry of medicine." She grew up in Calhoun, Georgia and, if given enough caffeine, speaks with a Southern accent.
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Medscape has a great article that got (surprise!) very little mainstream media-play - about the insurance industry going after concierge doctors who offer services to the uninsured.
For those of us who don't live in the rarefied world of "concierge" anything, here's how a concierge doc works: you, as a doc, sign up people for a fixed monthly amount, then you offer them hand-held service for that monthly payment. Also part of the arrangement is a limit on the total number of patients the doc will see - say, 600 people total.
So what kind of hand-held service are we talking about? Besides getting all your medical visits (sometimes unlimited, sometimes with a co-pay or capped number), you usually also get 24-hour access to your doctor by some combo of cell/email, no wait for appointment times, and even, when desired, you can be accompanied to visits with specialists. Patients who choose this route are expected to own at least catastrophic health coverage, in case of hospitalization or a specialist-heavy illness like a new cancer diagnosis.
The shocker for most of us is finding out just how relatively cheap these concierge docs are - we're talking monthly basic cable numbers. Specifically, anywhere from $39 a month to around $139 a month, usually scaled based on age, with wide variations depending on the doctor's demand, reputation, and geography.
It turns out, some of these free-wheeling docs got sick and tired of waiting for Washington to solve the healthcare crisis, and decided to offer their services for the same price - even if the patient did not have catastrophic (or other) insurance coverage. In other words, for the working healthcare-coverage denied/poor.
It didn't take long for insurance companies to notice. Their ploy? To accuse these individual docs of falsely pretending to be, and act as, insurance companies, and - therefore, not complying with the massive regulations that it takes to compete as an insurance company.
Individual doctors tried contacting their state legislators, who, outraged, then tried to introduce bills in various states to make these sole-practitioner doctors exempt from insurance-industry regulations, except the insurance lobby got involved at the state level and the doctor-protection bills died from that tragic legislative epidemic of - ignored to death.
Please read the complete article at:
http://www.sfgate.com/cgi-bin/blogs/gurley/detail?entry_id=41696&tsp=1
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