My Doctor (GP) is going to stop accepting insurance and will instead charge a flat fee of $2,000

[madinmaryland]

per year. First I had ever heard of this. I can understand hating insurance companies, but it seems a little drastic. This is what I going to send to the doctor. I left the doctor's name in for DU to see.

-----

To whom it may concern,

Our family received your letter this afternoon indicating you would no longer be participating in any medical/health insurance company whatsoever. It left us a bit confused. I would like to address a few issues.

First of all, there are two of us who would qualify for this plan, which would be classified as "well insured" by your plan. We have the option of medical insurance either through my wife's employer (Howard county government) and myself through my employer. As I am sure you are well aware of the cost of insurance to us and our employer is well over $15,000 per year. I would like to ask what the additional $4,000 would add to the value of our coverage.

Now, per your documentation, your plan covers my wife and I for the following. These are all items our insurance company currently covers (and will cover next year) for us, with our only expense being a $20 co-pay.

• All office visits
• An annual physical examination
• Lab work only related to and required by the annual physical examination.

Let us now take a look at the some of the examples you have included in your letter as to why our expenditure of $4,000 would be beneficial to us.

• When you call the doctor you get put on hold or you have to push a number of buttons in an automated answering system to get to the voice mail system for my doctor. This is an inconvenience, but over the last four years Dr. Reisett has responded within the day, or someone from the office has called us back.
• When you are finally offered an appointment it may not be soon enough or you may not be able to convey to the assistant what the problem is. The doctors and assistants have always been able to fit us in for any of our needs. If a patient is calling with an emergency, they will generally have a good reason for calling (i.e., they really are sick and want to see someone)
• They may wait an hour or more in the waiting room or feel rushed throughout the appointment with the doctor. Again, we have never experienced anything this drastic, though we understand that issues arise that are out of control of the doctor and the office and can cause an extended wait in the office.
• Simple answers are not answered over the phone and they cannot be answered by email. When I first met Dr. Reisett, I asked about email and was told the policy of the office was no email. I understood it to be a liability issue (i.e. a doctor making diagnosis' without actually seeing the patient.) If on the other hand, the issue is that the doctors would be spending extra time answering email queries, then as an alternative of some amount per year to patients who want email access to the doctor. As an example, for myself, I could relay my BP reading to the doctor so that he would be able to notice any abnormalities.

To make a comparison, will this work? What if other practices went to this type of payment schedule? We do have needs for other physicians including the following, hence the need for us to carry health insurance, which again begs the question, where is the additional value being added that we are not already getting from your practice.

• Pediatrician
• OB/Gyn
• Endocrinologist
• Neurologist
• Urologist
• Chiroprator (insurance companies do cover these folks)
• ENT
• Podiatrist
• Emergency/Hospital medical care

We have not seen any real justification in your letter as to why you feel the necessity to move to this plan. The underlying reason that I can gather is your refusal to deal with insurance companies and medicare providers. I think we can all agree that the existing "for profit" is extremely wasteful, redundant, and the worst possible system this country can have. This can only be solved by moving to a single-payer or universal health care system and taking the PROFIT out of the insurance part of health care.

I would like to say that I am sorry that you have been overburdened by the insurance companies requirements and by the volume of patients. Additionally, I would like to ask you and Dr. Reisett if you really believe that the items listed above are worth $4,000 per year. We feel a bit insulted that you try and rationalize us paying you $4,000 a year, so that you can provide us with better customer service. I am left with the feeling that you are frustrated with the health insurance companies (we all are - and go back to my comments above) and you willing to torpedo your practice or you really want to just be a service provider to the wealthy and elitist clients from the right side of the aisle.

-----

Does anyone have experience with something like this?

[kestrel91316]

1. Find a new doctor.

[madinmaryland]

2. No brainer comment of the year.

The only thought is if they get enough complaints, they'll think twice about what they are doing.

:shrug:

[nichomachus]

3. I hate to tell you

but this is the wave of the future. More and more doctors are doing it.

[mike_c]

4. I hate to say it, but by changing doctors you'll just be endorsing the current system....

Your doctor is trying to break away from it, you've expressed your contempt for it-- the government is NOT going to provide any real leadership in this regard, probably not during our lifetimes, so we can support folks who independently seek alternatives or we can endorse the current for-profit health care system with our feet (and our wallets).

Fair disclosure-- I'd have to think long and hard about this before I'd agree to it, too. But let's understand what message changing doctors in order to participate in the system we deride as broken sends.

[madinmaryland]

8. From my point of view financially, it makes no sense to agree to the doctor's plan.

I think in a few years a plan like this may make sense, but not now. I think we all are expressing contempt for it, but until there is a concerted effort, the actions by the doctor will not prove anything.

[cbayer]

5. Generalists have been the hardest hit among physicians.

I know many who can no longer keep their practices open between dwindling reimbursement and increasing malpractice insurance. They have been forced to see greater numbers of patients and spend much less time with each just to pay their staff. When physicians become overburdened and stressed by the system, they may become less thorough or more apt to make mistakes.

Another issue is that physicians only get paid when they actually see someone and patients can only be asked to pay their portion if they go to the office. Many issues which could be handled over the phone or by email are not simply because there is no reimbursement. Were that to change, I think many would be more willing to incorporate it into their practices.

Many doctors, primarily in bigger cities, have changed to these "boutique" practices. Their goal is to limit the number of patients they have in their practice and provide better service to the ones they have. Questions have been raised as to the ethics or fairness of this practice, but it has generally led to happier, more productive physicians and very satisfied patients. The biggest issue is that it excludes people who can not afford this additional fee.

If your physician is willing, it might be good to talk with him face to face before you make your decision. IMHO, this is fallout from the failing system and not unexpected. Physicians have virtually no power over the huge insurance companies, and their pulling out may help us get to single payer in the end.

Your letter is very good and you are asking the right questions. I just hoped to give you another perspective.

[marions ghost]

10. Better health care only for the rich

that's where this is going.... :mad:

I'd leave that "boutique" doctor to rot in his boutique. NO way would I want that person to treat me for anything.

I don't think that physicians are powerless against the insurance companies as a group.

[cbayer]

13. But they don't have a group.

Federal law prohibits them from organizing or unionizing. They are prohibited from taking any collective action whatsoever. That goes for groups as small as 2 individuals who are not in practice together. Trade organizations, like the AMA, can lobby for changes in laws and regulations, but the insurers are much stronger.

Older physicians bear some responsibility for the situation, as there was indeed greed and collusion. But that scenario is no longer the case.

To hold physicians responsible for this crisis at this time is wrongheaded. We need to be on the same team. The poor and other insured have NO access to this doctor now or in the foreseeable future. They are already the sacrificial lambs in this story.

All I ask is to attempt to understand where this guy is coming from. Possibly it is this:
This system is broken.
He wants to practice medicine because he loves it.
This is the only way he can reasonably stay in practice AND be a good doctor.

peace

To hold phy

[marions ghost]

15. Well I guess

this will become an indicator of what doctors NOT to go to, if it spreads. They'll be fine with that of course, but at least we pigs at the end of the trough can use it as a barometer. My family was not wealthy when I was a child and if we hadn't happened to have had access to good health care we'd be a LOT worse off today. I know and have worked with doctors. I'd have to have more background on this guy--is he trying to provide his new trophy wife with a vacation house? Sorry but I've seen enough to make me skeptical of the need for profiteering under the guise of "better care."

By the same token I would have to be absolutely sure that any lawyer is on the liberal side.

If you are a liberal, you do NOT EVER want a Republican lawyer. Same goes for doctors.

[madinmaryland]

23. I think you make a very good point..

"The biggest issue is that it excludes people who can not afford this additional fee." That is my concern.

I have and have to have insurance to cover the other doctors I listed in my OP. To add $4K to my expenses so that I can actually see my doctor is absurd.

One of my biggest concerns is with the doctors going to the "boutique" type practices, that many long time patients are going to be screwn out of medical care.

Thanks for the support. I am hoping that with a few more tweaks to the letter that I will have a chance to speak to my doctor directly.

[LiberalHeart]

6. I don't think this new plan is about frustration with insurance paperwork.

I think it's just doctors wanting more free time, so they're charging a flat fee to weed out those who are not profitable (by their standards ) enough to warrant the amount of time expended. It makes me wonder why such doctors became doctors in the first place. So glad I don't go to one like yours.

[mike_c]

7. I really can't blame them if my own physician is any indication....

I was thinking about this the other day. My GP spends maybe ten or fifteen minutes with each patient-- or at least with me-- then runs to the next. I was trying to imagine how that works. It has to suck. No time to talk, think about the symptoms being presented, enjoy the human dimension of care-giving. I would HATE what managed care has done to the medical profession!

[LiberalHeart]

9. My doc is part of a training hospital (she's one who trains 'em)...

She has very few hours per week to see patients. When she does see them, she takes all the time they need. There's a long wait to get an appt., but if you have an emergency you can see one of the other docs that are in training under her. If they're busy, you can get in to see someone on another training team. It's a great operation -- very smooth. Anyone else in the facility who sees you gives your primary care doc a full report. My doc sees four generations of my family, so she has a real sense of what the family dynamic is, what tendencies are inherited, what might show up in the younger family members eventually, etc. Through it all, she somehow finds time to go to other countries to provide medical care and once a year she gets her hair cut off to have it turned into wigs for cancer survivors. And she has three little kids. I don't know how she does it, but she does -- smiling through it all and seldom seeming tired. There are rare times when she is clearly exhausted, but mostly if she's down, it's because of the insurance problems faced by her patients.

[bemildred]

11. I like the idea, insurance is pretty worthless these days.

But I'm not paying a retainer unless it covers everything.

[hfojvt]

36. yeah $2,000 a year seems like a whole lot to pay

for just a few office visits and a physical. I would expect to get three office visits and a physical for about $600. At $150 per office visit, you are losing money unless you go 13 times (and I consider the physical to be just another office visit). Maybe office visits cost way more than $150. That's what I paid in 1996, but $60 of that was for testing.

[DemoRabbit]

12. I got deserted too - by my friggin' gynecologist!

Not only had I been with the same insurance company for over 10 years and the same gynecologist for twenty, but my MOTHER had also been with them since I was born (yes, different doctor)... I made an appointment for my annual exam, got there and they told me "oh, we don't take your insurance anymore". I had no recourse, and no choice to stay with them unless I wanted to pay out of pocket... which, ultimately, I could have for that one appointment, but got forbid they should find something wrong.

I was SOOOOOOOO angry and sad. It's funny to me when McCain/Palin say we don't want government controlling our health care - well Insurance companies do now and it SUCK very badly.

[LiberalHeart]

14. You should give him the finger. It's poetic justice with a gynecologist.

[cbayer]

16. Hold on a sec.

On the one hand, we are saying that doctors should stand up to insurance companies, and, on the other, we are saying that when they do, we should give them the finger?

Doctors have virtually no negotiating power with the insurance industry. Their only option is to refuse to participate with the worst of them. OB-GYN's pay the highest rates of malpractice insurance of any group, if they can get it at all. They have been significantly damaged by the current system.

I know that doctors can be seen as arrogant, self-absorbed assholes, and I am not defending them against that perception. However, many good doctors are being victimized by this crisis, and fewer and fewer are willing to go into it. This is a problem.

[madinmaryland]

21. It is a BIG problem. The question is how should the doctors stand up

to the insurance companies. By screwing the patients?

Until there is a unified and concerted effort to bring universal and NATIONALIZED health care to America then I call bullshit on anything else.

[LiberalHeart]

38. Um, it was an OBGYN joke. About fingers. Oh, never mind...

[Blue Diadem]

17. My daughter's Dr. group is closing their practice.

Our favorite Dr. in the group moved out of state recently. He used to be my Dr. too, but long ago stopped accepting my and DH's insurance. The other day my daughter received a letter from the "group" stating that the remaining two Dr's were now closing the practice. They had a few reasons they stated, from not having good quality Dr's in our area to replace the Dr. who left, to underpayment from insurance companies as well as the constant hassle dealing with insurance companies and government regulations. I'm suspecting your Dr. is experiencing the same problems with the exception of looking for a replacement Dr. to add to the practice.

I've read in the past about Dr's charging patients a flat annual fee and not accepting insurance. IIRC, they were $5,000 per year Dr's and again IIRC they promised to make house calls too.

In any case, $2,000 a yr flat fee is ridiculous for average people who may see a Dr. once or twice a year.

[TexasObserver]

18. I kind of like that approach.

Think of it like this. A doctor has to hire and pay many extra people to handle all the bullshit that goes with taking insurance. It's a huge chore and it's not the practice of medicine.

Suppose you were a doctor with an established practice, and you could set up your office the way this guy is doing. You can project easily your revenues for the year. You don't have to hire a bunch of people to interface with insurance companies, to get paid less than your rate by the insurer, and be left with a choice of either writing off the rest or asking the patient to pay it.

[seemunkee]

19. The doctor I had for many years did this

I see him in town now and then and he is very pleased with his decision. He makes house calls, picks up prescriptions for patients and all patients have his cell phone and email.
You get very personal care without him, but I couldn't afford it and sadly had to find a new doctor.

[Dem2theMax]

26. My Mom's doctor is just like this. Except for one small thing.

He's on her insurance plan. This is the normal care he gives all of his patients. I have his office, cell and home phone numbers, his email address - which he answers in record time, and he makes house calls. He's a jewel. The only bad part is, we have to put up with really bad jokes and new magic tricks every time we go to his office. :) That and the rubber chickens. He has rubber chickens everywhere. Seriously. LOL.

[Lydia Leftcoast]

20. If I could pay that $2,000 on the installment plan, I'd actually save money

given the lousy insurance I had.

It's actually a small-scale version of what Kaiser-Permanente used to be like, namely, paying a flat fee and then having only a small copay ($10) for each office visit or test and nothing for hospital stays.

I'd actually save money if I had a $100 copay and no deductible.

[madinmaryland]

22. Some people may benefit, but i think you would be in the minority.

They ask for the 2K up front. Whether you use it or not. What if you leave the area? No Refund is included.

Interesting concept they are offering, but unrealistic.

[high density]

27. You still need insurance for catastrophic coverage

Sending $2,000 to a doctor would give you jack squat if you need to use the emergency room or have an expensive operation. I buy heath insurance because I don't want to be bankrupted by unforeseen medical costs.

[2hip]

24. it is called concierge health care

Impact of Concierge Care on Healthcare and Clinical Practice
JAOA • Vol 105 • No 11 • November 2005 • 515-520

http://www.jaoa.org/cgi/content/full/105/11/515

[madinmaryland]

25. Thanks for the link. That gave me a lot more fodder to add to the letter,

:hi:

[Phx_Dem]

34. My GP switched to concierge care

he wanted 3K per year per family memeber. This is in addition to insurance premiums. My understanding is that this type of practice accepts insurance but requires yearly membership fees.

[madinmaryland]

28. Kicked for the weekday crowd.

[Horse with no Name]

29. I think your physician is not going to keep a sustainable practice

If he does this.
However...if this is just a response to retaliating with the insurance companies...why not guide him a different way? In the end, I think he would be able to keep more patients.
http://simplecare.com/

>>>snip
Welcome to SimpleCare.com, home of the largest patient/doctor organization in America. Here you’ll find a host of resources, links and contacts that will help you take control of your healthcare situation. If you’re a patient looking to cut your healthcare costs but get better care, SimpleCare is for you. If you’re a doctor looking to practice medicine your way while also getting fair market value for your services, SimpleCare is for you too. And if you’re a business owner struggling to insure your workers, SimpleCare has what you need. Better care for less money – it’s just that simple!

>>>snip
How does it work? We call it PIFATOS – Pay In Full At Time Of Service – and it is truly a “Cash-Based Revolution.” A patient sees a doctor for a non-catastrophic reason – yearly check-up, a nagging flu, a twisted wrist, an aching stomach, etc. The doctor bills the patient after the visit. The patient pays in full before leaving. Because doctor charges are anywhere from 25 – 50% inflated due to administrative costs caused by the health insurance industry, you’ll be paying drastically reduced rates for your medical expenses. In conjunction with a regular catastrophic health insurance policy to cover extremely costly procedures, PIFATOS can save the average healthy adult and/or family up to $5000/year!*

[DailyGrind51]

30. My oncologist moved from his high-rent office to the private doctor area

of the hospital where he has been on staff for 40 years, thereby saving money on overhead, which is reflected in his billing. He also adjusts his bills on an "ability to pay" basis and volunteers for one of those "Doctors without borders" organizations in South America, during his "vacation". He has also kept me cancer-free for 26 years!

[Cleita]

31. I've read about doctors and doctor groups trying something like this.

You pay into it per year and get all the medical care you need from that doctor or group of doctors with no extra charge. Okay it sounds good at first, however, it doesn't pay for what really does cost in health care, labs, MRI's, hospitalization and use of an operating room if you need surgery and prescription drugs. Sorry, but it's just another privatization scheme that makes the doctor rich and leaves you and your family short of the full range of quality medical care you may need.

[Missy Vixen]

32. Our former dentist tried something similar

almost ten years ago. He wanted up-front payment, and charged $300 an appointment. WHEN he got reimbursement from the insurance company, he'd write a check to the patient.

He was out of business within a year.

Julie

[madinmaryland]

33. Serves him right!

[TXDemGal]

35. No personal experience but I have heard

of other doctors doing this. In addition to docs who just refuse to take any insurance at all and require their patients to pay out of pocket.

Your letter is excellent; I'm sorry this is happening to you.

In your doctor's case, I'm sure he will lose some percentage of his patients. But probably enough will stay to make it financially worthwhile for him. So much for the Hippocratic oath.

[guitar man]

37. interesting

A couple questions:

1. Does he take it in installments or is it all up front?

2. If he does require full payment for the year up front, is there a provision in the contract to recover the remainder of the $2k if you have to fire him before they year runs out?