When Doctors Stop Taking Insurance

[dkf]

Private health insurance used to be the ticket to a doctor’s appointment. But that’s no longer the case in some affluent metropolitan enclaves, where many physicians no longer accept insurance and require upfront payment from patients — cash, checks and credit cards accepted.

On Manhattan’s Upper East Side, it’s not unusual for a pregnant woman to pay $13,000 out of pocket in advance for childbirth and prenatal care to a physician who does not participate in any health plan. Some gynecologists are charging $650 for an annual checkup. And for pediatricians who shun insurance, parents on the Upper East Side are shelling out $150 to $250 whenever a child falls or runs a high fever.

Efforts by insurers to rein in health care costs by holding down physician fees — especially for primary care doctors, who play a critical role in health care though they are among the lowest paid doctors — appear to be accelerating the trend, and some patients say it’s getting harder to find an in-network physician.

Orlene Paxson, 33, a stay-at-home mom on Manhattan’s Upper East Side, was unable to find an obstetrician she liked who would accept her insurance. Many were not accepting new patients, and one highly recommended doctor did not return her call for five days and did not want to see her until 12 weeks into the pregnancy. It was Mrs. Paxson’s first pregnancy and she did not want to wait, so even though her policy does not cover any out-of-network services, she and her husband chose a doctor who doesn’t take insurance and paid the entire $13,000 fee themselves.

http://well.blogs.nytimes.com/2012/10/01/when-doctors-stop-taking-insurance/

[Robb]

1. This is just stupid.

If I want a roofer to inspect my roof before the storm hits, I'm going to have to pay for it. My homeowner's insurance covers damage -- if it gets blown off, the work is free.

And if I absolutely MUST have the same roofer as Bobsie and Chas down the street, I should expect to get fleeced. Easy come, easy go.

[HereSince1628]

2. Yep that was just s****d

Comparing prenatal care to a roof-inspection that is.

[Robb]

5. These are affluent people who have good insurance, but don't like the terms.

They also apparently can drop tens of thousands of dollars because they "don't like" a particular doc.

I'm frankly having difficulty scraping together any sympathy for them. Rich people have their own problems, clearly.

[dkf]

9. We don't have enough doctors so as their capacity gets filled we may see more

After all if all the doctors are booked, and they know it, why would they want to deal with insurance companies?

[Robb]

13. What makes you think that?

These people just didn't "like" their docs for some unstated reason.

[dkf]

16. It's pretty well known we aren't producing enough doctors to cope with the newly ACA insured.

Doctor Shortage May Swell to 130,000 With Cap.

http://mobile.bloomberg.com/news/2012-08-29/doctor-shortage-may-swell-to-130-000-with-u-s-cap.html


Doctor Shortage Likely to Worsen With Health Law

This isn't to go off on the ACA but to acknowledge the problem.

[JaneyVee]

23. The problem is, not everyone needs to see a doctor. Nurses and other HC professionals can deal with

it. And the healthcare industry is hiring at record rates. Many rich people don't carry health insurance because they pay out of pocket. They have personal trainers, chefs, nanny's, etc. and are generally healthier people. Poverty is a disease.

[Lindsay]

3. Three Americas now, I guess.

Those who can afford out-of-pocket medical care, those who are dependent on insurance (and the jobs that offer it) and doctors who accept it, and those who are well and truly screwed.

[Whovian]

4. Graph of healthcare costs 1950-2007

http://www.nejm.org/action/showImage?doi=10.1056%2FNEJMp1200478&iid=f01

Flash image couldn't post as graphic. Sorry. from http://www.nejm.org/doi/full/10.1056/NEJMp1200478

[MiniMe]

6. My mother has to pay a yearly fee to her primary care doctor to get her to take Medicare

I was surprised, but apparently it is getting more and more common. I live in the DC suburbs in Maryland.

[dkf]

7. Wow I can't believe that is allowed.

[MiniMe]

24. I was surprised too

Mom says that this is common. I will say that it is a flat fee for the year.

[Zalatix]

8. Their licenses should be pulled to make an example.

[lapislzi]

10. Before the rush to judgment...

I live in a semi-rural area. There aren't a lot of independent doctors, although there is one gigantic, multi-tentacled medical group with hundreds of doctors (who, incidentally, donate large sums to the local tea party candidate).

That group won't accept my insurance, which is skimpy.

So I have to take my chances with the independent practitioners, many of whom have limited hours or out-of-the-way offices...and limited hospital privileges. And, not even all of those will accept my insurance. My choice of doctors is limited to about 2 or 3. If I want the OB-Gyn who treated me for a serious condition several years ago (when I had better insurance), I will have to pay out of pocket for her services, as her group does not accept my insurance.

This is not a snooty rich-people problem. The crap policies don't pay doctors enough to make it worth their while to accept them. If you think your premium dollars are going to doctors, think again.

[Jackpine Radical]

11. "If you think your premium dollars are going to doctors, think again."

Absolutely--at least in the mental health field, where insurance payments per service are maybe 1/2 what they were 10 years ago. Also, its much harder to get the insurance cos. to authorize needed diagnostic & treatment work. For example, they won't pay for psychological testing in many cases, because they don't want to permit serious mental health concerns to be documented. They want brief therapy and (generic) medications only.

Small clinics are closing all over the place because they can't afford to keep their doors open, leaving only the giant providers, where you get put on a waiting list, get maybe a few monthly appointments, & get maybe a generic antidepressant or anxiolytic to tide you over until you have the good grace to get off their plan.

[hobbit709]

12. Which is why we need to get rid of health insurance and start getting health care.

[Jackpine Radical]

14. Absolutely.

"Health insurance" is just a way of squeezing down the quantity & quality of services provided in the interest of corporate profits.

Health CARE, not health INSURANCE.

[NotThisTime]

15. I look at my bills and it's EVERY doctor and EVERY facility no matter the specialty

I've seen the insurance company pay 10% of the charges for one fee from a day surgery center. The bill was six grand the insurance paid 600!!!!! The surgery center had to write the rest off, this was 2 years ago.

[Jackpine Radical]

19. You're probly lucky the docs didn't come after you for the rest.

[Zalatix]

21. Been there, done that, the doctor lost that fight.

[WolverineDG]

17. I had a doctor who did this

I needed surgery on my hand & the only one in town who did this type of surgery didn't accept insurance. He was kind enough to take payments (which I made at $100 a month until I paid everything off). Then I had another doctor who did take insurance & billed me what the insurance didn't pay & refused further treatment until I did pay it. Suffice to say, I'm looking for another doctor.

[TreasonousBastard]

18. And then you go on Medicare, where it's...

even tougher to find a doctor.

[lonestarnot]

20. Dentists already do that.

[lumberjack_jeff]

22. ... they subsequently file for unemployment. n/t