NY Times examines when doctors stop taking insurance. Dr. Charschan weigh’s in

Many doctors get into the profession to help others. Some are more self serving. All have overheads, staff, and concerns about running their business like any other businesses. The business of health care, unlike other businesses requires professionals who are highly trained and schooled and unlike widgets, cannot be stamped out with cheap labor as a commodity would be. Medical schools are careful to keep their admissions to specialties in check to keep the prices many specialists charge high by allowing for shortages.

Market forces, that explanation for what helps drive and creates checks and balances within an economy in many areas controls the costs of what we buy, from food, to electronics to fuel. These are in many cases seen as necessities that we need and we often buy after researching what is the best fit for us. This does not work for most medical providers other than primary care because primary care does have competition; namely walk in clinics as well as chains such as the minute clinic.

Medical care has become the wild west with regards to prices for years, with new procedures or methods becoming cash cows for the few doctors who used them (many a fortune had been created in the early years of lasiK which improves peoples sight, which was at one time $4000 for about 10 minutes of work), while over time, competition allowed to prices to come to more appropriate levels.. Insurance was supposed to tame this unwieldy beast with the promise that the public would be able to visit a network of doctors, obey some rules (referrals, etc) and the insurance industry would hold down costs. They didn’t. In many countries, with social systems, costs have been kept in check (although to be fair, many countries also have doctors being paid under the table for procedures patients believed they needed quickly).

HMO’s and PPO’s have gone up well over the pace of inflation over the past 10 years, costing over 100% more than it did 10 years ago, for reduced access to doctors. As a consumer, you have noticed that you are poorer because more of the the cost has been handed over to you, since the insurance industry had decided that after they modified medical care into a more expensive model that costs you more, pays most doctors less in the network and drains both small and large businesses alike of free cash flow they would use to hire or improve their businesses, that now you are responsible. Even in our small office, we have left some networks for the same reasons, as the large carriers continue to try to strangle practices by lowering reimbursements, not paying for codes that adequately described the fee for the service or other games that have nothing to do with helping you. Unfortunately, while Obamacare gets more people insured, it leaves the big players such as Aetna, United healthcare and others free to continue doing things that fail to improve the quality and costs in healthcare while harming many effective providers and in come cases, putting them out of business.

Since there is no transparency of what it costs to do something medically, and many of the doctors who formally were in your network may either be leaving or are deciding to leave, even more costs are shifted to you, the consumer is at a major disatdvantage because there is no way of comparing cost, quality and value other than trying out a new doctor . The public have been underinformed as to what we need, so we purchase care out of fear rather than knowledge.

The NY Times took a hard look at the cost of going out of network. They use the example of an up town Obstetrician charging $13000 cash to deliver a baby while in network, doctors fight to be paid 3-4000 to do the same service. While I personally know of doctors who went out of network in their specialty to find out that their patient dropped by 1/2 but because they made more per patient, they lived better and improved the quality of their lives.

There should be a happy medium, however, this will likely never occur while for profit medicine, both from the doctor’s point of view and the insurer’s agree on what services are worth, what they should cost and what people really need to do for themselves. Perhaps, the time is growing near for a single payer system (yes, government healthcare, but failed experiments such as our current system do not bear fruit).

Read the article here

When Doctors Stop Taking Insurance

By RONI CARYN RABIN

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.