Thoughts for the New Year 2007

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Well, it is almost the end of January. This was a strange winter. Not too cold so far, and some unseasonably warm weather. Because of increased demand, we have added Tuesday mornings to our Scotch Plains schedule.

A big concern of mine this year is the way insurance companies have abused our patients and are not giving us what we have paid for. Most of us have been continually subjected to higher co payments which is blurring the line between weather to go in or out of network. The truth is, out of network doctors are out of network because the insurance companies are paying them less and less, while charging us more and more. In our case, we are no longer in United Healthcare. There were a number of reasons this happened, but we are finding out that with the higher co payments, the paperwork our patients were required to fill out and the nasty things they were doing to us, and to our patients and to the relationships we have with those patients, out of network was better for everyone. The benefits are as follows: The paperwork has gone away. That is correct, no precert forms anymore. With the loss of participation will be the loss of wondering if they misinformed us about precert, as they did last year and then withheld our reimbursements. Although we in good faith tried to straighten it out and get paid after providing proof, this was ignored and more United Healthcare excuses were given. It turns out many medical doctors felt the same way and more are opting out daily.

Many people have been brainwashed to believe that out of network is unaffordable. The reality is that although some doctors price themselves that way, most of us are priced reasonably and have ways for patients to comfortably afford care. Sure, you may not have the 40 dollar co pay which is becoming more common, but for $55, you can get the care you need, without the referral, the hassle, the angst and everyone is happier.

We have tried to stay in network with most plans, for the benefit of our patients. Most doctors would like to. Today, I met with a medical doctor I am friendly with who just terminated Horizon Blue Cross after many years because they continue to pay him less and less, while his overhead continues to escalate. He was quite upset by this especially when he contacted the representative to question her about their policy and the answer was simple, here is how you can resign from the plan. Here is a well respected physician who is caught between whether to do an appropriate EKG on a patient that he is not being paid for anymore. He told me the allergist friend of his has to fight with a clerk to give a non generic medication.

Out of network does not look so bad after his stories. As a doctor, I am torn between great care, a lousy health plan, can I afford to stay in network and trying to stay in network so more people can access us more easily.

What would you do if you were me? For those that know me, I always go the extra mile for my patients. I will do whatever it takes to help them resolve a problem. As a patient, you need to begin to demand your plan becomes accountable and your doctor needs to be treated with respect, and paid at a level that allows him to feed his family as well. Just my thoughts...