Insurance industry goes after docs who help the uninsured

[Kadie]

Insurance industry goes after docs who help the uninsured
Posted By: Doc Gurley | June 13 2009 at 11:19 AM

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 (sometimes explicit, sometimes assumed) 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.

more...
http://www.sfgate.com/cgi-bin/blogs/gurley/detail?entry_id=41696&tsp=1

[Horse with no Name]

1. Organized crime

backed by the stamp and seal of the lawmakers in Washington. Nice.

[Trajan]

2. Wow ... Never heard of this tactic ....

Kinda brilliant ....

Who are the insurance companies to try and restrict the marketplace ?

I thought they were for absolute market FREEDOM ?

Fucking hypocrites ...

[Tangerine LaBamba]

3. So you don't want to have the government

(read "insurance companies") handle all your health care needs. You take it upon yourself, and you pay OUT OF YOUR OWN POCKET, to take care of those needs. Fortunately, there are good doctors available who will cooperate with you in this plan that keeps government ("Insurance companies") out of it, and keeps you healthy.

Wonderful.

That's a great idea for people who can afford it. Excellent.

I wonder who pays for the medication they might need. I glean from the article that they do. If that's possible, good for them.

So, of course, the government ("insurance companies") do whatever they can to bring this to a halt.

How much more fucking through the looking glass can things go?

[PM Martin]

4. Bring a single payer system now!

[ThomCat]

5. At what point do the Insurance companies have so much control

over the health industry, solely for profit rather than to provide health care, that it qualifies for a RICO lawsuit?
:grr:

[shadowknows69]

21. Years ago probably

[dipsydoodle]

6. Oddly enough

that's more or less the way our UK doctors are paid by the NHS. None of them literally work for the NHS and they're still able to do any private work they want to.

BTW - I'm one of the stupid ones who really believed you'd get single payer.

[Dragonfli]

17. You are not stupid! - Just from a saner environment.

It is difficult for people not raised here to fathom the insanity that passes for truth within our corporate oligarchy. It is like a bad dream that one assumes one will awake from.

We may yet get it (single payer) but I am convinced it will take millions in the streets and many innocents beaten and thrown in jail for their views first.

[wroberts189]

7. knr

[DCKit]

8. If a doctor on retainer is a de facto insurance company, what does that make a lawyer on retainer?

Or a cab driver? The DOJ and DOT?

The laws requiring everyone to be covered with mandatory insurance haven't even been drafted yet (though I'm sure the insurance co.s are working on it), and the corporations are acting like it's a done deal or a newly discovered corporate Constitutional right.

The insurance corporations are going to fight every single option that doesn't mandate that every dime flows through their hands first and, if they win, we are screwn like we've never been screwn before.

[Sal Minella]

9. So some people have found a way to buy "health care" instead of "health insurance"

and the insurance bloodsuckers are up in arms.

It's absurd that the "insurance" bean-counters have any say about anybody's medical care.

[Karenina]

10. . .

[old mark]

11. I had no insurance when I first retired - I had to find another doctor

because my former family doctor's practice was bought out by a local hospital (for profit) and she would not treat me because the hospital did not accept my new insurance, even when I offered to pay cash!
Her office manager had a fit when I told them what insurance I had, and they cancelled an appointment I had made.


mark

[Kadie]

14. Amazing.

Cash is worthless in health care. Insurance is gold.

[northernlights]

12. being ordered to deny health CARE to the uninsured?!?!

"others in different states being told they can't offer services to the uninsured at all because they aren't qualified to be an insurance company."

They can't treat the uninsured because only insurance companies can provide health care?!?! WTF?!?!

[snot]

13. k&r'd

[Scurrilous]

15. K & R

:thumbsup:

[Better Believe It]

16. Just saw this posted here in GD. K & R

I posted this in another forum before I saw it here.

[earth mom]

18. I think this is a fantastically brilliant idea! Insurance gangsters can suck it!

:evilgrin:

[Cleita]

19. Somehow this isn't very different than the non-profit HMOs like

Kaiser Permanente. When I had Kaiser, I only paid $125 a month and $2 for each visit or procedure, but the problem is that in order to keep solvent they sign up way too many people, so that it often takes months to see a doctor or get a mammogram or any number of other procedures.

[sarcasmo]

20. Insurance industry equals SCUM.

[ThomCat]

22. So, the double standard here is:

Insurance companies regularly override doctor's orders, essentially practicing medicine even though they are insurance companies. So insurance companies are allowed to be doctors.

But they are raising hell, when doctors deliver healthcare (not health insurance) and try to prevent doctors from practicing medicine, merely claiming that it is because the doctors are trying to be an insurance company.

If they get away with this, the insurance companies will have established that they can break the rules and play both sides, but doctors can't do their own job without approval from interfering insurance companies. That is a hell of a double standard, and it's very incredibly blatantly corrupt.

:grr:

This is because the doctors are delivering healthcare, instead of health insurance.

[catrose]

26. And when I'd call the insurance company

to ask if they would pay for a procedure or tests that my doctor wanted me to have, they'd say, "We don't practice medicine. Turn in your bills and we'll let you know." And I'd say that I didn't want to run up bills that weren't going to be paid; I'm being a "responsible" patient. (And they damn well do practice medicine if they determine what they will and won't pay.)

[crikkett]

27. It's as if insurance companies can't handle a free market solution. n/t

[ThomCat]

29. No major corporation can handle a free market. The first thing

they all do with their money and influence is shape the legal and corporate environment to remove as much of their risk as they can, making it less "free."

[sutz12]

23. So the insurance companies want to regulate the doctors?

Right?
:shrug:

[ThomCat]

30. Yes, thtat's exactly right.

Instead of just paying medical expenses, they want to be a profit-making governing body over doctors and the health care industry.

[sarcasmo]

24. This thread can not die.

[marmar]

25. Wow. The mob can only wish it was as effective as the insurance industry gangsters....

n/t

[wolfgangmo]

28. our clinic is "concierge"

But we have been very careful to structure it as a discount service offered as only a part of our overall practice. By not making all of our money from the concierge plan and by the plan not being all inclusive, but rather only a discount (patients pay less for visits, treatments and services) then we avoid the entire "acting like an insurance company thing." I double checked with 2 law firms before starting it.

Having said that, it allows us to charge patients who need care and who have lost insurance about 1/3 to 1/2 half of what a doc who bills insurance is able to charge due to much lower overhead (I don't need insurance specialists to fight the insurance companies insurance specialists) and thus serve many new clients who have lost jobs and insurance all the while giving more time, attention and care to our patients.

And all of the people at the clinic are praying daily for single payer.

[Joanne98]

31. There is nothing lower than an insurance company. SLIME

[Liberal_in_LA]

32. I had no idea... thanks for posting this

[hobbit709]

33. I'm afraid it's going to take torches and pitchforks

before these bastards get the idea.

[wuvuj]

34. We could drop by the....

...banks and oil companies on the way?

[avaistheone1]

39. Not a problem.

[annabanana]

35. The way I see it.. the docs can

pretty much treat who they want at whatever price they like.
the insurance companies should

have no imput in this case.

K&R&bookmark

[quidam56]

36. G R E E D is good in health careland

We MUST have health care reform this year. As a former health care giver, I am sad to see Profit Care is now more important than Patient Care. http://www.wisecountyissues.com/?p=62 In East Tennessee and southwest Virginia what the heath care system is selling is nothing at all like what really is their "acceptable standards " on public record in Greeneville, TN Federal Court, cases no. 2:04-cv-375. Apparently it's legal to lie about health care and legal to run false and misleading advertising about health care in TN & VA.

[LaPera]

37. And shit like this is never brought up - We desperately need a public option for health care now.

[avaistheone1]

38. This captialism gone rottten - when a doctor and a patient can't agree

to services and fees amongs themselves - and if you have got the insurance companies sticking their noses in.