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Posted on 03/08/2009 1:45:43 PM PDT by traviskicks
The state is trying to shut down a New York City doctor's ambitious plan to treat uninsured patients for around $1,000 a year.
Dr. John Muney offers his patients everything from mammograms to mole removal at his AMG Medical Group clinics, which operate in all five boroughs.
"I'm trying to help uninsured people here," he said.
His patients agree to pay $79 a month for a year in return for unlimited office visits with a $10 co-pay.
But his plan landed him in the crosshairs of the state Insurance Department, which ordered him to drop his fixed-rate plan - which it claims is equivalent to an insurance policy.
Muney insists it is not insurance because it doesn't cover anything that he can't do in his offices, like complicated surgery. He points out his offices do not operate 24/7 so they can't function like emergency rooms.
"I'm not doing an insurance business," he said. "I'm just providing my services at my place during certain hours."
He says he can afford to charge such a small amount because he doesn't have to process mountains of paperwork and spend hours on billing.
"If they leave me alone, I can serve thousands of patients," he said.
The state believes his plan runs afoul of the law because it promises to cover unplanned procedures - like treating a sudden ear infection - under fixed rate. That's something only a licensed insurance company can do.
"The law is strict on how insurance is defined," said an Insurance Department spokesman.
A possible solution that Muney's lawyer crafted would force patients to pay more than $10 for unplanned procedures.
They are waiting to see if the state will accept the compromise. Still, Muney is unhappy because, he said, "I really don't want to charge more. They're forcing me."
(Excerpt) Read more at nypost.com ...
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It will probably be just a matter of time before they try to shutdown www.mdvip.com
He should charge $11.
Another option - “rebates”.
Some how I don’t think the ‘Bamster’s health plan will help make local community innovation like this work.....The Doc needs a free enterprise award...and his critics need an enema.
this is sort of like the “botique practices for the rich....except this is for everyman...and we canno have everyman having contrl of their lives.
There is another group in NJ doing this for a flat $50 office visit plus a small copay depending on the procedure. But it’s based on a walk-in clinic business model, not a subscription plan like this guy.
The doctor is doing good work, but without a doubt he is acting as an unlicensed insurance company as defined by the current laws of NY State.
The doctor can come into compliance in under 2 months, with maybe 3 to 5 further conversations with the NYDoI.
Problem is in marketing materials, false representations, and marketing an unlicensed insurance product as an insurance product in the state. he could face sanctions on or loss of his medical license.
Dr Muney could create his own Federal ERISA plan if he can find a federally recognized labor union with a nexus in NY State to act as the umbrella for the trust. Also, Dr Muney could put together a Federal level cooperative buying agreement through an association or union on his own, and offer it as a member-only service plan that is outside the purview of the NYDoI’s jurisdiction. $50 a month to join the union, the medical benefits become a defined benefit of union membership, and the copay is part of the arrangement between the union and the Doctor’s medical practice LLC. This would also allow the Doctor to cap the max usage of the plan, to make sure 5% of the patients are not (ab)using 50% of the resources.
Dr Muney could switch to a walk-in clinic model which there are several dozen if not hundreds of such clinics within 25 miles of his offices. This is the easiest solution.
The Dr is copying the fitness club model, 20/80 rule. 20% of users will regularly use the plan, 80% will rarely use the plan but subsidize the active 20% user base.
Dr Muney has problems if he doesn’t switch, he is going to be open to massive lawsuits for selective discrimination based on age/health under NY State’s anti-discriminatory medical benefits insurance laws. He must know this, I don’t know a single doctor who isn’t well aware of the malpractice dark cloud that comes along with denying access to patients on age/health in NY State.
Also, he’s going to bankrupt himself, his target market is going to be biased toward high cost needs and very low household income levels.
thanks, bfl
I think we just found the real Surgeon General for the 21st century. The man needs to start franchizes nationwide. Wait. The feds will shut him down. No gov’t $$$ for the political beaurocrats.
I have no reason to doubt your knowledge, but do you see the absurdity in that paragraph?
I’ve worked for an employer who was on the receiving side of a NYDoI pogrom for a similar situation during my tenure with the company. So yes I definitely have seen the absurdity first hand.
However, the NyDoI enforces laws that were put on the books do to rampant and flagrant abuse of the health insurance and medical benefits industry in the late 1980’s and early 1990’s in NY State. There were situations where “insurance companies” were using 75%+ of premiums for “administrative overhead” and sales force compensation, leaving no money in the company’s claims pool to pay outlays to actual medical benefits.
The first Federal ERISA law was passed before the Doctor in this article was out of Med school, and was passed specifically to end-around state governments that are overzealously anti collective bargaining. Collective bargaining units do not have to be from the bottom up, in cases like this doctor’s situation, or American Express’s rewards program, or CostCo, or various vacation packaging collective bargaining groups, it can often work from the middleman down to end users. And this doctor is attempting to build one from the top down, eliminating the middlemen bureaucracy. It’s a brilliant concept, if not an original business model, but he needs to get it legal.
It comes from the Lancet, a study called Eurocare 4, I forget who created the actual posted graph, maybe a news organization, but the raw data come from this study:
http://www.thelancet.com/journals/lanonc/article/PIIS1470204507702462/fulltext?iseop=true
Maybe your brother will become a righty on this issue, or at leats ambidextrous :)
thanks for your comments, very interesting. I have to say it would be gratifying to use some of these silly unions laws against them (liberals) in this way.
bump
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