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To: ladyinred

Not all your comments are accurate.

"The health care system in this country has gone down hill for years, starting with the horrific HMO type insurance."

Yes, this is true. Ever since the introduction of Medicare in the 1960s, the government has mismanaged the program. Many HMOs, especially community based HMOs, are in effect hired contractors to the government to manage doctors and their Medicare coding. HMOs are 'middlemen' in the business that take revenues off the top of doctors for themselves and at the same time perform contractual adjustments in negotiating reimbursement rates from the government. They save the government money and make themselves rich. Doctors and their staff get screwed.

Because of poor reimbursement rates, clinic budgets are stressed. RNs are replaced with MAs who hold a six month degree. Experienced docs are replaced by young docs who are glad to be making something better than resident pay that they had for the last 4-6 years and they have monster medical school loans to be repaid.

HMOs tell the docs to see more patients. Every year more patients must be seen to offset cuts in reimbursement rates and to support HMO administrative staff. More patients each day translates to less time for each patient.

Lots of docs are fed up, especially the experienced ones. They are going back to private practice and some are attempting to charge fee for services or negotiate their own plans with patients. Each step of the way they are impeded by government regulation and legalities. HMOs try to stop docs from going to private practice by blocking hospital priviledges or acting as credentialing certifiers. They know that docs going to private practice means less revenue for them, and less acceptance of medicare and medicaid patients because of poor and declining reimbursement rates. There are many procedures that are so poorly reimbursed that the docs lose money by seeing these patients.

"The doctor gets paid not to see you, not to send you to a specialist, and not to send you for tests."

Not exactly. For standard insurance plans or fee paying patients, docs obviously do get paid to see the patient. For Medicare and Medicaid, docs and their staffs are often not paid or are very poorly paid so they try to close their practice to new Medicare ot Medicaid patients.

However, for an existing patient in a doc's practice, they must by law see the patient, whether reimbursed or not. And they must by law refer a patient to a specialist when there is even a slight possibility of missed or delayed diagnosis or treatment. To not do these things increases the risk of malpractice liability exposure.

So docs do not get paid to NOT see a patient. They just refuse new patients to stop the cash bleed from patients that have no insurance or poorly reimbursed insurance. Most docs do accept some charity cases, about 10% as an unwritten rule. But they don't advertise it because they would be bankrupt in no time with so many patients expecting free healthcare.


63 posted on 03/23/2006 8:27:11 PM PST by Hostage
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To: Hostage
Lots of docs are fed up, especially the experienced ones. They are going back to private practice and some are attempting to charge fee for services or negotiate their own plans with patients

My allergist, who was our pediatrician before she went back to school for a couple of years, and whose husband (well now ex) is a general surgeon, told me 10 years ago that she was telling her daughters not to go to medical school. Too much of a pain in the rear. They were hardly fresh out of residency, and there two doctors. Yet I know where they lived, not far from my humble tract house abode, and it wasn't a mansion or anything. Those seem to be reserved for the money men, insurance company execs, the CEOs of medium to large companies, along with professional athletes and other entertainment figures, and of course politicians.

71 posted on 03/23/2006 10:00:20 PM PST by El Gato
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To: Hostage

Okay, you addressed a problem I have with our PPO - Before I was insured, I went to my doctor and paid $80 for a visit. The next time I went (when I was insured), I paid a $30 co-pay. When I looked online at the charges for services, I was shocked to see that the insurance co discounted all but $15 of the charges. So, therefore my doctor has to take a cut just to accept my insurance yet hire employees to do all the paperwork to file the insurance. I think that's wrong...

And don't even get me started on the amount of $$ we shell out every year ($5,500) to go to the doctor at the most 4 times a year. It just erks me to know that I'll pay this amount year after year just because of the possiblity of having some catastrauphic problem one day..... I'm basically giving my hard earned money to the insurance company to "negotiate" 1/2 price fees for someone who has already had "the big one". Where does the excess $$ go? Or rather, whose pockets are they going in to.

My personal belief is that insurance is just another "terror tactic".... always paying for the "what if".

My husband and I are considering going to a "catastrauphic" plan only and paying cash for the "time to time" doctor visits.

One other note.... most doctors keep on hand lots and lots of samples of medication.... all you have to do is ask for them. I always ask for samples for new medications, so that I don't waste the money on the rx if I can't tolerate the medicine.


86 posted on 03/24/2006 6:13:52 AM PST by redlocks322
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