The Doctor is (not) in ..Well, maybe.

The Orange County Register has an interesting article about medical practices that have stopped accepting any insurance — HMO or PPO — because of low reimbursement rates and the hassle of getting claims filled.

Dr. Felice Gersh, a gynecologist and medical director of Irvine’s Women’s Medical Group, recently sent 10,000 letters to patients telling them that they’d have to pay cash for visits from now on. Prices range from $75 for a visit with a nurse practitioner to $200 for an annual well woman exam with a doctor.

While these so-called “concierge” or “retainer” medical practices aren’t typical (and fortunately, don’t seem to be growing at such a rapid pace), the tangle of causes and effects that culminated with this medical group spurning insurance companies underscores the problems in our current system.

A Wall Street Journal Story in February reported that providers and insurers — together — spend $20 billion annually in admistrative and associated costs to recover — or fight — claims. (Think of how much health care we rededicated that $20 billion!) The agony of wrangling with insurers, and the poor reimbursement rates, understandably aren’t worth it to providers.

But doctors will get paid. So will insurers, who will continue to recruit new enrollees.
It’s consumers who suffer most here.

As a baseline, whether their doctor’s take insurance or not, the consumer medical experience is getting worse, not better. Consumers are being asked to wait longer for appointments, facing more limited benefits, or being asked to pay more when they go to the doctor.

A doctor who refuses to take coverage layers on additional complications for consumers; they’ll either have to find a new one that does accept their insurance card, uprooting years of medical history or pay up front, and hope for quick reimbursement later.

Health Access California promotes quality, affordable health care for all Californians.

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