How physicians can transition to an insurance-free practice
Physicians have long expressed dissatisfaction with the amount of time and money it takes to deal with insurance companies, but the alternative, going insurance-free, may seem a risky, problematic model of operation that could send patients fleeing from their practice-something no physician wants to happen.
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Going to an insurance-free model of practice can mean a variety of options. Some practices stop contracting with insurers altogether and only accept cash from patients, either at a set rate, or they negotiate with them individually. Other practices transition to a concierge model in which their patients pay a monthly or annual subscription fee that includes various amenities like an annual physical and 24/7 access to practice doctors. Depending on the model, physicians may submit insurance paperwork for patients for special services, or give the patients the forms to do it themselves.
Patients who have high deductible health plans-which the IRS defines as $1,300 or more for an individual or $2,600 or more for a family-pay out of pocket until they meet their deductible anyway, so an insurance-free practice might not be a problem.
“Many of my friends and colleagues thought I was insane. They said no one will ever see you,” says Larry Good, MD, a gastroenterologist affiliated with Concierge Choice Physicians in Lynbrook, New York, speaking about his transition to an insurance-free practice.
“About eight to 10 years ago, the functional and economic changes in medicine that were happening at the time became progressively more intolerable and so I began, over a period of several months, to drop those insurances that made it more difficult for me to provide the quality care that I truly believe my patients deserve,” says Good.
He eventually dropped all commercial insurers except Medicare for a few elderly patients who had been with him more than 25 years.
“It’s just not emotionally comfortable for me to abandon them now,” he says.
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But being insurance-free doesn’t emancipate a physician from some of the perils of the insurance industry, warns Good. You still need things like prior authorization for special testing and procedures for your patients, and for prescribing medications that may not be on their insurer’s formulary since your patients have to deal with their insurance in order to get reimbursed.
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