Doctors Threaten Medicare Backlash

[GreenSky]

The is a point were it costs a doctor more than the payment from Medicare/Insurance. We are not at the point but (for instance) my urologist no longer accepts Blue Shield because the reimbursement rate is too low.

When the cuts to Medicare cause a doctor to work at a loss, then the doctor stops accepting Medicare. This has already happened all over CA with MediCal (Medicaid). It's becoming more difficult to find a quality physician to accept 60 cents on the dollar.

Unlike some other businesses, doctors can't work without making a profit.

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Rick

 

[retread]

The (sic) is a point were it costs a doctor more than the payment from Medicare/Insurance. We are not at the point but (for instance) my urologist no longer accepts Blue Shield because the reimbursement rate is too low.

When the cuts to Medicare cause a doctor to work at a loss, then the doctor stops accepting Medicare. This has already happened all over CA with MediCal (Medicaid). It's becoming more difficult to find a quality physician to accept 60 cents on the dollar.

Unlike some other businesses, doctors can't work without making a profit.

Rick

I heard this very same argument from a local internist at a party last Christmas. He said he had told his staff that beginning in January he would not be accepting any new Medicare patients.... he can no longer afford them. He will serve his current patients until they leave (one way or the other).

Rick has the best explanation I have seen (besides Frank's) regarding Medicare assignment. "Assignment" is not unique to Medicare. Most, if not all, health providers make you sign an agreement that the claims your insurance carriers pay are "assigned" to them before they agree to treat you. Creditors can seek assignment through legal process, too, if you renege on payment. One of the advantages of Life insurance benefits is that they are exempt from assignment, etc. etc.

Assignment is a business practice favorable to the business. Not accepting assignment leaves the business needing a collection agency at additional cost.

Just guess what the chances are of collecting on a $5000 bill when the $5000 reimbursement has already been sent to the patient? Just how fast do you think he will spend it or at least a portion of it? In P&C this happens all the time. A beneficiary gets, say $1500 for an accident claim, spends it and still has a damaged car. He drives it around until he gets tired of the ugly mess and then tries to find somebody to fix it on the cheap.

This won't work in health insurance. That's why providers WANT assignment.

Along comes Medicare and attaches some limits of responsibility on the provider, such that he can only charge 115% of the standard Medicare rate to a Medicare beneficiary and still get the benefit of assignment.... if he wants to charge more, he can't get assignment rights. Yet if he doesn't agree to assignment and wants to collect on his own, Medicare still protects the beneficiary by limiting the provider to an "non-standard rate" (as it were) reimbursement schedule... which happens to be less than the rate he would get if he did accept assignment. Their argument is that it is more efficient to coordinate billing their standard procedures than to manually deal with an independent (non-standard) billing process, so since it costs more to process his independent claim, they will pay less. In that case, the provider ends up with very little more than he would if he just accepted the assignment rate. If he is that bad off, he may need it....

 

[somarco]

Rick is master of his own domain.

Yada, yada, yada . . .

 

[Josh]

I was printing in bold print as a courtesy to make it easier to read. If its that much of a crime to help people out then I will not use bold type any more. Does that make you happy?

I certainly find it easier on the eyes. We've got you quoting instead of doing "someone said" and knocking off the bold, now all we need to do is get you to stop talking out of your backside and we'd have ourselves a respectable member of the forum!

 

[Russ]

Good grief!....A two page letter!....Thats almost going to far man! I mean she might be thinking your desperate if youre sending her 2 page letters trying to make the sale. Man oh man oh man I aint doing it. I aint that poor. Ive never sent out out no letters like that in 25 years. And lets not forget its a tricky deal when you leave written material with a customer and the Department of Insurance gets a hold of it. I mean you think people pick your words over on forums like this just wait until some dept of insurance investigator gets a hold of that letter and goes over it with a fine tooth comb. This is golden so remember it "AS A RULE ITS ALWAYS A GOOD IDEA TO LEAVE THE CLIENT WITH ONLY PRE APPROVED LITERATURE PRINTED UP BY THE INSURANCE COMPANIES". That rule is golden did I say that yet. I dont think you had a lawyer proof read that 2 page letter before you sent it out did you? When the insurance companies print up their marketing brochures they have their legal dept scrutinize it over and over before they release it. You have got to be careful. You will probably be alright this time but dont do that anymore. What Im reading into the situation is you lost the ladies confidence somewhere. You needed to pull out a calm cool laid back answer that sounded good right there and then and nip the problem in the bud. But you didnt and now your chasing it. Im not you and your not me but if it was me I would of went for all or nothing right there on the phone.

Yoda....whatever you're smoking, I'm staying away from.

Yeah, it was a 2 page letter explaining the difference between MA's and med-supps and the med-supp rates for plan F in Florida for BC/BS vs. what I was offering her.

Calm down, I doubt the FL. DOI is going to be knocking on my door this week or sending me a letter of investigation.

Oh...I don't think her buying is going to mean I can retire and if she doesn't, I'll be jumping off of a bridge, ending it.
- - - - - - - - - - - - - - - - - -

There is not an insurance company out there that wants an agent printing up 2 pages of their own words in an attempt to market their insurance. I can almost guarantee you that Mutual Of Omaha would not approve of an agent sending out a 2 page letter in his own words. You call Mutual Of Omaha monday and talk to the marketing dept and come back here and tell me they said it was alright to send out 2 page self composed letters about medicare to customers your marketing Mutual of Omaha too and I will eat my words here. Otherwise shut up and you just might learn something here son!

You need help. You've convinced me.

 

[Yoda]

Yoda....whatever you're smoking, I'm staying away from.
Calm down, I doubt the FL. DOI is going to be knocking on my door this week or sending me a letter of investigation.

Lets put it this way. You post that letter here and I bet I can quickly show you things in it that will get you in trouble with the DOI and the CMS. And if I and others on this forum can you bet the DOI and the CMS can. We live in a very litigious world and that letter leaves you hanging out there.

 

[Russ]

Lets put it this way. You post that letter here and I bet I can quickly show you things in it that will get you in trouble with the DOI and the CMS. And if I and others on this forum can you bet the DOI and the CMS can. We live in a very litigious world and that letter leaves you hanging out there.

I'm so worried. I'm not sure I can sleep tonight.

Talk about being paranoid.

 

[MedSuppPro]

Over 99% of doctors today accept assignment.

Can you please tell us where you got the 99% figure (i.e. source), or is that from Boone County?​

PS I thought I'd try the Yoda bold fresh! Glad to see Rick hasn't lost his humor.
You guys crack me up! ​

 

[Frank Stastny]

Can you please tell us where you got the 99% figure (i.e. source), or is that from Boone County?​

I have no idea what you mean by "Boon County". If that was suppose to be either sarcastic or funny I missed the point. I do not live in Boon County and neither do the vast majority of my clients although all doctors that I am aware of who practice there do accept assignment.

The information is the results of a national study that was done and reported by Ron Iverson in one if his NAMSA news letters. (Ron is a very credible and accurate source of information. I have known him for many years.) I did not make note of the source. I didn't feel it was necessary.

It is the same thing I have experienced in Missouri and what agents are reporting in other states throughout the country. (Yes, there are a very few exceptions.) In sixteen and a half years of selling Med Supps and not selling Plan F I only know of a hand full of doctors in the St. Louis and KC areas who do not accept assignment. (Midwest Broker in KC and I compared notes on that and I think we came up with six less than ten doctors.)

Interestingly, my clients who go to those doctors have a Plan D with me because it saves them money. I have never had a client tell me that they have had to pay more than literally a few dollars "out of pocket" because their doctor does not accept assignment.

I will continue to sell Plan D for those companies that offer it. Once again I say, "the sky is not falling".

For those who think it is I would suggest that they stop selling Med Supps. That would make those who believe and have experienced what I have very happy.

 

[GreenSky]

Once again I say, "the sky is not falling".

For those who think it is I would suggest that they stop selling Med Supps. That would make those who believe and have experienced what I have very happy.

Are you telling me that Henny Penny AND Chicken Licken BOTH wrong?

I have it on good authority that the sky is falling. And it's George Bush's fault.

Rick