Friday, November 30, 2007

Doctors Seek Cash when Insurance doesn't pay...

Friday, November 30, 2007
Doctors seek cash when insurance doesn't pay
Some patients opt to stay with provider and pay more out of pocket, while others seek new care.
The Orange County Register A small but growing number of Orange County doctors has stopped accepting private insurance, saying they are fed up with low reimbursements that can take months to receive, lost claims and denials of necessary medical care.

This fall, Women's Medical Group of Irvine dropped roughly 20 preferred provider organizations after more and more staff time went to insurance paperwork rather than patients.

To read the complete article, please visit the OC Register's website.

"There's so much frustration as far as the wrangling over the claims," said Michele Revelle, executive director of the Orange County Medical Association, which on Thursday held a first-ever conference on how to negotiate insurance contracts. "It's too expensive to chase."
As doctors seek to avoid bureaucratic hassles, their patients can be left with higher costs in some cases or finding a new doctor within their insurance network.

Karen Hochwald, a 45-year-old Irvine homemaker, paid $140 for an October visit to Gersh, a change from her usual $10 co-pay through her Blue Shield PPO. She left with an itemized bill, which she mailed to her insurer. Blue Shield sent her a partial reimbursement within about two weeks.

To read the complete article, please visit the OC Register's website.

Here's an excerpt from a follow-up letter Women's Medical Group of Irvine sent to patients to answer questions about the decision to stop accepting private insurance:

"But how much more is this going to cost me? That's hard to say, since each plan sets its own rates for out-of-network payments. Your best bet is to check your policy or call your insurance company to find out what your specific coverage is. We can, however, offer these guidelines:

"First, during the past five years, deductibles have skyrocketed. It is not unusual to find plans with $250, $500 all the way up to $5,000 annual deductibles. In these cases, you end up paying the full bill, whether we submit the claim or you do. We have kept our charges close to insurance-company reimbursement rates so that your actual out-of-pocket payment for services will be virtually the same.

"Second, some insurance plans reimburse out-of-network providers at close to the same rates as in-network providers. In these cases there may, or may not, be a small additional cost to getting your care at our office. If your co-pay is more than the difference in the reimbursement rate, then it will likely cost you less to come to our office now than it has in the past."

To read the complete article, please visit the OC Register's website.

Contact the writer: 714-796-3686 or


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