I may not accept your insurance, but I will always accept you

I may not accept your insurance, but I will always accept you

Just for the record: I am happy to see you — irrespective of your insurance.

I accept most insurance plans. And if I don’t accept your insurance, I have a very good reason.

I will not sign a contract with a health insurer that:

Abuses and bullies me and/or my patients.

Denies all my first claims.

Reimburses me so little that I may go out of business.

Leverages a $50 penalty against me when my patients accidentally go to out-of-network labs.

Charges me hundreds of dollars of “membership fees” before I’m allowed to see their patients.

Offers me a contract that dictates my responsibility for their legal fees if they determine I did something wrong.

Keeps me on hold and rotating through multiple phone lines while never addressing my concerns.

Treats me like a criminal.

Assigns me patients who have not selected me as their doctor.

Pays me through a complex formula that even a mathematical prodigy can’t understand.

Penalizes me financially if I don’t use the type of computer system that they think I should use.

Penalizes me financially if I don’t electronically submit my prescriptions the way they think I should.

Threatens me and my colleagues every year with all sorts of financial penalties if we don’t do what they (non-physicians) think we should be doing.

Insurance companies have done all of these things to me. My choice to end my relationships with abusive insurance companies will never impact the quality of medical care that you’ll receive from me. I will always care for you even if I do not care for your insurance company.

Just saying.

Pamela Wible pioneered the community-designed ideal medical clinic and blogs at Ideal Medical Care. She is the author of Pet Goats and Pap Smears. Watch her TEDx talk, How to Get Naked with Your Doctor

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  • DeceasedMD

    sounds a bit like dealing with the mafia…

    • rtpinfla

      At least with the mafia, the rules are pretty clear.

      • Patient Kit

        But the mafia actually whacks you if you break those rules.

        • rtpinfla

          I’m OK with that. I like clarity. :)

          • Patient Kit

            Clarity is a very good thing. But now, with all this Mafia talk, I’m getting all teary-eyed thinking about the time I literally physically bumped into James Gandolfini on the street. He was a sweetheart and a real gentleman. :-(. And an actor not a mobster, of course.

  • LeoHolmMD

    Bravo. I had no idea “pay to play” was happening. Patients need to know how their insurance company is behaving. In fact, it should be published in our new “consumer driven marketplace”.

    • Patient Kit

      I agree. All this kind of stuff that insurance companies routinely get away with doing to doctors and patients needs to be documented, exposed and changed. Why does the choice have to be evil insurance or no insurance? Why can’t we reform insurance? Why is that considered so impossible? Consider the pre-existing conditions change a start and build from there. Transparency is the answer to so many of our problems. What would insurance companies do without doctors and patients? Why are we so powerless against them? I still think that mounting a credible threat of converting to single payer would be a good strategy to make the insurance industry more open to reform.

      • http://www.idealmedicalcare.org PamelaWibleMD

        Boycotts work.

        • Patient Kit

          A successful boycott of health insurance companies would be extremely difficult to organize for a number of reasons, including how many people are dependent on them, especially if they have serious health issues; the fact that so many people get insurance through their employers; the contracts involved, etc.. You might be able to target one “worst” insurance company, get people to switch to another and make an example of the “bad” one. But it would be very very hard to do this and, if it could be started, it would be almost impossible to sustain. And unsuccessful boycotts are worse than no boycott. You end up in a weaker position after a failed boycott.

          Boycotts, in general, are hard, short of blood diamonds and dolphins in nets (diamonds and tuna aren’t that hard to give up). But trust me, it’s hard to get people to give up a brand of clothing even if they know that clothing was made by 5-yr olds in Bangladesh who die of toxic dye fumes. IMHO, a boycott of health insurance companies would not work.

          • http://www.idealmedicalcare.org PamelaWibleMD

            I’m still a fan of standing up for the truth. I’m a perpetual idealist and has worked for me so far in life. . .

          • Patient Kit

            I certainly believe in standing up for what is right too. I just don’t think that a boycott would be a successful tactic to try to use against health insurance companies. And if it was tried and failed, the insurance companies would be in a stronger position than they are now. I do think that mounting a credible threat of replacing the entire insurance industry with a single payer system could be successful in weakening insurance companies and forcing them to reform if they want to survive. You and I agree about organizing to fight back against insurance companies. We just disagree on tactics.

          • http://www.idealmedicalcare.org PamelaWibleMD

            I am for all tactics that are non-violent. Just get off the Lazy-boy chair and do anything other than watch TV. Apathy is the real enemy.

          • Patient Kit

            Dr W, I agree with you about apathy and non-violent tactics (One doc here called me a thug when I suggested threatening the insurance industry with a single payer system in order to force them to reform — no intention of any violence but just the idea of threatening and forcing a business caused him to call me a thug. We can’t ask nicely for the insurance industry to change. We need some leverage).

            Where I disagree with you is this: I don’t believe that any action — no matter how good it feels — is better than no action. If we really want to change big things, we need a well-thought out big strategic plan and a series of strategic specific targeted tactics. And we don’t use our biggest “guns” first. Because, if we do, there is nowhere to go next but to our smaller “guns”. I hope I don’t have to say (but I will), that I do not mean literal guns. Some unthought out action can do more harm than good and end up weakening rather than strengthening a movement.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Are you familiar with Bertolt Brecht? Read the 5 Difficulties of Writing the Truth: http://ricardo.ecn.wfu.edu/~cottrell/ope/archive/0903/att-0196/fiveDifficulties_brecht.pdf

            My favorite part: The cunning to spread the truth via unmonitored positions. Just great. Yes, I do have a strategy.

          • Patient Kit

            Yes, I’m familiar with Brecht. I’ve been lucky to see good productions of some of his plays including Mother Courage and Her Children and The Caucasian Chalk Circle, not to mention Threepenny Opera. Keep us posted about what you’re boycotting. ;-)

          • http://www.idealmedicalcare.org PamelaWibleMD

            Current boycotts:

            1) My ex-husband (he wanted alimony). I’m boycotting supporting a grown man.

            2) Medicare, Hopefully Kevin will post my Medicare blog next.

            3) “Pay to play” insurance schemes.

            4) Factory farming.

          • Patient Kit

            LOL!, well I’m with you on factory farming and pay-to-play insurance schemes. But I don’t think that thing with your ex counts as a boycott. And I definitely will not be boycotting Medicare. I’m closer to the “Medicare for All!” camp. Are many patients joining the Medicare boycott? Many patients 65 and older? I think you and I define “boycott” differently. Personally, I don’t eat McDonald’s food but I’m not boycotting it.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Well I can’t boycott Medicare because I am paying Medicare tax every year whether I use the insurance ever or accept it as payment to not. I think you’ll find the Medicare (part 2 of this blog) quite interesting so I will post it early here: http://www.idealmedicalcare.org/blog/i-love-old-people-but-i-will-not-accept-medicare/

          • Sarah

            Why weren’t there more doctors at the national hearings for reforming our health care system? If you recall, the few docs and other health care professionals that were there…..speaking out for a single payer system…. were actually handcuffed and led out of the hearings. There were no advocates for single payer even allowed to be on the panel……yet most were reps from the health insurance industry. Come on people lets get real!

          • http://www.idealmedicalcare.org PamelaWibleMD

            Maybe because our “democracy” does not work.

    • http://www.idealmedicalcare.org PamelaWibleMD

      Yup! Shine the light of day in the dark corners.

  • buzzkillerjsmith

    An excellent list of insurance abuses. It is terrible that they can get away with this.

    • http://www.idealmedicalcare.org PamelaWibleMD

      I’m sure my list is far from comprehensive. And I am so glad buzzkillerjsmith and I are on the same page on this post. :))

  • QQQ

    When I was in college, in article came out and thought this was worth sharing. Is it true? I can’t really say. So anyone can be the judge of it!
    ————————————————————————————————————

    “The biggest killer of ALL Americans is not some degenerative disease
    like cancer, heart disease, diabetes, etc. Can you guess what it is?

    In July 2004, Gary Null Ph.D, Carolyn Dean M.D., N.D, Martin Feldman
    M.D., Debora Rasio M.D., Dorothy Smith Ph.D. wrote a paper that revealed
    very disturbing facts regarding an annual iatrogenic (induced
    inadvertently by a physician or surgeon or by medical treatment or
    diagnostic procedures) death rate of 783,936 in one year. It is further
    disturbing to realize that as few #$%$ percent and only up to 20 percent
    of iatrogenic acts are ever reported. This means that iatrogenic death
    rate of 783,936 is much higher.

    As we look at the causes of death from degenerative diseases and other
    causes in America in 2004, it is obvious we are not good at solving this
    problem on any level. Deaths from: Heart Disease 652,000, Cancer
    553,000, and Stroke 150,000.

    When comparing the iatrogenic acts of modern medicine in America with
    the statistical numbers of people dying of any particular disease, it is
    evident that the American medical system is the leading cause of death
    and injury in the United States. And when we look at the cost of these
    iatrogenic deaths, the cost is in the billions.

    A definitive review and close reading of medical peer-review journals,
    and government health statistics shows that American medicine frequently
    causes more harm than good. The number of people having in-hospital,
    adverse drug reactions (ADR) to prescribed medicine is 2.2 million. Dr.
    Richard Besser, of the CDC, in 1995, said the number of unnecessary
    antibiotics prescribed annually for viral infections was 20 million. Dr.
    Besser, in 2003, now refers to tens of millions of unnecessary
    antibiotics. The number of unnecessary medical and surgical procedures
    performed annually is 7.5 million. The number of people exposed to
    unnecessary hospitalization annually is 8.9 million.”

    • http://www.idealmedicalcare.org PamelaWibleMD

      Bg problem. Not sure how big. But many medical tests such as CT scans carry health risks that are never discussed. And throwing pills at people is assembly-line office visits without fully listening or evaluating their complete situation can certainly lead to mishaps. Watch this video from my last physician retreat (lengthy but absolutely worth it): https://www.youtube.com/watch?v=H_57Jc8W5rY

      • QQQ

        Thank you!

        • ninguem

          Real simple, just from your numbers.

          Deaths from: Heart Disease 652,000, Cancer
          553,000, and Stroke 150,000.

          Calculated to the nearest thousand, because that’s the best they can do.

          That cancer patient may have died of a stroke after treatment for his heart attack, so into which column do you count that death.

          So, the best they could come up with, is to the nearest thousand. And that’s fine with me.

          In the presence of that, they can calculate the number of IATROGENIC deaths to 783,936.

          Down to the single digits.

          It’s hard enough to say whether the patient died of heart disease or cancer or stroke. I had a guy with advanced prostate cancer. He had diffuse metastatic disease to bone. Leuprolide therapy shrank the metastases. He died at age 99, just a few weeks short of a century. Did he die of prostate cancer, or pneumonia, or old age?

          But if Mable the nurse on third shift gave him two Tylenol’s instead of one, and the error was duly noted, therefore there is a medical error, it’s now an iatrogenic death?

          Bullshit.

          I have complete disrespect for that paper.

    • ninguem

      Deaths from:
      Heart Disease 652,000
      Cancer 53,000
      Stroke 150,000.
      Medical error 783,936

      Look at the pattern. The best we can do with cancer, stroke, and cardiovascular statistics, is down to the closest thousand.

      We have cancer registries for Pete’s sake. Every cancer goes to a registry and we STILL can’t calculate these mortalities any closer.

      A cancer patient develops heart failure, goes into atrial fibrillation, strokes, and lives to age 99, feels tired and slips away in his sleep.

      What’s the cause of death?

      I had a patient like that.

      In the presence of uncertainty like that……even when diagnoses are clear-cut and cancer duly registered….the best these agencies can do is estimate to the nearest thousand.

      But “medical error”. That gets calculated to a single digit.

      To claim that kind of precision makes this study automatically suspect.

      • http://www.idealmedicalcare.org PamelaWibleMD

        That’s an interesting take. Where did you get the stats?

        • ninguem

          From QQQ’s post right above.

          The principal author has his doctorate from some distance education school, Union Institute and University, in Cincinnati. He mailed it in.

          Personally, I take the stuff he writes with a big grain of salt.

          There are certain authors…….I don’t want to say I reject what they write, outright…….it’s just that you end up with the attitude “where did they hide the bias this time”.

          After a while, paper after paper discredited, it’s not worthwhile to pay attention.

          • http://www.idealmedicalcare.org PamelaWibleMD

            I’m a pretty open-minded person so I always try to look at both sides of any issue. Always interesting to speak with folks who are polarized on one side of a topic. Seems very hard to have any real conversation. As you recall, my piece on assault weapons and stethoscopes (attached below) ended up generating a lot of pro-gun and anti-gun comments when I was just comparing the obstacles to legally using a stethoscope vs. a gun.

            http://www.kevinmd.com/blog/2013/01/easier-assault-weapon-doctor.html

          • ninguem

            “Facts are stubborn things; and whatever may be our wishes, our inclinations, or the dictates of our passion, they cannot alter the state of facts and evidence.”

            John Adams, 1770, in defense of the soldiers in the Boston Massacre.

            Death from medical error is surely a number greater than zero.

            Is it 783,936? This is a numbers thing, more so than ideology. I suspect the analysis.

        • ninguem

          There’s a certain Heisenberg Uncertainty Principle with counting……say……suicide.

          The guy that drove his car into a tree, with a high blood alcohol on autopsy. Accident or suicide?

          Wife left him the day before. But no suicide note.

          Painful cancer, maybe there was prescribed oxycodone on autopsy blood testing as well.

          Opiate-alcohol interaction? Maybe he was tired of the pain.

          Suicide or accident?

          Same with iatrogenic death. Anyone claiming to be able to calculate the number of iatrogenic deaths to that precision, has an agenda. And as far as I’m concerned, the number is highly suspect.

          • http://www.idealmedicalcare.org PamelaWibleMD

            Yes. Very good point.

  • Leslie Saltzman

    One more…forces me to accept what ever they decide to pay, yet won’t share the fee schedule

    • http://www.idealmedicalcare.org PamelaWibleMD

      Yes. It is illegal for doctors to share fee schedules or even discuss what they charge with each other, but insurance companies can pay all of us different rates even if we work in offices down the street doing the same thing. And big mega-groups manage to get all sorts of higher payments than the mom and pop shop in the hood.

      • ninguem

        I needed a gold crown on a back molar.

        Paid cash. Asked a few dentists the cost of the crown.

        They all gave me the same price. To the dollar.

        They discuss price. I doubt random chance resulted in dentists over a three-county area (I looked around), would all randomly arrive at the exact same price, to the dollar.

        If I discuss price with you…….we’re not competitors. No antitrust violation.

        Although it’s legal, the antitrust investigation can be painful. Seeing what’s going on with Lois Lerner and the IRS, one cannot be confident the investigation will be impartial.

        Therefore, docs don’t discuss price.

        • http://www.idealmedicalcare.org PamelaWibleMD

          Lois Lerner?

  • Becky

    Aren’t ALL insurance companies like that? Are there any that are different?

    • http://www.idealmedicalcare.org PamelaWibleMD

      Most in our region (Oregon) are fair and easy to deal with. What that means:

      1) 5-page contract (not a 20+ page contract with sneaky anti-doc clauses) that states you be doctor, we be insurance company, you submit claim, we pay in a timely manner.

      2) No excessive hoop jumping (prior authorizations)

      3) Check comes in mail (or direct deposit) 2 weeks after patient seen.

    • http://www.idealmedicalcare.org PamelaWibleMD

      All different with their own quirks.

    • http://www.loveyourniche.net LoveYourNiche

      That was my concern reading through this.

      There are many people out there who face insurance options that just won’t pass this list…like, none of them. Patients need to know these things, don’t get me wrong, but for some people, they’re answering a question of treatment/none while a doctor is answering a question of business /none.

      I spent over a decade dealing with nothing but insurance companies around the country, and I think that these complaints…it’s a bit unfair to put them on the backs of the patients who don’t have that many options. We’re not talking about bad service at a restaurant.

  • ninguem

    Who charges a “membership fee”?

    That’s one I have not encountered.

    Not that I doubt you, just hasn’t reached my neighborhood yet.

    • http://www.idealmedicalcare.org PamelaWibleMD

      OHP. LIPA charged $3200 year for me to be able to care for even one OHP patient (state Medicaid). Needless to say that was a huge financial loss.

      • http://www.idealmedicalcare.org PamelaWibleMD

        And to get paid 1/3 of commercial insurance. But i’m sure somebody is making a fortune. I was on the QA team there. Asked the treasurer (a doctor friend) to find out about the flow of money through the organization. He tried to find out and they gave him a few Dutch Brothers coffee receipts. ZERO financial transparency.

        • ninguem

          I had a patient who ran a coffee stand. She paid me in coffee. Unfortunately, she moved. It was a great deal for some time. Developed one helluva coffee habit, though…….

      • ninguem

        Oh, I see your point. The IPA’s.

        The insurance companies don’t hit you with “pay to play”, or at least I’ve never seen it.

        The IPA’s are another matter.

        • ninguem

          Funny, though, I’d have pictured the Lane County IPA more like this:

          http://www.jqjacobs.net/photos/fair/fair_trail.jpg

          • http://www.idealmedicalcare.org PamelaWibleMD

            No the meetings were not like that at all. Everyone in suits. Mostly men. I came in my biking gear.

          • ninguem

            They have suits in Eugene?

            Who knew?

            I hope they were Gore-Tex, at least.

            I just noticed this…..$3200 A YEAR ??

            I didn’t realize that was an ANNUAL fee.

            Crap. Any IPA I’d looked at, they wanted that as a one-time thing.

          • http://www.idealmedicalcare.org PamelaWibleMD

            It was $800 quarterly. Yup. $3200 year for the benefit of . . . .???? taking care of the most challenging low paying clients in town??? I’d rather do it for free than pay to do that. Can anyone, someone explain?

        • http://www.idealmedicalcare.org PamelaWibleMD

          For a while there was no way to take Providence, EHA, or OHP patients without payola baby.

          Also when I explained to my ex-husband that I needed to pay my hospital staff dues, he asked: “You have to pay to be admitted to the hospital to see a patient?”

          Seems ludicrous.

  • ninguem

    Say Pam, you’re moving up in the world.

    No more cardboard and marker pens?

    • http://www.idealmedicalcare.org PamelaWibleMD

      I’ll get back to those. Didn’t you see what I did last weekend at the Eugene Marathon?

      • http://www.idealmedicalcare.org PamelaWibleMD

        Check out my FB page for more photos. Yes! I had my own medical booth! Preventing marathoners telerrhagia.
        Here’s the video: How one doctor can prevent 12,000 bloody nipples from 17 countries in one hour:

        https://www.youtube.com/watch?v=L9Ax8xf6J_E

        • ninguem

          Whaddaya got for jock itch?

          • http://www.idealmedicalcare.org PamelaWibleMD

            I’ll work on that. I did have guys applying it to their thighs.

          • ninguem

            That green structure right behind you, was that your booth?

          • http://www.idealmedicalcare.org PamelaWibleMD

            Hahaha!

  • ninguem

    Suggestion for next post.

    I may accept your insured, but if you come in here with an insurance contract…….

    http://cdn2.kevinmd.com/blog/wp-content/uploads/IMG_35383.jpg

  • http://www.idealmedicalcare.org PamelaWibleMD

    Aw . . .sweet! It;s a group effort. We really can have ideal medical care. It’s not rocket science. :)

    http://www.idealmedicalcare.org/blog/how-one-ted-talk-is-changing-the-world-of-medicine/

  • http://www.idealmedicalcare.org PamelaWibleMD

    Thanks for trying to educate the masses. The insurance issues take on a whole new dimension when marking down mental health codes.

  • Leanne Ceadaoin

    Isn’t that the definition of an insurance company?! :(

  • Sara Stein MD

    Great blog, Pam. Do you have any insurers left?

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