In the face of the Affordable Care Act (ACA), and in recent years, the overly aggressive nature of HMOs, insurance companies, and other third-party providers, the concept of dropping insurances has been revisited and is gaining increased popularity with physicians and physician groups. However, there are numerous issues that need to be analyzed and addressed if a physician is going to drop insurance carriers and opt for private pay directly with patients.
The most obvious benefit is that the insurance carrier no longer has their hand in the physician’s pocket and/or increased scrutiny over the physician’s practice. Also, the physician would avoid any unnecessary audits or attempts by the insurance company to call back money. However, there is a very real balance between not only the patient paying out of pocket for services, but the patient becoming more cautious about making appointments. Even routine appointments might seem more of a hassle to a patient if their carrier is not paying for it.
Depending on the physician’s patient base, the demographics of the practice, the location, and their speciality, this option may not be available for many physicians. Before entertaining this option, it is beneficial for a medical group to develop a very clear set of policies and procedures, an internal fee schedule outlining what it will charge patients, and how it will proceed.
Additionally, it is extremely important for the physician to properly fill out the bill in such a manner that it is in line with the patient’s insurance carrier, third-party carrier, or HMO’s guidelines, so that the patient can get properly reimbursed directly from their insurance carrier under their plan when they submit the bills on their own. This affects the patient more directly than the physician, and might mean that there is very little change in administrative costs.
Before implementing any such concierge or private patient procedures, the physician needs to do a proper analysis of their business to determine if this will benefit or hurt their practice.