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Kowalski

Doctors Boycotting California's Exchanges

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An estimated seven out of every 10 physicians in deep-blue California are rebelling against the state's Obamacare health insurance exchange and won't participate, the head of the state's largest medical association said.

“It doesn't surprise me that there's a high rate of nonparticipation,” said Dr. Richard Thorp, president of the California Medical Association.

Thorp has been a primary care doctor for 38 years in a small town 90 miles north of Sacramento. The CMA represents 38,000 of the roughly 104,000 doctors in California.

“We need some recognition that we’re doing a service to the community. But we can’t do it for free. And we can’t do it at a loss. No other business would do that,” he said.

California offers one of the lowest government reimbursement rates in the country -- 30 percent lower than federal Medicare payments. And reimbursement rates for some procedures are even lower.

In other states, Medicare pays doctors $76 for return-office visits. But in California, Medi-Cal's reimbursement is $24, according to Dr. Theodore M. Mazer, a San Diego ear, nose and throat doctor.

In other states, doctors receive between $500 to $700 to perform a tonsillectomy. In California, they get $160, Mazer added.

Only in September did insurance companies disclose that their rates would be pegged to California’s Medicaid plan, called Medi-Cal. That's driven many doctors to just say no.

They're also pointing out that Covered California's website lists many doctors as participants when they aren't.

Link: http://washingtonexa...article/2540272

Edited by Kowalski
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The biggest problem in the Health Care world, is the Health Care providers. If we could get them to explain why a Tylenol, while given in the hospital, could possibly cost $23, maybe we could stem the tide of the the insanity that goes for 'health care'. They do it than for no other reason than they can.

Things like this were a problem way before Obamacare, yet they are still roundly ignored by our Politicians.

Obamacare is just a symptom of a larger sickness. Insurance companies and Health Care providers continue to fleece consumers, and we are unwilling, or unable to stop it.

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The biggest problem in the Health Care world, is the Health Care providers. If we could get them to explain why a Tylenol, while given in the hospital, could possibly cost $23, maybe we could stem the tide of the the insanity that goes for 'health care'. They do it than for no other reason than they can.

Things like this were a problem way before Obamacare, yet they are still roundly ignored by our Politicians.

Obamacare is just a symptom of a larger sickness. Insurance companies and Health Care providers continue to fleece consumers, and we are unwilling, or unable to stop it.

It isn't the doctors, though. It's the insurance companies and the government that have caused skyrocketing prices in healthcare. You need to get the government and health insurance companies out of the way if you want to reduce the cost of healthcare.

In 2011 the average American medical practice spent $82,975 per doctor dealing with insurers, according to the Commonwealth Fund.

Link: http://mobile.busine...-of-health-care

They really need to just outlaw health insurance. It's nothing but a ponzi scheme, set up to make millionaires even more money....

WellPoint Inc. revealed Friday that it boosted its chief executive's compensation 51% last year, even as the health insurance giant prepared massive rate increases in California that embroiled it in a national controversy over skyrocketing health insurance costs.

The proposed rate increases of up to 39% in individual policies turned the insurer into a flash point in the healthcare overhaul battle.

Link: http://articles.lati...oint3-2010apr03

I think Ron Paul had it right.....

We should remember that HMOs did not arise because of free-market demand, but rather because of government mandates. The HMO Act of 1973 requires all but the smallest employers to offer their employees HMO coverage, and the tax code allows businesses — but not individuals — to deduct the cost of health insurance premiums. The result is the illogical coupling of employment and health insurance, which often leaves the unemployed without needed catastrophic coverage.

While many in Congress are happy to criticize HMOs today, the public never hears how the present system was imposed upon the American people by federal law. As usual, government intervention in the private market failed to deliver the promised benefits and caused unintended consequences, but Congress never blames itself for the problems created by bad laws. Instead, we are told more government — in the form of “universal coverage” — is the answer. But government already is involved in roughly two-thirds of all health care spending, through Medicare, Medicaid, and other programs.

For decades, the U.S. healthcare system was the envy of the entire world. Not coincidentally, there was far less government involvement in medicine during this time. America had the finest doctors and hospitals, patients enjoyed high-quality, affordable medical care, and thousands of private charities provided health services for the poor. Doctors focused on treating patients, without the red tape and threat of lawsuits that plague the profession today. Most Americans paid cash for basic services, and had insurance only for major illnesses and accidents. This meant both doctors and patients had an incentive to keep costs down, as the patient was directly responsible for payment, rather than an HMO or government program.

The lesson is clear: when government and other third parties get involved, health care costs spiral. The answer is not a system of outright socialized medicine, but rather a system that encourages everyone — doctors, hospitals, patients, and drug companies — to keep costs down. As long as “somebody else” is paying the bill, the bill will be too high.

Link: http://archive.lewro...ul/paul339.html

Edited by Kowalski
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Wow, according to the article California pays $160 for a tonsillectomy, other states pay $500-700, but it costs us $4100-6400. http://www.ask.com/q...sillectomy-cost

Makes me wonder what the true cost is.

SOmeone's getting ripped off here.

Quite possibly, EVERYONE'S getting ripped off here!

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It isn't the doctors, though. It's the insurance companies and the government that have caused skyrocketing prices in healthcare. You need to get the government and health insurance companies out of the way if you want to reduce the cost of healthcare.

This is a thread about providers asking for more money. And you think the problem is the people they're demanding give it to them?

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there is not enough teats on the cash cow udder is what its all about ...

~

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This is a thread about providers asking for more money. And you think the problem is the people they're demanding give it to them?

No, they are not asking for more money.

When someone provides a service, they get paid for it. All their asking for, is the money for the service they provided to the patient who is on Medicaid. I used to work in medical billing for awhile. Medicaid is a friggin nightmare. As the article states above, the payout is poor, and takes weeks. No one seems to have a clue on how to do their job over there either.... Doctors don't make that much when you factor in student loans and malpractice insurance, which can be in the $1,000s of dollars range. And if your running your own clinic you then have to make payroll for your employees, overhead, electricity, water, and taxes (This is why a lot of doctors aren't in a private practice)..... you add the whole Medicaid debacle and worrying about getting the bills paid....Yeah, I understand why most doctors and providers don't want to take Medicaid and similar programs. They have to make a living too.

Our government needs to run it's programs better. I mean, seriously, what business or company could run a program so half assed and not go out of business? I'm not against a single payer system (although I don't believe healthcare is a right), some countries (not all) have fairly good healthcare systems. I just don't think our government could run it efficiently.

I read a really good article about concierge healthcare. Because of Obamacare, I think a lot of doctors will go to this. Which isn't bad actually....

An anxious woman in her mid-40s showed up last winter at Atlas MD, a family doctor’s office in Wichita. She had lost her job as a restaurant cook, and along with it her health insurance and her home. She needed to see a doctor.

Atlas MD isn’t a free clinic. It’s a concierge medical practice, which means you can’t get an appointment unless you pay cash. Atlas MD’s two physicians, Josh Umbehr and Doug Nunamaker, don’t accept insurance. Instead, they charge most of their adult patients $50 a month for unlimited visits. They also offer free EKGs and biopsies and cut-rate prices on prescription drugs. Two-thirds of their patients have insurance but feel the fee is well worth it for personalized service, including house calls, the doctor’s cell-phone number, and quick responses to e-mails and Twitter messages. The rest of Umbehr and Nunamaker’s clientele are uninsured. For those patients, Atlas is the only way of seeing a family doctor regularly. Contrary to those who say concierge doctors like themselves are getting rich by focusing on personalized care at a high price, Nunamaker and Umbehr, who are in their early 30s, contend that they can grow their practice by appealing to a broader clientele.

It was midway through the month when the homeless woman arrived at Atlas MD, so Nunamaker asked her for $25 and examined her immediately. She told him she was always tired and couldn’t keep a job. She was living in a storage shed. Nunamaker gave her a blood test, which revealed an extreme case of hypothyroidism. That explained her exhaustion. “I get why you are so fatigued,” he said. “Your thyroid isn’t working as well as it should.” He put her on medication that would boost the hormone her thyroid gland wasn’t producing and restore her vitality.

The woman stayed with Atlas MD for three months until she was feeling better. Then she left. Nunamaker gave her three months of inexpensive prescription refills and wished her well. He would have preferred to see her stay on. But he and Umbehr are proud that they were able to restore her health for $147, including tests and prescriptions. (They made money on her monthly retainer, but not on the tests and labs. Atlas MD provides them at cost.) They estimate that she would have paid as much as $1,500 if she had gone to a regular doctor. It was undeniably a good deal for her; had she required hospitalization, however, the bill would have been enormous and not covered by Atlas.

Link: http://mobile.busine...-of-health-care

Edited by Kowalski

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I've asked this before but you cannot explain. HOW? An insurance policy purchased thru any exchange is a private transaction between you and the insurance company. How does a doctor "opt out"? You private insurance card is no different than mine.

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I've asked this before but you cannot explain. HOW? An insurance policy purchased thru any exchange is a private transaction between you and the insurance company. How does a doctor "opt out"? You private insurance card is no different than mine.

I would assume by not accepting certain types of insurance.

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I've asked this before but you cannot explain. HOW? An insurance policy purchased thru any exchange is a private transaction between you and the insurance company. How does a doctor "opt out"? You private insurance card is no different than mine.

Well here in the backwards lands of Australia, you have to fill out a form everytime you see a GP who isn't your own GP, on that form is "do you have private health insureance" and "if "yes" who".

Or you could simply have a sign that says "Are you with company X on plan Y? Then sod off".

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Maybe those doctors should go get a job where they couldn't possibly make 160 dollars in one day then see if they'll go back to it. There are many people who would love to be in their position and would take that pay in a heartbeat, even if it meant paying for the education to get there.

Edited by andy4

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Maybe those doctors should go get a job where they couldn't possibly make 160 dollars in one day then see if they'll go back to it. There are many people who would love to be in their position and would take that pay in a heartbeat, even if it meant paying for the education to get there.

And MOST of those folks would be unable to finish the education.. Like it or not, these guys and gals - for the most part - are quite a cut above the field in intelligence. If you want an auto mechanic cutting into you go for it. I'm sure you'll get a bargain rate :)
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Unfortunately education takes longer than a heartbeat, especially med school.

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I'm aware of that. Do you know how many people don't have jobs that would go through school to reach that? There are plenty. There are also many others who do have jobs who would do the very same. I didn't say I wanted an auto mechanic to go through med school and give me or anyone else treatment. If they don't like their job, they should leave it. Or at least get a second job to make up the discrepancy in pay and stop complaining.

I honestly cannot believe this made the news at all. (Well I kinda can, but still)

I also wanted to say that this story exposes a huge flaw in the healthcare system which is why so many doctors (from what I've heard) seem to be walking away from their jobs, and it's something which is blatantly overlooked. The education needed to get there is ridiculously overpriced. These doctors need high income to pay off their large debt to the schools, which is why to me, healthcare has always been so expensive. Now that it's lower they are complaining because they had to pay so much to get there, and now their income has been significantly reduced. Now that the ACA has been passed, fewer people are wanting to be doctors because the income is lower. If everyone wants better doctors and faster healthcare, reforming the (highly overpriced) education system is a must. The two go hand in hand, and they really shouldn't be that way.

Edited by andy4

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I'm aware of that. Do you know how many people don't have jobs that would go through school to reach that? There are plenty. There are also many others who do have jobs who would do the very same. I didn't say I wanted an auto mechanic to go through med school and give me or anyone else treatment. If they don't like their job, they should leave it. Or at least get a second job to make up the discrepancy in pay and stop complaining.

I honestly cannot believe this made the news at all. (Well I kinda can, but still)

I also wanted to say that this story exposes a huge flaw in the healthcare system which is why so many doctors (from what I've heard) seem to be walking away from their jobs, and it's something which is blatantly overlooked. The education needed to get there is ridiculously overpriced. These doctors need high income to pay off their large debt to the schools, which is why to me, healthcare has always been so expensive. Now that it's lower they are complaining because they had to pay so much to get there, and now their income has been significantly reduced. Now that the ACA has been passed, fewer people are wanting to be doctors because the income is lower. If everyone wants better doctors and faster healthcare, reforming the (highly overpriced) education system is a must. The two go hand in hand, and they really shouldn't be that way.

It's too bad government is setting interest rates at the same time it's handing out student loans. Now college is unaffordable in the US and we're becoming a dumbed-down nation as a result.

Thanks, 20th century bureaucrats! :)

Like Bush said, "Mission Accomplished!"

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It's too bad government is setting interest rates at the same time it's handing out student loans. Now college is unaffordable in the US and we're becoming a dumbed-down nation as a result.

Thanks, 20th century bureaucrats! :)

Like Bush said, "Mission Accomplished!"

Yes, I see that they have been lowered, but still, why the high price? Why the need to get a massive loan to pay for an education? It doesn't matter that the interest rates are lower when the money you need to pay back is so high. They lower the interest rate to get more people to get an education on an individual basis, but they are still making just as much. Good illusion they pulled there.

Oh, and if you flunk out or dropout for any reason, sorry, you won't see that money again. Who knows, you may still owe it, even though you received a 10,000 dollar debt and nothing in return! I can see why so many are just itching to get a loan for education. Fix this, and you'll have more doctors and less complaining about the pay. There are many who actually enjoy helping others.

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It isn't the doctors, though. It's the insurance companies and the government that have caused skyrocketing prices in healthcare. You need to get the government and health insurance companies out of the way if you want to reduce the cost of healthcare.

That's incorrect. Just think of the doctors, hospitals and pharma companies as one entity. The beginning of high healthcare costs began when hospitals realized they could charg exorbitant amounts if they billed a pool of people (insurance) rather than individuals.
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I am not sure i do know my doctor does not accept several types on insurance. He says they are too difficult to work with and opts out of their network. I think he is getting toward the autumn of his career and is at that point where he says I don't need this ****. Its not to say he doesn't work he does rounds and manages care for a dialysis unit. I think he has enough going on that he can say no if the BS and red tape annoys him.

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I would assume by not accepting certain types of insurance.

so they would not accept Blue Cross, Aetna, Cigna ??? be serious

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I am not sure i do know my doctor does not accept several types on insurance.

That's been true for DECADES. Doctors are part of networks that they decide are cost effective to be a part of. It has nothing whatsoever to do with the ACA. The insurance company networks still exist.

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so they would not accept Blue Cross, Aetna, Cigna ??? be serious

I didn't specify. Just taking a crack at your query.

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How does a doctor "opt out"? You private insurance card is no different than mine.

The cards might be the same, but the numbers on it are different, and when the doctor's office runs those numbers, they will know if you are on a plan that is allowed, or not, or is Out of Network.

So obviously you are right, they will accept everyone's card, but they also will send you a bill for Out of Network, where you pay 5 times as much as if you went to an In Network facility.

Opting out is called, being Out of Network. Doctors can chose that, to be Out of Network for various plans and insurers, if they so wish.

so they would not accept Blue Cross, Aetna, Cigna ??? be serious

And you don't believe that there's going to be a database of what plan everyone is on? Come on. Everytime I go to the doctor, they check my card and run a check on it, to see that I am ACTUALLY insured, what my deductable is, and what my other specifics are. It is almost inconceivable that it will not come up "Exchange Plan" when they run an exchange plan insured person.

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so they would not accept Blue Cross, Aetna, Cigna ??? be serious

I know a doc lost his job due to the hospital he had a contract with decided to refuse to accept what Blue Cross was offering as reimbursements for his specialty. So yes, hospitals can and DO drop insurances if the insurance co. decides not to pay as well as they did.

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Maybe those doctors should go get a job where they couldn't possibly make 160 dollars in one day then see if they'll go back to it.

Actually what they make is closer to 100 dollars an hour. That would be about $200K a year. Still not "Rich" by many people's standards. And not overly greedy either. The most "greedy" doctors probably make $500 an hour and are highly specialized.

Most of the engineers I work with here at Intel have a Doctorate degree and they get paid around $150K per year, I believe. Or about $75 an hour. $600 a day. That is why they got a Doctorate degree.

That some people get crap degrees that have no good rate of pay return, is on those people. That they have loans, is also on those people. They could have gone to Community College and gotten a Associate in engineering and be making $75K to $90K a year like me in the Technology industry. But, nooooooo.... They want a Masters Degree in Early Greek Bronze Sculpture, and then complain when they get stuck working in an office doing data entry for $12 an hour, because there is no Openings for Greek Sculpture specialists. They are the one who chose Greek Sculpture!!!......

I don't really feel sorry for these people, other then to acknowledge that they made a bad (financially) combination of education and career choices. They may love their education, but if it does not pay the bills, it is wasted.

Edited by DieChecker
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