Forcing Doctors to Take Medicare Patients

Doctors may negotiate, but labs sure don't. I needed some fancy lab tests done that BC/BS wouldn't pay for, no amount of arguing by the doctor would change their mind so I had to suck it up and pay $800, the tests are essential to my care . If it had been convered by insurance they would have been paid less than $200, but they would not agreed to cut their bill for me, pay the full amount or they would send it for collection.

Maybe Doctors in rural communities don't get rich off insurance companies as most big insurance companies only service certain area codes.
So if you live in Denver Metro where the big insurance co.'s service then those doctors, clinics do submit invoices to the insurance co.
More patients, multiple codes, more money

Doctors, nurses, other health care professionals, and hospitals are not excited about having their pay cut by low reimbursement rates and some have responded by refusing to take patients with those insurance plans. Only about 50 percent of doctors accept new Medicaid patients. While a much higher percentage of doctors accept Medicare patients, PBS recently reported that in Texas less than 60 percent of doctors are taking on new Medicare patients because of the low payment rates.

Come January 1, unless Congress acts between now and then, Medicare reimbursement rates will be cut by 24 percent under a law passed in 1997 to prevent Medicare from going broke. Generally Congress passes what is known as the “doc fix” and postpones those cuts for a year. With the budget negotiations underway and all the attendant pressure on spending, will Congress allow the cuts to go into effect or delay them again?

Maybe I missed the "doc fix" (did congress get to that yet?) and yes, I did confuse medicare and medicaid, but most new ACA signups have been for medicaid, by far... so it seems logical that if medicaid only pays 35%, these will be the last people doctors will want to take. The whole premise of the ACA was to provide more access to healthcare... getting signed up for medicare may not mean getting easy access to care when the pool of doctors keeps shrinking.

Rick wrote:

Doctors, nurses, other health care professionals, and hospitals are not excited about having their pay cut by low reimbursement rates and some have responded by refusing to take patients with those insurance plans. Only about 50 percent of doctors accept new Medicaid patients. While a much higher percentage of doctors accept Medicare patients, PBS recently reported that in Texas less than 60 percent of doctors are taking on new Medicare patients because of the low payment rates.

Come January 1, unless Congress acts between now and then, Medicare reimbursement rates will be cut by 24 percent under a law passed in 1997 to prevent Medicare from going broke. Generally Congress passes what is known as the “doc fix” and postpones those cuts for a year. With the budget negotiations underway and all the attendant pressure on spending, will Congress allow the cuts to go into effect or delay them again?

Maybe I missed the "doc fix" (did congress get to that yet?) and yes, I did confuse medicare and medicaid, but most new ACA signups have been for medicaid, by far... so it seems logical that if medicaid only pays 35%, these will be the last people doctors will want to take. The whole premise of the ACA was to provide more access to healthcare... getting signed up for medicare may not mean getting easy access to care when the pool of doctors keeps shrinking.

I am still confused, was your last point about medicare or medicaid?

archer wrote:

Rick wrote:

Doctors, nurses, other health care professionals, and hospitals are not excited about having their pay cut by low reimbursement rates and some have responded by refusing to take patients with those insurance plans. Only about 50 percent of doctors accept new Medicaid patients. While a much higher percentage of doctors accept Medicare patients, PBS recently reported that in Texas less than 60 percent of doctors are taking on new Medicare patients because of the low payment rates.

Come January 1, unless Congress acts between now and then, Medicare reimbursement rates will be cut by 24 percent under a law passed in 1997 to prevent Medicare from going broke. Generally Congress passes what is known as the “doc fix” and postpones those cuts for a year. With the budget negotiations underway and all the attendant pressure on spending, will Congress allow the cuts to go into effect or delay them again?

Maybe I missed the "doc fix" (did congress get to that yet?) and yes, I did confuse medicare and medicaid, but most new ACA signups have been for medicaid, by far... so it seems logical that if medicaid only pays 35%, these will be the last people doctors will want to take. The whole premise of the ACA was to provide more access to healthcare... getting signed up for medicare may not mean getting easy access to care when the pool of doctors keeps shrinking.

I am still confused, was your last point about medicare or medicaid?

It's about both. Doctors don't have to accept either if they don't feel that the reimbursements cover their costs plus adequate profit.

This may help if congreesss gets around to passing it:

There are now three bipartisan bills sitting before the U.S. Senate or the U.S. House of Representatives to finally fix a flaw in how Medicare pays physicians by basing more of their reimbursement on performance and quality measures.



Congress may finally repeal the controversial Medicare payment cut to physicians known as the “doc fix.” (Photo credit: Wikipedia)

Doctors, who have watched Congress dither and delay for years, may see the repeal of Medicare’s “sustainable growth rate,” or SGR, reimbursement formula. Doctors have long been upset at the lack of a permanent solution for dramatic cuts to doctor payments from Medicare in what has since been labeled the “doc fix.”

www.forbes.com/sites/brucejapsen/2013/12...are-doc-fix-in-2014/

I have seen doctors that charge a little less for a visit for paying cash. But this is no big deal as the basic fee for a basic visit is not the major cost in health care.

That same doc may charge you $6000 for the $200 snake vaccine or charge the ins co less for heart surgery.

And to the person that needed a doctor to explain this to her???? The doctors barely know medicine, they just have the exclusive right to sell it to you. Doctoring and getting into that field IS LITERALLY ABOUT GETTING RICH OFF OF MISUNDERSTOOD BILLING. This is the goal, so to ask them to explain it would be like asking a con man to explain why he is not conning you. Businesses, of which doctors run, do not have to do business with anyone. I would not want to be in business if I could not tell someone like you to leave my store(s) when you piss me off. I don't build homes for people that are offensive or have a bad attitude or whatever else I want. The economy would break down more than it already has due to licensing if we make businesses do business with people (like the gay cake guy).

End the monopoly on medical services and you will end this the endless price increases. If you like the endless price increases, simply license more professions. Lets at least license parents, like come on.

Are you really suggesting that docs shouldn't be licensed?

towermonkey wrote: Are you really suggesting that docs shouldn't be licensed?

That got me scratching my head too. I can think of a lot of professions where a license shouldn't be required, but a doctor would be the very last one I would ever exempt.

I'm hoping that OTN meant we should utilize more medical professionals like physicians assistants, nurses, and paramedics for routine medical care freeing up doctors for the more serious medical issues patients face. I have used many PAs and Nurse Practitioners who I thought were not only as competent as a doctor for routine care, but in many ways better.

archer wrote: I'm hoping that OTN meant we should utilize more medical professionals like physicians assistants, nurses, and paramedics for routine medical care freeing up doctors for the more serious medical issues patients face. I have used many PAs and Nurse Practitioners who I thought were not only as competent as a doctor for routine care, but in many ways better.

But even those people need to be licensed in some way don't they? As a car dealer I needed a license, and my sales guys did too. That's just selling a car not performing medical proceedures or doing anything that would effect one's health.