Sunday, November 16, 2008

Double barreled refrigerated proctoscope sign

(Increased rectal tone that occurs suddenly if you are about to have a rectal exam with al doube barreled refrigerated proctoscope or if you get both your latest managed care contract quotes on the same day your get the quotes for you and your employees health insurance). Our health insurance plan for our employees is coming up for renewal. To keep the plan the same, with a $35 deductable for office visits, $2500/5000 individual/family max out of pocket and 80/20 coverage we will have to pay an increase of 27%. If you look at our utilization, no one in our practice has even used up to their max out of pocket. The only way we can keep it the same $562/month per employee is to have the employees pay the difference and then we go up to $5000/$9000 max out of pocket and no script card. We can try for HSAs but up till now non have wanted it.

On top of this, all our managed care carriers are quoting us on the average of 20 to 30% less on their fee scales. Most are take it or leave it. It is hard to negotiate with them because Pete Stark made it illegal for us to talk to other physicans and groups to come to some solidarity. At least CMS (Medicare) threw us a bone. A 2% increase if we E-precribe. This is like adding the discount KY for the double barreled proctoscope.


Frontier Psychiatrist said...

Excuse me: what does

"our managed care carriers are quoting us on the average of 20 to 30% less on their fee scales. Most are take it or leave it."


They're only paying you 70-80% of the due amount?

Amazing. Seems to be an international conspiracy on the way. Over here, they just announced a 30% cut for 2009, take it or leve it. Who's behind this?

SeaSpray said...

Throckmorton...I'm sorry you got the double barrel notification. Funny analogy though. :)

So the companies are raising rates and covering less. And these are tough times. It seems like the companies have a win-win going on. How do they get away with it?

You work in such a noble profession. It just doesn't seem right that they treat physicians that way.

I have wondered how physicians know when to raise prices. Then if you all can't discuss do you figure your price increases with anything? Who sets them? The AMA regionally? And why is it illegal to discuss your practice finances with another physician? That seems like censorship.

You said "It is hard to negotiate with them because Pete Stark made it illegal for us to talk to other physicans and groups to come to some solidarity."

Wow! I know I don't understand any of this but... your prevented from achieving any solidarity with your colleagues?? Is KGB involved? seriously! What about free enterprise and freedom of speech?
Regarding employee ins: When I worked at the hospital...I dropped my health insurance after I had a baby. Since I only worked part time...I didn't want to pay the increased premiums. I was fortunate though because I had my husband's insurance and so I didn't have to keep it.

Maybe I am wrong, but I don't care if I have health ins offered when I go for a job soon. Which is a good thing I guess because I am hearing that doctors/businesses are preferring to hire PT employees that work just shy of the the required hours to qualify for benefits.

Maybe I am being shortsighted still... but I would rather have the money vs the benefits... at least now... since I have my husband's insurance. I guess it would depend on the price of the pkg offered. Ha! Although I would never refuse accrued vacation days. We had a time bank at the hospital and so if you didn't use your sick could take them for vacation which is much better than a sick day any day. :)

I have to say your plan with 2500/5000 max out of pocket is good. I think our catastrophic is 4500 with PPO and 7 something nonppo. I should review that.

27% increase is high and they're giving you less? Gee!

We got the open season insurance book but I never switch. We have had the same plan since we dropped fed BC/BS in 89. I suppose I should review the plans. But I know our plan has a good turnaround time for reimbursements/provider payments and has been decent for us.

Now I am curious. I wonder what our plan will be for 2009. they have been good about keeping costs down, but I don't know what or if they've taken anything away to compensate.

Good luck with everything! :)

Oh... one more thing...what is an HSA?

Andrew said...

Nothing to do with this particular post of yours, but I can't find an email address for you on your blog.

I think you should take a look at the Nov. 20th New England Journal of Medicine, which has both an article and an editorial about the "script" law in North (maybe South) Dakota that requires physicians to "inform" women seeking abortions such helpful things as "You would be ending the life of a whole, separate human being (paraphrasing here). If the physician fails to deliver this drek, he could be criminally prosecuted at the midemeanor level. The NEJM sees it as an infringement of First Amendment rights, and I tend to agree.
By the way, I am the author/editor at The New York Medical Malpractice Law Blog. Keep up the good fight!