A Shifting Patient Population for this Doctor

January 22, 2018

A new year means some patients will have new insurance plans, meaning a lot of transition for this doctor's practice and his patients.

With the start of the New Year, we experience a shift in my patient population. Insurances have changed and some of the patients have entered new plans in which I do not participate and others now have insurance which covers my office.

The largest problem is the Medicare patients, who get takeaway plans, which are really HMOs or state aid programs. Many get very upset when they find out I am not in these insurance plans. The best I can offer them is to see them at a lower rate, which cannot be billed to their insurance or will allow me to transfer their records to the new doctor.

This happened to one of my COPD patients, who was told by his new family physician he could not see them until April and if they have problems, they should go to the ER to get medication. Considering I was seeing her twice a month for flare-ups, this was a real problem for treating this patient as she will not be sure which doctor will see her or what they will do for the flare-ups.

One of my patients required hospitalization and was seen by a hospitalist, since the new doctor only works in the office. The hospitalist declined to call any specialists for consultation during his stay. After discharge, the family came back to see me about the problem. I called a specialist who saw the patient that day for the problem. He called me back very upset about the condition of the patient and sent him to the ER immediately.

The patient was admitted under my care and the surgeon operated on the patient that day. The surgeon then called in an infectious disease physician. The patient will go home on IV antibiotics for a month after discharge. Both specialists called the insurance company and explained why the patient was admitted to a different hospital not on the plan. They both told the family to retain legal consul against the new family doctor, hospitalist, and first hospital if the plan does not cover the out of network care.

This should make for an interesting year at my office.