Why I am a "Fee For Service Provider" and not a "Network Provider" for Managed Care or Insurance Companies...
In 2007, after considering this move for several years, I made the decision to drop off all of the network panels for managed care & insurance companies. There are a number of reasons I decided to do this:
- Managed Care Organizations have become increasingly intrusive into the doctor-patient relationship, asking for more personal patient information for the purposes of "utilization review" than many of my patients were comfortable releasing.
- These organizations also have become increasingly proscriptive, often attempting to dictate to the physician and patient the type, frequency, and duration of appointments and other forms of treatment.
- Most of these companies have decreased reimbursement, or failed to provide even cost of living increases over the past 15 years. Physicians, like everyone else, have continued to deal with rising expenses (staff salary, insurance costs, rent, equipment, professional services, etc.).
- Shrinking reimbursement has forced not only maximum efficiency, but also changes in the style of practice for many physicians. Many colleagues have resorted to scheduling patients for shorter and shorter appointments in order to "keep their heads above water".
- I decided that this was not the manner in which I wanted to practice. I believe in working hard and being as efficient as possible, but I believe my patients deserve more than a minimum level of care and service
Many patients find that given the deductibles and copayments required by their insurance policy, their out of pocket cost to see a "fee for service provider" of their choosing is not much higher than seeing a "network provider". Many patients have "out of network benefits" which is a provision of many insurance policies that allows you to see the physician of your choice, and submit a copy of your bill and receipt to receive partial reimbursement for the cost of your office visit. (check your policy or with your benefits director for more information)
Fees for office services are due at the time of your appointment, however, for your convenience, our office will file claims with your insurance company if you have out of network benefits saving you the time and hassle of attempting to collect and submit this information on your own.
Transparency Statement/Disclosure of Potential Conflicts of Interest
In the spirit of transparency and disclosure of my potential conflicts of interest, I would like to make you aware that I derive a significant portion of my income each year as a consultant for a number of pharmaceutical and educational companies. I spend a good deal of my time traveling across the country lecturing to other healthcare professionals on the use of medications to treat certain conditions as well as speaking on certain disease states to professional and public audiences. I also consult with a variety of companies in several capacities including sales force training, speaker training for physicians and other healthcare professionals, and the development of scientific and marketing materials. I am compensated for this work according to the guidelines of Pharmaceutical Research and Manufacturers of America (PhRMA). I choose the medications and companies for whom I speak based on my clinical experience with the medications and my review of available scientific literature. I am only involved in educational and promotional activities for those medications which I use routinely in my practice. While I use nearly every available medication at some time, I frequently turn down offers from some companies whose medications I do not use as first line agents.
I am/have served as a member of the lecture bureau and/or as a consultant for the following companies (current companies in bold):
- Eli Lilly & Company
- Forest Pharmaceuticals
- Glaxa SmithKline
- Janssen Pharmaceuticals
- Jazz Pharmaceuticals
- Medical World Conferences
- Myriad Pharmaceuticals
- Nestle Health Sciences
- Neuroscience Education Institute
- Pan American Labs
- Takeda Pharmaceuticals
- Teva Pharmaceuticals