Staying Independent...Together

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   RE: Insurance networks and small practices
 From: Melissa Weakland
 To: Member Forum
 Posted: 01-17-2018 10:50
 Message: Jessica,

As per what M said, this is a piece of what happened here in Washington state. I’m talking with many others here in IMPs most are reeling a bit after the marketplace. We lost many patients.

But the good news:
1. We just opened up to new patients again because of this. And ad Jean said we’ve had to tighten the faucet to manage the stream. So no real problem with numbers.

2. I believe the system needs radical change as there truly is no such thing as patient choice in providers- well kind of. While we lost some patients that I’ve worked with for over 10 years, we had tons of calls and questions. Some patients decided to buy the lower quality more expensive plan with Molina specifically to stay with us. Some are choosing to pay out of pocket. Some are using Liberty Mutual- something we just are learning about that pays for insurance but isn’t insurance.

(Anyone else with experience with this? Seems honestly very cool but also too good to be true)

So wow- seems our patients have spoken. And even more I want to work for system change. Talk to the press, talk to politicians...

3. and finally, we do have one local IPA we may be eligible to join. And this shows we here in our NW bubble May have missed the boat but we can still climb aboard. Gwen Hanson did join and it makes her still eligible for all the marketplace premera plans.

So yep- to me the challenge continues with many enlightening outcomes and much to do.

Be in touch Jessica when you can.
Two independent providers here in Seattle are closing their doors after many many many years. Just don’t feel they can make it work. Makes me sad as I believe we can stay afloat. We just have to talk and work together.

Melissa


Melissa Weakland, MD
Ballard Neighborhood Doctors
5416 Barnes Ave NW
Seattle, WA 98107
Phone: (206)-297-7678
Fax: (206)-297-5930

------Original Message------

In our area you must be in an ACO, IPA, CIN to be in any of the healthcare.gov plans.

You can still be small, independent and operate your own practice but be a member of one of these above.

It's not that one necessarily, "wants to be in this type of plan". It's more than patients will assume you take Cigna and Blue Cross so therefore you would take Cigna Connect Silver 2200 or Blue Local. They can show up with their card and see you and your claim will be denied because the staff may have just seen it as a regular Blue Cross card. Then you are either stuck eating the cost or billing the patient who you did not inform about being out of network.

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Mamatha Agrawal, MD
Family Doctor CaryNC
Cary, NC
Live in Raleigh, NC
Solo since 2012
Practice Fusion and NueMD
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Original Message:
Sent: 12-28-2017 09:43
From: Jean Antonucci
Subject: Insurance networks and small practices

Hi
 This used to stress me out about narrow networks
Now i do not  give a hoot Any sensible patient will vote with their wallet, I would. Some will stay with you anyway bless tier hearts
 You lose some, later they may come back, but you get others Primary care is in a shortage There is plenty of work out there
Make sure you are in an ACO or  IPO or something to connect you to networks and protect you Don't sweat over this one

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Jean Antonucci
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Original Message:
Sent: 12-20-2017 18:02
From: Jessica Rongitsch
Subject: Insurance networks and small practices

Hello
I am hearing from many patients that in 2018 they won't be able to use their insurance to see me because I'm "not in their new network." I've heard this regarding ACA plans and also employer-based plans.  Increasingly networks are narrowing and patients can only go to one specific larger institution.  I'm wondering how others in small practices are navigating this? Any luck trying to get in preferred networks with insurers like Regence or Premera?
Thanks!
Jessica

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Jessica Rongitsch MD, FACP
Capitol Hill Medical
Seattle, WA
98104
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