I don't believe that is correct – here is CMS opinion paper on the requirement for states to have "any willing provider" options for access.
We are an opt out Medicare practice. It is my understanding that those covered by certain 'advantage' plans operate essentially as the old fashioned HMO in that a referral from a contracted PCP is required. We have about 150 or so Medicare folks and only one of them, to my knowledge, has this sort of plan. So I think it depends on how much penetration these plans have in your market. Same with commercial insurers who require a 'mother may I' from the PCP to see a specialists or have testing paid under their insurance.
Good morning Dr. Bradley,
Congrats on starting your cash practice – we've been in a direct care practice for 9.5 years and have helped over 700 docs convert to the model.
It's a fantastic model, especially for the uninsured b/c you can do a membership that offers unlimited visits, no copays, free procedures and wholesale medicines and labs for up to 95% savings
Here's a link to our wholesale pricing on meds/labs/imaging as an reference point: http://bit.ly/2JoVyJi
In our experience the patients don't/won't submit their own claims to typical insurance carriers. The Christian co-ops may give discounts back to families that are working with DPC – the coops are finding out that they save $$$ when the families are using DPC.
Referrals generally work 1 of 2 ways depending on the type of system (hmo vs ppo etc). either the system allows any referral, or they require all referrals to go through an in network provider first. The first is easy and the second is a hassle for sure, but really just 1 extra step and we blame it on their insurance J. In our area, both hospital chains take all insurances so it ends up be a non issue when referring. But with wholesale meds/labs/imaging/pathology, there's a lot you can do without going through the insurance system.
Also specialty consult services like rubiconmd.com make it easy to get doc-to-doc curbsides quickly (flat monthly rate for the service, unlimited consults)
If you're opted-IN to medicare, then you can't charge cash/memberships.
You CAN moonlight as an opted-OUT physician - https://www.dpcfrontier.com/opted-out-moonlighting
If/when you opt-OUT, then you can charge medicare patients cash/memberships.
Let me know if there's anything else I can do to help.
Colorado and Kentucky are the only states that do not allow Medicaid patients to use doctors outside of the Medicaid system -- https://www.dpcfrontier.com/medicaid
Hi Dr. Lathrop,
The only states that don't allow Medicaid patients to privately contract with doctors outside of Medicaid are Co and KY - https://www.dpcfrontier.com/medicaid
Hi Dr. Justin – I agree! Referrals go way down when you have time to spend with patients and affordable resources like wholesale meds and las.
You're also correct, in California you don't have to take Medicaid and Medicaid patients are allowed to privately contract with other doctors.