Member Forum

1.  Insurance networks and small practices

Posted 26 days ago
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

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


2.  RE: Insurance networks and small practices

Posted 18 days ago
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

------------------------------
Jean Antonucci
------------------------------



3.  RE: Insurance networks and small practices

Posted 11 days ago
Edited by Mamatha Agrawal 11 days ago
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.

------------------------------
Mamatha Agrawal, MD
Family Doctor CaryNC
Cary, NC
Live in Raleigh, NC
Solo since 2012
Practice Fusion and NueMD
------------------------------