Member Forum

Expand all | Collapse all

Insurance networks and small practices

  • 1.  Insurance networks and small practices

    Posted 12-20-2017 15:03
    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?

    Jessica Rongitsch MD, FACP
    Capitol Hill Medical
    Seattle, WA

  • 2.  RE: Insurance networks and small practices

    Posted 12-28-2017 06:43
     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 01-04-2018 12:52
    Edited by Mamatha Agrawal 01-04-2018 12:54
    In our area you must be in an ACO, IPA, CIN to be in any of the 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

  • 4.  RE: Insurance networks and small practices

    Posted 01-17-2018 07:50

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

  • 5.  RE: Insurance networks and small practices

    Posted 01-21-2018 22:20
    Can you explain what Liberty Mutual is and how it works?

    Mike S

    Michael S. MD

  • 6.  RE: Insurance networks and small practices

    Posted 01-22-2018 07:46
    What I was referring to is actually 
    Liberty Healthshare. Anyone work with them? 
    (There is also liberty mutual...confusing) 

    It's completely new to us. I haven't formed an opinion yet. 

    Health sharing group-  founded by Christians for people who pledge to be honest and have intent to lead a healthy life style. Members (patients) can join if they pledge to a statement of shared beliefs including no Tob and no EtOH. 

    Members can use with any provider- no networks. So any specialist is fine also. Covers labs and imagining. No PAs. No med coverage. We get paid Medicare allowable in our area plus between 50 - 70% after patient deductible of $500. 

    On our side, we just bill to the address provided (no contact). They say no denials, no coding parameters. 

    We haven't billed to them yet. Have our first patient coming in who uses them.

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

  • 7.  RE: Insurance networks and small practices

    Posted 01-23-2018 03:09
    We have a about 10 patients that have Liberty Healthshare. LH typically pays easily without too much hassle (one time they did request more information). However, they are the SLOWEST paying insurance company we work with. It is easily a good 60-90 days before payment is sent. There is a deductible with this plan and from what I understand, their year goes from Dec to Nov, not Jan to Dec. I believe they follow Medicare's fee schedule.

    Renea Clark, MA
    Office Manager
    BlueSky Health
    138 W. Highland Rd #950
    Howell, MI 48843
    (517) 545-2400 - (O)
    (888) 258-0150 - (F)

    Like us on Facebook!

  • 8.  RE: Insurance networks and small practices

    Posted 01-23-2018 14:50
    Re Liberty Healthshare:

    Thank you to Melissa and Renea for info on Liberty Healthshare.

    The website and the philosophy of healthcare sharing group sounds very interesting and a potential good option for someone who cannot obtain group insurance thru work or affordable insurance on an exchange and does not have significant pre-existing conditions.  Reimbursement of Medicare plus 50-70% also sounds good.

    I spoke to them and patients do not have to be Christian.   Just say you respect their values, dont smoke and moderate etoh only.   (Hopefully that applies to providers as well.  ;-)

    We shall see how it goes and report back.

    Michael S. MD

  • 9.  RE: Insurance networks and small practices

    Posted 01-24-2018 04:02
    We have several patients that use Liberty and they love it. I am not enrolled with them so patients pay our discounted cash price and submit the receipts. No one has voiced any complaints with this. Patients with the other cost sharing plans are also very satisfied. Overall I feel the health cost sharing plans are an excellent option to ridiculous premiums and provide a very needed service.

    Tracy Baum
    Mountain Sage Family Clinic
    Dubois, WY