The problem with this, as we see it, is the fundamental nature of the patient / physician relationship. Patients should be able to choose any physician of choice. Physicians should retain the same right in choosing and building their client base without third party interference.
A patient/physician relationship is based upon a contract. The physician agrees to provide a service and the patient agrees to pay for that service. A third party, such as an insurance policy should be irrelevant to the transaction. The insurance policy will pay what it will pay, nothing more and nothing less, irregardless of the patient/physician contract.
However, the traditional patient/physician relationship has changed with the advent of “Managed Care.” Patients and employers who sponsor group medical insurance have essentially given up their “contractural rights” by allowing third party intermediaries to represent them and be bound by them. Physicians, historically poor businessmen, have done the same.
Purchasing health insurance through carriers that require participation in their proprietary PPO networks such as Humana, Cigna, Blue Cross, United HealthCare and others effectively handcuffs the patient and physician to a very large degree. The patient/physician contractual relationship is relegated to “second class citizenship” status by secretive PPO contracts that effectively rule the relationship and has “veto” power over both of the intended beneficiaries.
The good news is some employers who sponsor group health insurance and fed-up physicians are, after 25 years of failed Managed Care strategies (arranged and supported by third party intermediaries) are taking back control.
Self-funded employee welfare plans is the only vehicle available to employers who want to take back control of the patient / physician relationship. The fully-insured group medical market is not a viable option.
Today’s Announcement in the Brownsville Herald:
MANUEL G. GUAJARDO, M.D., P.A. – NOTIFICATION FO MY HUMANA PATIENTS:
IT IS WITH DEEP REGRET THAT I INFORM ALL OF MY HUMANA INSURANCE PATIENTS THAT AS OF NOVEMBER 22, 2011, I WILL NO LONGER BE ACCEPTING HUMANA INSURANCE. I HAVE REGRETTABLY BEEN FORCED TO TAKE THIS POSITION DUE TO THEIR FAILURE TO REACH A SETTLEMENT OF PAYMENT DUE ME FOR SERVICES RENDERED TO THEIR MEMBERS.
I WOULD ALSO LIKE TO TAKE THIS OPPORTUNITY TO URGE AND INCOURAGE EMPLOYEES AND EMPLOYERS, THAT WHEN CHOOSING AN INSURANCE CARRIER MAKE SURE TO VERIFY AND FULLY UNDERSTAND THE INSURANCE BENEFITS YOU ARE PURCHASING.
I WISH TO THANK ALL OF MY PATIENTS FOR ALLOWING ME TO SERVE YOU OVER THE PAST 24 YEARS. IF YOU HAVE ANY QUESTIONS OR CONCERNS REGARDING THIS NOTICE, FEEL FREE TO CONTACT MY OFFICE AT 956.350.5007.