Guys,
Now this is a practice manager's question. My dear wife who in principle I agree with although I'm scared CHITTless that we will starve to death, wants to try and go "No Insurance" what so ever. So two questions come to mind.
1) If one does not take insurance does one still need to have call coverage by most laws? Is this also a hospital privilages kind of requirement too? If we don't admit our own, but turf to hospitalists anyway, do we even need privilages anyway?
2)For docs to really be coverage for one another, do those docs have to have the same or extremely similar panels of carriers that they PAR with, so as to be able to actually see eachothers patients in a real pinch. Especially with managed care in primary care, because in general these folks are supposed to only see PCP's who are their declared PCP, right? Can one doc cover for and see the other guys managed care patients if he is the coverage of record even if he doesn't PAR with that plan???
And as a side note. How come with "exclusive" in network provider type contracts these are not seen and ruled as "restrictions of freetrade". Both patients and providers want to be able to do business out of network. Even if a patient wanted to see us out of network and was willing to pay the entire freight themselves, they would still be SOL, because if and when they need referal, prior auth's, and fight for drugs on and off of formulary, these too can only be done by a PCP that is in network. It would seem to me to be an obvious restraint on freetrade, but then again I'm not some lapdog appointee, on the FTC, who is beholdant to politians who are beholdant to large insurance carriers, so what do I know, right???
But it seems obvious to me that if the primary care specialty organizations had any balls (
) at all, that they would combine forces in a joint, class action against such as a restraint on freetrade, refuse to settle nicely even if it takes a generation to see it through to it's end, and take it all the way to the federal supreme court to finally get these exclusive contracts deemed as such. The class would be all PCP's who are out of network and all potential patients in all national and regional type plans. That is a huge class there. How many Americans are in or have been in some sort of a managed care plan?
But on a happier note...Bert you are a tease...There are few places left in America that I want to revisit more than The Tetons and the surrounding country. I haven't been there since I was trout fishing and going cross country with my folks in the backseat of a fairly new, 225 slant-6, 4 door sedan, Dodge Dart. Oh the cutthroat were so beautiful and tasty.
Bonus points to any member of the board who is not from out there or has visited recently (Leslie I'm sorry but that means you too...) who knows why they are called the Grand Tetons and what does the name mean.... (Who's board is it Anyway???). Hint, those guys were really lonely.
Good Night and Good Luck,
Paul
