RE: Resignation From HMO (Michael Loshigian, DPM)
From: Multiple Respondents
I have to agree with Dr. Loshigian. My
group also has just resigned from HIP and we are
making the patients aware of the reason why we
are electing to do so. If HIP becomes successful
in their current strategy, other insurance
companies will be sure to follow.
Ronald L. Soave, DPM
Brooklyn, NY
I resigned from HIP when the market share
program was first introduced to my office in Jan
2002. My rep brought in a 400 page manual which
could not tell me what I would be paid for any
given procedure. I politely showed her the door.
My first weekend on call in the ER of Jan 2002 a
HIP patient was brought in w/sepsis secondary to
a diabetic foot infection. I was paid out of
network by HIP and the patient for all his Sx
and after care. I have never looked back. $120
for 6 months. At that rate the out of network
care I provided for one patient will pay be back
for years to come. Its time we realized the
worth of our work, and told the insurance
companies where they can stick their 400 page
manuals!
Paul Kesselman, DPM
Woodside, NY
January 5, 2003, was my last day as
a "provider" for a large Sacramento-based HMO.
We too were capitated, and every time I had to
care for a recurrent diabetic ulcer which I had
just finished getting to heal, I wanted to jump
out of my skin. Sending my letter of resignation
was a real "high," and on my last day as
a "provider" my staff and I went out for a
luncheon celebration.
I was apprehensive about resigning because
25% of my practice income was derived from the
HMO payments, and I received many PPO, and
private pay referrals from the PCP's who
were "providers" for the HMO. A past experience
made me aware of the fact that if I am out of
the HMO loop I'm out of their loop altogether,
and I would lose those other referrals. (I have
experienced this to be the case once again).
Since my resignation in January I have
experienced the following:
1. My stress level is way lower
2. My attitude is better.
3. My overhead is lower.
4. I only see 30 patients per day instead of 50
plus.
5. I see 5 - 7 new patients per day instead of
10 - 12.
6. My gross and net practice income is higher
than it was when I was a "provider."
7. I have free time to engage with my
patients.
8. I have more time to pursue my other practice
of neuromyofascial reeducation on my patients,
and their referrals.
If any podiatrists are interested in learning
about about neuromyofascial reeducation as an
adjunct to the traditional practice of Podiatric
Medicine, please contact me, it consistently
improves patients’ quality of life.
Mitchell R. Mosher, DPM
Roseville, CA
RE: Resignation From HMO
I will also be resigning from the HIP market
share program for podiatry in NY. I have worked
too long and too hard in my training and to sell
out for $120 for six months of care. This HIP
program is blatant discrimination on our
profession. In addition, HIP requires providers
to refer patients out for radiological services
(including plain films) and then to see them
back for review for yet another "free" visit.
The HIP referral form limits consultation
services for Podiatry to 99242, while most other
specialties are permitted to bill for 99243 and
99244 services when appropriate. I also
encourage my colleagues to strongly consider
their participation status in this program. Yes,
it may be a financial hit, but the line must be
drawn at some point. I will not be providing my
services at this price.
Michael Loshigian, DPM
Fresh Meadows, NY
RE: Resignation From HMO (Michael Schumacher,
DPM)
Kudos to Dr. Schumacher for not selling
himself and his services short. I now
participate with no insurance companies other
than Medicare and will opt out when we, as
DPM's, are given equal rights under the law. I
think it is just a matter of time before
everyone else has to follow suit. After all, how
long can you continue to be at the mercy of
insurance companies whose sole vested interest
is to limit care and reimbursements,
not "insure" a patient's access to healthcare?
Bob Kornfeld, DPM
Lake Success, NY
