Why You Want to Self-Pay Your Ophthalmologist
“Is he in-network?”
When you are diagnosed with a potentially blinding disease such as glaucoma or cataracts, is the very first thing you ask when searching for a doctor “Is he in-network?” If so, why? It’s not as if being part of a network reflects some measure of competency. Insurance companies, however, have spent millions of your dollars trying to get you to see their “preferred in-network” doctors. Why do you think this is?
“Preferred Providers List.” – Preferred by Whom?
Every time you see a “preferred provider” only the copay is coming out of your own pocket. The majority of the payment is made to the doctor by your insurance company. You’ve heard the saying, “He who pays the piper, calls the tune”. When you don’t pay cash, your doctors are chosen for you by the insurance company. And,…the insurance company controls them.
How do you think insurance companies come up with “Preferred Providers List.”? How do they chose these doctors? Is there a competition? Do they accept only a small percentage of those who apply to be part of this “preferred” network? Sorry to disappoint, but physicians who apply to be in a preferred network are generally accepted into the network so long as they have an active license to practice medicine and are willing to sign the contract.
What’s In The Contract?
Heavily discounted payment terms are a given. More concerning for you, the patient, are the hundreds of pages of legal control the insurance companies gain over your doctors when they sign these contracts.
So, it should be clear that what “preferred” means is that your insurance company prefers to work with doctors who are willing to accept discounted fees and be controlled.
What about you? What do you prefer? Probably a doctor who genuinely cares about you and is willing and able to spend the time you need. This is not going to be possible if your doctor is too busy with an overbooked schedule because he has to see more patients to make up for the discounted fees he agreed to accept when he signed the preferred provider contract.
The danger is that instead of serving as your agent, doctors will become agents of third parties— insurance companies, employers, Medicare, Medicaid, and so on. To the degree that this occurs, the third party’s needs become more important than the patient’s needs. And remember, the primary need of the third party is to avoid spending too much money on you.Goodman, John C. 2012-06-01
Just think about your typical experience in a doctor’s office: the impersonal and hurried staff, unending paperwork, long waits, limited time spent with your doctor, leaving the office with many problems unaddressed and questions unanswered. Do you think your doctor enjoys this any more than you do?
Of course not! But, when doctors sign insurance company contracts they must abide by the terms dictated by the insurance company. They are contractually obligated to fill out forms exactly as specified even if those forms are there to benefit the insurance company, not you. They are obligated to accept payments that may be at or even below their costs on many services they provide. They have essentially indentured themselves to the insurance company and the only way to make that work is to spend more time doing what the insurance company demands leaving less time to spend focusing on you, the patient.
You do have the freedom (and the responsibility), to choose your doctor. Your choice of doctor should be determined by you, and not pre-determined by your insurance vendor. But sadly for most people, their choice of doctor has already been pre-determined for them the moment they/their companies purchase insurance. Don’t let this happen to you.David Richardson, M.D.
When You Need An Untainted, Expert, Second Opinion…SELF-PAY
It should be obvious by now that what you prefer in a doctor and what your insurance company prefers are very different things. So, what can you do to be certain that your doctor is truly preferred by you? It’s simple, really. You take it out of the control of the insurance company…self-pay your ophthalmologist.
Doctors who have opted out of insurance networks are not chosen for you. If they are not part of the “preferred” network they cannot be controlled by a faceless insurance company. If you (instead of the insurance company) were given the choice, left on your own, you would want to see them. Why? Read on to find out why…