Posted on 03/21/2009 11:43:25 PM PDT by genghis
New York, NY - The state is trying to shut down a New York City doctor's ambitious plan to treat uninsured patients for around $1,000 a year.
Dr. John Muney offers his patients everything from mammograms to mole removal at his AMG Medical Group clinics, which operate in all five boroughs.
"I'm trying to help uninsured people here," he said.
His patients agree to pay $79 a month for a year in return for unlimited office visits with a $10 co-pay.
But his plan landed him in the crosshairs of the state Insurance Department, which ordered him to drop his fixed-rate plan - which it claims is equivalent to an insurance policy.
Muney insists it is not insurance because it doesn't cover anything that he can't do in his offices, like complicated surgery. He points out his offices do not operate 24/7 so they can't function like emergency rooms.
"I'm not doing an insurance business," he said. "I'm just providing my services at my place during certain hours."
He says he can afford to charge such a small amount because he doesn't have to process mountains of paperwork and spend hours on billing.
"If they leave me alone, I can serve thousands of patients," he said.
The state believes his plan runs afoul of the law because it promises to cover unplanned procedures - like treating a sudden ear infection - under a fixed rate. That's something only a licensed insurance company can do.
"The law is strict on how insurance is defined," said an Insurance Department spokesman.
A possible solution that Muney's lawyer crafted would force patients to pay more than $10 for unplanned procedures.
They are waiting to see if the state will accept the compromise. Still, Muney is unhappy because, he said, "I really don't want to charge more. They're forcing me."
One of his patients, Matthew Robinson, 52, was furious to learn the state was interfering with the plan.
"The whole point is, he [Muney] found a way of paying his rent, paying his workers, and getting to see patients for the price," said Robinson.
"How can the state dictate you've got to charge more?"
Exactly - they realize that such a plan would destroy their power and then the bureaucrats would be out of a job.
And such regulators are interfering with the free market and a businessman’s ability to set his own fees. This is exactly the kind of price competition American medicine needs desperately. How the hell did we get to this place in America?
"Show me just what Mohammed brought that was new, and there you will find things only evil and inhuman, such as his command to spread by the sword the faith he preached." - Manuel II Palelologus
Here is a man that is honestly trying to help and has a wonderful idea; and who else; but our crooked government doesn’t like it.
I would love that.
He’s right. This isn’t insurance. Not even close.
Government officials are becoming more unhinged by the minute. Obama Effect for sure.
"Show me just what Mohammed brought that was new, and there you will find things only evil and inhuman, such as his command to spread by the sword the faith he preached." - Manuel II Palelologus
If they’re that worried about illegal insurance rackets, they should go after Big Mike, who offers pizzeria owners a great deal on fire insurance. A thousand a month guarantees that their businesses won’t burn down.
“That’s something only a licensed insurance company can do.”
Name one insurance company worker that ever graduated medical school.
Why is there a law that prevents this doctor from doing this? Who is it designed to protect? The doctors? Patients? Or the insurance companies?
"Show me just what Mohammed brought that was new, and there you will find things only evil and inhuman, such as his command to spread by the sword the faith he preached." - Manuel II Palelologus
When the people fear their government, there is tyranny; when the government fears the people, there is liberty. - Thomas Jefferson
Hero doctor versus sub-human democrat party power mad cockroachs.
"Show me just what Mohammed brought that was new, and there you will find things only evil and inhuman, such as his command to spread by the sword the faith he preached." - Manuel II Palelologus
Boy those are dumb bureaucrats. An insurance company is regulated because it promises to late pay for something for you that it does not have. This MD in fact is an MD, so he certainly can provide care.
It is the MD’s business how he prices his services. He can in fact deliver these services. Thus he is not insuring patients, he is merely selling his services using a two part pricing scheme.
Are you sure this wasn’t written by John Semmens....
"Show me just what Mohammed brought that was new, and there you will find things only evil and inhuman, such as his command to spread by the sword the faith he preached." - Manuel II Palelologus
Right and again the key difference is an insurance company is not offering medical services, it is promising to pay for your use of them. This MD is in fact promising to deliver these services. That is what makes it not insurance.
$75 is the price to visit the doctor in the “After Hours Surgery” here in New Zealand — with insurance 80% if that can be reimbursed, subject to policy maximums.
(”Surgery” has a slightly different meaning here in NZ to what it means in the US. As well as being the process whereby a doctor cuts up a patient, a “surgery” is also another name for the doctor’s office)
Regular price (business hours) is about $45. With insurance 80% of that is reimbursed, subject to policy maximums.
So $79 for a NY doctor isn’t too bad, by New Zealand standards.
(A Big Mac costs NZ$4.95 here, by way of comparison)
Thanks!
I was looking for this article earlier this afternoon.
Not if it's up to them and they can get away with it. That is if they didn't get pre-authorization (dumbest thing I have ever heard of from insurance people who aren't anywhere close to being doctors).
Oh, and let's not forget all the paperwork for the government (Medicare/Medicaid) who can withhold payment for any reason until they decide to pay you! If they can't find a real reason they will make up one.
But he’s bypassing the insurance companies, and that chain of money up to and including kickbacks to politicians. How could they possibly let his scheme of not including payoffs stand?
the state sees money running through its fingers. Rather than Dr. Muney submitting claims to Medicare, he collects cash. Rather than paying the state insurance licensing fees, he shuns insurance, enabling his patients to pay cash. The government worries that if all doctors did this, the government would not be able to continue employing people to process insurance, doctors could cut overhead by laying off insurance billers and accounts receivable employees.
Update:
The State wrote to the doctor and said he could continue to offer his fixed fee $79/month medical care for preventative health but if someone came in complaining of an illness or injury, he would have to charge them at least $33 for that visit. Bureaucracy at work.
http://blog.americanjusticecenter.com/2009/03/state-orders-dr-john-muney-to-stop.html
Insurance Industry Wins, Low-Cost Doctor Raises Fees
Muney, a former surgeon, started offering the $79-a-month plan in 2008.
http://www.foxnews.com/story/0,2933,508990,00.html
Want laser surgery to correct your vision?
It’s not covered by insurance.
When it first began, it cost a few thousand dollars.
Now, with competition, it’s down to a few hundred dollars.
That’s downright American.
Gov't and Insurance people ..
The barber shop is down the street.
"Show me just what Mohammed brought that was new, and there you will find things only evil and inhuman, such as his command to spread by the sword the faith he preached." - Manuel II Palelologus
What a crock. The guy offers medical service like a gym membership and the state freaks out.
"Show me just what Mohammed brought that was new, and there you will find things only evil and inhuman, such as his command to spread by the sword the faith he preached." - Manuel II Palelologus
The government’s position is simple: No one should be permitted to offer a viable alternative to socialized medicine.
Medicare says you can’t charge anyone less than you charge Medicare.
Of course, that’s a fiction, because many insurance co’s pay doctors on a percentage of Medicare. I hear that in some areas with a lot of competition among doctors and large groups of doctors, Family Physicians are offered 90% of Medicare.
There’s also the anti-trust laws that prohibit doctors from sharing information about charges and payment. We’re advised that we had better keep even private conversations and on-line discussions, etc., very general or we will be charged under the anti-trust. Also, a large group of doctors can’t be responsible for more than some set percentage of an area’s population -— while there is no such law against the insurance co’s.
Clinton’s administration charge and prosecuted a group of physicians and some hospital officials under these laws in Florida in 96 or 97 because they were advertising rates less than Medicare. The offer was considered unfair collusion. Some of the doctors went to jail, but the officials just paid fines.
Oh, for the good old days when Reno and Freeh held rallies in football stadiums to teach Medicare patients how to turn in their doctors for “fraudandabuse.” These words were melded under Reno. This was code for “We can get triple damages from the courts and pay for our department.” That was around the time that the Office of the Inspector General and the FBI made armed raids on hospitals and doctors’ offices because of alleged “fraudandabuse.”
The State wrote to the doctor and said he could continue to offer his fixed fee $79/month medical care for preventative health but if someone came in complaining of an illness or injury, he would have to charge them at least $33 for that visit. Bureaucracy at work.
The doctor should draft a one-page summary of his experiences with NY state government, which explains how he was forced to raise his visit fee to $33. Then every patient should be given a copy. Let them see the real effects of government up close.
I know of 2 doctors in Scottsdale who have small private family practices and still DO HOUSE CALLS!
I have the best medical care in my life - for $45 a visit.
This guy teaches other Drs how to set up a practice like his.
He files no insurance. If you have private insurance, you can file.
Send this to your Dr.
http://www.aafp.org/fpm/20070600/19brea.html
Insurance is the monetization of risk. Risk is the chance of loss when such chance is probabilistic. So charging a flat annual fee (in monthly installments) to cover, among other things, fortuitous accidents is, in essence, insurance.
What if the doctor were, in reality, running an intentional or unintentional Ponzi scheme by charging less than it cost to provide services? Very quickly he would run out of money and go bankrupt. This would leave patients in the hole to the extent of their prepaid premiums. And by relying on the good Doctor, they would have no other insurance. This is why insurance is regulated.
But I do believe that the State has put formalism ahead of logic. The fact that payments are monthly (I assume) removes the most serious consequences of inadequate pricing. It is an insurance-like service that is being provided. But it does not trigger in a serious way the concerns insurance regulation is intended to deal with.
This sounds exactly like a retainer.
Does that mean that lawyers are charging for legal insurance?
Somebody needs to get this Doc an award for free market capitalism..and common sense. His critics need an enema.
The insurance companies and bureaucrats can't afford to have this catch on. Otherwise the next step would be comprehensive group practices doing the same thing. The step after that would be for people to only have catastrophic hospitalization insurance, plus a yearly plan with their local doctor/group.
which will do away with any need for a national health care system
Or he will have to change his rates, or not retain patients with chronic conditions (For this to work, the doc has to have the option of not renewing a patient who has a chronic condition at the end of the year).
For other patients, it is reasonable to assume that illnesses and accidents will be fairly evenly distributed over the year, and that this month's payments can be used to cover this month's expenses.
Key observation.
It is because There's few limits to their authority. The presumption of enumerated powers of government is pretty much gone. Many officials, from the local queen bee at the town hall to the State and Federal bureacracies, feel that if they say it, its the law unless some other more influential politician or agency says otherwise. If you don't like it, tough... go to court and fight government paid drone lawyers... with the high costs and lengthy delays. Good luck in anything but the clearest cases, because of the politicization of the courts, too. And, for the official... the consequences of a reversed decision are minimal.
You have described an actuarial (insurance math) solution. I think NY State is being foolish. But it is an insurance-type product.
Easy, the state is a dictatorship and can do whatever it wants. We gave them that power one slice at a time over the last 200 years. Maybe it's time to take it back.....
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