Many people think all doctors are wealthy. That’s not true. Wealthy doctors are usually those trained for a specialty such as cosmetic surgery or any popular specialty practice that doesn’t accept insurance. I recently received a letter from a local doctor that is reminiscent of what many insurance-accepting doctors deal with. Read it carefully and think about it.
My staff and I have spoken with many of you about the changes in our office this last week.
I’ve received many emails, texts, hand written messages and letters. I have personally read every one of them.
Some of you have been very understanding, and some of you have been down-right nasty.
I get it. I understand.
Most other front office medical staff personnel around the valley, and the country for that matter, have no idea that 50% of health care entities are grappling with prescription and payment clearinghouse reimbursement because no one in the news is talking about it. And, those stories that are present have been on the Friday back pages of newspapers and websites.
Many of you didn’t read previous emails and are still confused as to why our office is making changes.
First, I have grown to love and deeply care for each of you over the years. This decision to switch and no longer accept any insurance was not an easy one. I may lose many of you as patients.
Second, to be completely transparent, our office received NO payments, nor communication as to why, from ANY insurance for 4 weeks, in the case of Medicare, it’s been 6 weeks, despite our calling each of them and asking why. You can read about it here [1].
I, and many other providers I’ve spoken to over the last month, have been told by all of the insurance companies that “everything is fine” and “we have paid you” when they had not. Apparently, their computer systems were shut down and their customer service people, being left in the dark, could not actually see what we had billed and submitted and what they paid from January through March.
Quite convenient for them, I must say.
According to the American Hospital Association, “the full financial impact of the hack is still unknown.”
“Billions of dollars stopped flowing to health care providers because of the data breach.”
Medicare, for whatever reason, routinely stops making payments through the month of January (this has been their standard for the last 10 years without any explanation) and then mid-February all the insurance stopped paying due to this “cyber data breach” occurring at Optum’s Change Healthcare. That essentially is six weeks without regular insurance reimbursement.
It is physically impossible to operate a business, pay rent, cover payroll and taxes for 14 employees without any reimbursement from insurance for more than two weeks, let alone 4-6 weeks. Small medical offices don’t have that kind of cash flow cushion.
How can I ask my employees to work without being paid for six weeks? They won’t do it.
I doubt you would either.
I had to make a VERY hard decision to either close my practice all together, let all my employees go and find some other kind of employment, or cash out all of my retirement to cover the day to day costs of running a medical business for nearly 2 months. To stay in business and provide for my patients, I took a risk and did the latter. Initially, until we got some answers about what was happening, I required a retainer from patients for about 7 days just to stay afloat until we understood when insurance payment reimbursement would begin again.
I sent out emails and notifications, and had my staff call patients before their appointments to notify them of these issues, as we were also blindsided by these events.
It was either charge a retainer or close our doors. Many of you were angered over the short notice of this change. I apologize that it came with only 24 hours of notice to you. had NO control over that.
As a physician in a small practice, I cannot afford to do this again. I can no longer afford to be at the mercy of insurance payers who require me to submit claims within 7 days, all the while they can sit on claims payments for billions of dollars in services rendered for up to 90 days without any recourse.
I have dedicated my life to providing you, my patients the very best care of which I am capable. This type of game playing with insurance companies has happened on at least 10 different occasions over the last 25 years of my practice. It has forced me to refinance my home, use my own retirement funds and pull multiple loans to float the medical practice during these periods, putting me, my family and my livelihood at risk.
I am done playing games with these hospital systems and insurance companies that have neither their patients nor their medical provider’s interests at heart. They may claim they do, but their actions speak much louder than their words, their blogs and their emails.
So that you are aware, some of the insurance companies, including Medicare, began reimbursing on Friday, March 22nd. Since they are now reimbursing, I have removed the retainer requirement. Yet, I am still over two months behind in being reimbursed for services that I and my staff have rendered.
I am accepting insurance through April 30, 2024. I am happy to and intend to take care of each of my patients with anything you need through that time and our office will bill your services through the insurance.
I have officially withdrawn from all insurances, including Medicare, as of May 1, 2024.
However, I am still providing you the very best medical care and spa services you can get. I am not changing how I practice medicine, I’m just removing the middle man that has been the wedge between me and providing the very best care to my beloved patients for over 25 years.
In fact, these four different programs through which you can receive that care now and after May 1, 2024 make it easier for you to see me and my staff:
1. Fee for service cash payments – You pay cash or card at the time of service and we will provide you the 1500 HCFA form and you can self-submit for reimbursement from your insurance. (https://www.docmuscles.com/why-is-nally-family-practice-no-longer-accepting-insurance/)
2. Direct primary care – $65-$85 per person per month – covers basic office visits, osteopathic manipulation and medical issues in the office, via tele-health and email. (https://www.docmuscles.com/direct-primary-care/)
3. Concierge medicine – $4500 per year. Comprehensive VIP medical care 24 hours a day, 7 days a week including weight coaching, advanced testing (Ultrasound, Autonomic, Cognitive Screen and testing), access to all health training modules. (https://www.docmuscles.com/membership/)
4. Concierge Services + All Our Monthly Spa Services – $11,999 per year (https://www.docmuscles.com/membership/)
Please go to each of the links above to learn more about the benefits of each plan.
To Your Health & Longevity,
Adam Nally, DO
References:
1. Hacked health care giant makes progress in recovery, but concerns for small clinics remain
President/CEO
DocMuscles
DrNally@DocMuscles.com
(623) 584-7805 – Work
www.DocMuscles.com
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