Re: Capitation
From: art fougner, md (evsono@pipeline.com)
Sun Jun 25 12:39:36 2000
well then - now that you know this one - why not renegotiate? or leave
that plan? why do we feel obligated to live with this?
art
At Sat, 24 Jun 2000, Dean Huffman wrote:
>
>One of the bets tricks I have seen managed care companies do is to capitate
>patients for OB/GYN but not make the patient declare an OB/GYN until her
>first visit. Therefore it is possible for me to be responsible for a
>patient for a year or longer, but since she has never declared an OB/GYN
>physician until she finally has a visit, a pregnancy, or an emergency, the
>managed care company gets to keep the payments for the past year, whereas I
>get to assume the responsibility for that year.
>
>--
>Dean Huffman
>
>- - - -
>
>Capitation
>
>From: Pam Palmer (wapp88@gateway.net)
>Sun, 14 May 2000 20:53:41 -0500 (CDT)
>
>It has been my experience over the past several years dealing with a
>capitated carrier. Now, the carrier has decided to change the contract and
>now make this a fee for service contract.
>
>I know this should be good news, but we do not have the fee schedule yet,
>and I've been told its equal to medicare rates. The contract reads that
>once sign, they can alter the contract and not have approval. Also, the
>change effects the current patients that have been seen. We no longer are
>paid for the patients we've seen in the last 3 months. It will mean a loss
>of thousands of dollars.
>
>The carrier stated since we are up for renewal we have no choice but to
>sign or get out. We can't afford to get out but is there a way to fight the
>contract or the losses. The fact is this is 30% or more of our patient load.
>
>Do you have any advice or suggestion. My e-mail address is
>wapp88@gateway.net.
>
>Thank you!
>
--
art fougner, md
A series of 1000 cases begins with but a single anecdote.
