Wellness

[Lindsays Grandma]

Because you have been associated with insurance companies for many years, I am hoping you can answer my question.  Shortly after the DEA put fear in all pain management clinics, doctors and whomever, a provider with the management where I was a patient opened his own clinic.  He does not take insurance and charges $150.00 cash for a monthly visit and has no problem writing prescriptions for the medication I and other patients were getting prior to his leaving the other facility.

My question to you is, what does he need to do to provide insurance for his patients?  Does it cost him anything? I have the feeling he does not want to take insurance patients because he will be discovered by the DEA and either warned or shut down.  According to him he is not breaking the law and can legally provide people the medication they need which other pain management facilities will not because of the DEA warnings.  So, Carmie, there it is, looking forward to hearing from you.

[CrazyDaisy]

Don't know about the DEA, however any facility accepting insurance has considerably higher overhead. Must have a staff that knows all the different policies, different approved payments, filing claims, setteling disputes, waiting for payment it goes on and on.  In many ways doctors could provide healthcare cheaper if they didn't have to deal with insurance companies.

[masque]

@Lindsays Grandma

It didn't work out well for Dr. Lawrence Wean. (Delaware County,PA)

ttp://6abc.com/news/delco-doctor-sentenced-to-prison-for-illegally-selling-prescriptions/1116505/

Thursday, December 10, 2015
A Delaware County doctor convicted of using his practice to illegally sell prescriptions is heading to prison.

Sixty-one-year-old Dr. Lawrence Wean of Media, Pennsylvania, was sentenced to 10 to 20 years behind bars on Wednesday.

Wean was found guilty of 99 counts of unlawfully prescribing a controlled substance as well as insurance fraud.

Investigators say Wean charged $200-300 to write them.

Wean served the community for 27 years before his arrest last year.

[Lindsays Grandma]

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@Carmie wrote:

When a provider (doctor, hospital, etc) accepts insurance, they agree to accept an agreed upon amount of money from the insurance company for the procedures they perform.  Also, some services are bundled so that they can’t bill them separately.

For instance, if you go to the office for a flu shot, they might get paid for the vaccine and the injection, but not the office visit.

I don’t think your doctor’s decision had anything to do with the DEA. He probably had a disagreement with someone in the sandbox and took his toys and left.

If he charges $150 a visit, most probably the insurance company will not pay him $150: he will get paid less.

Insurance companies do not report doctors, nor do they release any confidential information to anyone....ever.  The only time they would do an investigation is if they suspected a doctor’s of committing insurance fraud.

This doctor can join an insurance network anytime he wishes, as long as he is in good standing with the medical bureau.  Insurance companies do not want doctor’s who have been disciplined in their networks.

If this doctor has not been disciplined or arrested in the past for his actions, I would assume it is a money issue.

Call your insurance company and ask if they will pay anything for an out of network doctor and if they do, ask how you can submit your bills for reimbursement. If you have Medicare, this doctor is suppose to submit the claim for you, even though he does not accept.  The payment will be sent to you.

If he refuses, call Medicare, they will tell you how to submit the claim yourself.

Oh, I,wanted  to add...he only takes cash?   No checks?  That raised my eyebrow and makes me think all sorts of reasons why and none of them are good.

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Thank you so much Carmie.  I assume he accepts checks, I always pay with my debit card.  By the way he is not a doctor, he has credentials which allows him to prescribe prescriptions and worked for a doctor who who sold his business.  I will contact Medicare to see if they will help pay for visits, that would be a big help if they do.  Incidentally, the doctor he worked for was pressured by the DEA to stop prescribing pain medication and is now charging a lot of money helping people who want to get off the drugs.    It is a vicious cycle.  Again, thanks for your response.

[Lindsays Grandma]

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@Carmie wrote:

@Lindsays Grandma  Whoa!  If he is not a doctor or licensed professional like a mental health provider, he cannot legally prescribe RX drugs to anyone. RED FLAG!!!!!!!!

If he is a mental health provider, why is he prescribing pain killers?

Physician Assiistants and the like can prescribe RX drugs if they work under and are monitored by a doctor they work under.

The script should have the monitoring doctor’s name on the letterhead.

This doesn’t sound right and I suspect it is not going to end well.  You might want to find another provider.  It sounds like this guy is going to be shut down soon and arrested.

Drug stores DO REPORT the over prescribing of addictive drugs.  They are required to.  Since you mentioned that the doctor he worked for was contacted by the DEA, they are keeping en eye on everyone who worked there.  

Your choice, but I would run as fast as you can away from this situation.  If he is prescribing opioids/pain killers to you, you could be part of the investigation.

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Carmie, he is not a mental health provider.  His credentials  allow him to write prescriptions which he was doing while working for a pain management doctor.  He has opened his own pain clinic which I have no doubt will one day be shut down.  His name and the name of his clinic are on the prescriptions.  I am in the process of looking for another pain management facility to go to. Unfortunately every one I have visited so far want to bring my meds way down so I am considering going to a rehab facility to get off the pain meds and go on marijuana medical which many here on the boards are having great success with.  The one I am seeing is prescribing meds that do  not meet with the DEA's approval so I know he will be shut down eventually.  Even if he would take patients who have insurance, once the insurance companies notice what he is prescribing they will report it.  As he said, "I am not doing anything illegal", maybe not, but again it does not meet with the DEA's approval.  Believe me if my chronic pain was not so horrific I would gladly opt to take a lower dosage  than what I am currently taking, which incidentally is not all that earth shattering.  I know the numbers the DEA approves of and anyone with a high level of pain would get very little relief from it.  I contacted Medicare and was told I would not be reimbursed since the provider does not accept insurance.  The woman I spoke with did not impress me and I will call them again just to be absolutely sure of what she told me.  One doctor who was affiliated with the clinic I was going too before it all went south told me the DEA pressured him not to prescribe pain meds even to those who needed it.  He is now a medical director at a prison here in AZ and likes what he is doing but still feels bad that he can't help patients like me.  So be assured I will do what I have to do to protect myself.