Doctors Going “Non-Par” – A New Trend in Medicine

Health_Healthcare.jpgFor those of you that don’t know, there is a new trend in medicine these days — it’s called going “Non-Par.” Non-Par simply means “Non-Participating.” When a physician goes Non-Par, it means that he or she is no longer participating in certain insurance reimbursement schemes. What this means is that a physician will no longer accept insurance or even Medicare. I know that sounds crazy, but it is happening.

Physicians are frustrated with the payment mechanism in the United States. When you bill out $250 for an office visit, the insurance pays you $60. In the old days, the insurance companies paid out a lot. The lowest payer was Medicare. However, as the elderly populations has swelled, Medicare has dropped reimbursements to all-time lows. Insurance companies have gotten smart and decided to match Medicare payments. Why should they pay more for a service that Medicare pays less for?

MedicinePhysicians, being the poor businesspeople we are, didn’t balk but kept receiving the lower payments. It has gotten so bad that in most major cities such as San Francisco or New York, physicians cannot afford to make a living there. The ones that do are the ones that take cash for things such as Plastic Surgery, Dermatology and Skin Care.

Now there is a backlash in some areas. Doctors are fed up. They need to see a ton more of patients in order to pay for overhead. They are working like dogs and running hard in the rat race. Some of simply backed out and informed their patients that they can only see patients who can pay cash or can pay the difference of what insurance does not cover. For example, if their surgery costs $4,000 and the insurance can only pay $2,000, the doctor asks that the patient pay the $2,000 difference.

Some are saying that this is unethical. Others are saying that this is simply doctors fighting back. They are not trying to gouge their patients — they are simply trying to make a living.

It’s tough to say whether this is a fad or the start of a trend. Going Non-Par is not sustainable for generalists because there are simply other doctors that patients will go to see. Many specialists cannot do it either because there are too many specialists. But if you go out to a rural area, you’ll find that a specialist can call the shots and go Non-Par.

From a patient’s perspective this is bad. It limits choices of care. However, some could argue that going non-par separates those doctors that want to care for patients regardless of patient socioeconomic status, versus those doctors that only want to treat high end paying patients.

  • Jennifer

    My gynecologist of many years did that recently. I don’t have a problem with it. He bills my insurance company as a courtesy and applies any payments to my account, but I’m responsible. The other day he avoided doing a test to save me money, because he felt it wasn’t necessary. Would he have done it if Blue Cross was paying? Not sure…

  • Emmanuel L.R.Diaz,MD.

    I totally agree with these article. As I was begining my practice as a doctor here in the Philippines I have worked with a HMO which pays me by the hour to see patients. I also get paid for procedures that I do on the patient. But to be honest I get paid for services after a month and payment is only aorund 30-40% of what I would charge if I did the procedures in my own clinic. A lot of doctors here have gone none par which is much better thing to do since doctors who do co-pay are given the silent disaffiliation treatment. silent disaffiliation means that doctors who charge extra are not referred any patients but are still considered as affiliates of the HMO. I agree that doctors are really bad business people primarily because we were not trained to be business people. I dont mind seeing 100 people a day but if 20-25 of them were paying and the rest were either “gratis” or insurance were would that leave me. I would most likely just be breakeven at the end of the month.
    In order to make insurance pay more i think that the various medical societies should work as a team in demanding fair and adequate payment. This is currently being done in the Philippines when the Society of neurologist requested all fellows not to accept referrrals from HMO’s until a reasonable agreement regarding payments can be achieved. Sanctions of course were given to fellows who did not follow the societies request. At present both the society and the HMO are sitting down and discussing agreeable payment schemes for both parties. Most of the neurologist now are making good money (i guess) since most of their patient are paying patients and they get the payments on time.

  • In Delaware County, PA where I was an intern, the insurance companies were ruthless in trying to play one doctor against another to cut reimbursements. The hardest hit were surgical specialties, like orthopedics. They would tell Doctor A that Doctor B down the street was willing to accept less for a procedure, and demand they lower their rates as well. Then they would go to Doctor C and say that Doctor A and B just approved a cut in their reimbursement, therefore Doctor C could either accept the new rate, or be kicked out of the plan.

    To fight back, all the orthopedic surgeons in the county joined together as one huge “group practice” with multiple satellites (i.e. their individual offices) Now if any patient in the county needed a procedure done, it had to be done by that group, since they were the only game in town. The insurance companies suddenly realized how much leverage the large group had, and magically reimbursement for procedures went back up again. It’s sad that this is what physicians have to do just to make a living. I can’t really blame my colleagues for going non-par when this is the kind of treatment they get for being a provider.

  • On the Fence

    While I agree providers are going non par because of low reimbursements, I do not agree this is best for the patient. I’m on the fence because I work for an insurance company. Insurance companies are mostly large corporations that are for profit. Besides employee salary, the highest cost that impacts what a provider is paid and what a patient is charged for a plan is fraud and regulatory compliance. This is fraud committed by patients and providers. These are regulations that protect patient and provider rights. It almost seems like a circular argument. Patients don’t have enough money to pay for insurance and providers are not paid enough from the insurance company. Government intervention won’t help. It would be like going to the DMV for treatment. While I cannot offer any words of wisdom, I can say that every provider that calls me for assistance especially related to claim payment problems gets my 5 star treatment and help.

    • Dianne McKoy

      Well you can’t be an employee for BCBS because we hardly get any coorperation from them because I work for a non-par physician.

  • Anonymous

    Some… only see patients who… can pay the difference of what insurance does not cover. For example, if their surgery costs $4,000 and the insurance can only pay $2,000, the doctor asks that the patient pay the $2,000 difference.

    I’m not quite sure how they get away with this. Every provider agreement I’ve ever seen requires that the provider accept the insurance payment plus co-pay or co-insurance as payment in full. And they were expressly prohibited from billing the pt. for the “contractual discount”, which is the difference between the billed amount and what the insurance actually pays (plus pt responsiblity/co-pay/co-insurance).

    Patients need to be very careful to read their “Explanation of Benefits” or EOB for every claim and compare the “pt responsibility” with any billing statement they may receive. You should also keep it for at least a year (I recommend 3 yrs), as dr’s offices have been known to bill pt’s a year or more later with the excuse that they did an audit and found that you had an amt due that had been “overlooked.” Yeah, right….. If you have your EOB you can prove that they got paid appropriately.

    I know that providers are getting paid less and less, but if docs keep pulling out of insurance contracts, then a lot pf pts will have no alternative than to go to ER with things that they can’t find treatment for any other way. That would be bad…

    • Dianne McKoy

      Like I said, I work for a non-par physician. We have tried for almost two years to get Cigna to pay the bills of their subscribers. They did not pay so we had to bill the pt for the full amt. Of course they waanted to know why they were receiving a bill after almost two years? We said that “for almost two years, we have been trying to get CIGNA to pay”


    When we get sick, really sick we all want to see a Dr. We see a Dr. or NP or PA because they have spent years in school at astronomical education prices to achieve the skills to be able to diagnose our illnesses, stitch our wounds, heal our minds and bodies etc.

    A friend of mine was laid off and paying $630.00 per month for COBRA coverage and very high co-pays not to mention that a lot of the care she is receiving still is not covered.

    Some of my co-workers are paying upwards of $275.00 per month for them and one child which is only THEIR portion of their premium for a company sponsored health insurance plan, not to mention co-pays, a $900.00 deductible per year and co-pays for drugs.

    It seems to me that the insurance companies are making out like a bandit – BIG-TIME.

    I say we pay our physicians, nurses and other health care personnel every penny of what they are worth and what they are asking. Look what they do for us when we are in need! What would we do without them? Do we ever thin about that?

    I say we hire more investigators to spot and prosecute the FRAUD which by the way is rampid in this country with very few investigators.

    I say we start an insurance reform and look at that industry also and see just what is going on behind those doors for once – like the lovely banking industry in this country….HMMMMM – What a concept Obama……

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Dr. JC is a medical doctor who has a passion for health promotion and education.

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