September 24, 2014

Hi Jennifer,

I'm ready for a change.  I am ready to go completely out of network and have a cash practice.  I believe my patient base, a good portion at least, will support me.  What are your thoughts on this?  Good idea? Please feel free to use for your email newsletter. 

Feedback is appreciated. 
Dr. G


Dr. G, what an appropriate time of year for this question!  Not only are the holidays this week reflective of this concept, but also you are right in the sweet spot realm of insurance company participation termination requirements for notice.  In concept, I am 100% on board with you going completely non-par, however, I must caution that from my perspective, having to deal with carriers on a daily basis for audits, prepayment reviews, payment issues, misclassification problems with reimbursement and more, going cash only is not as simple as just sending notice to carriers and demanding payment upfront.  In a way, yes that is what you would be doing - terminating your existing contracts, notifying patients of the change and modifying your internal procedures, but in reality you will not be able to completely avoid the "system" by this fresh start you are planning.  The issue from my perspective is regulation - regulation from carriers your patients may continue to seek reimbursement from your services, and regulation from government agencies you are still under the purview of.  

Going down the road of all cash may solve some procedural practice hurdles for you, but your documentation obligations will not change much - so your administrative practices internally may not change much.  Also, I am concerned that patients who will follow you and stay with you forever, will quickly change their tune once bills start rolling in.  Depending on the model you are looking to adopt, whether you are look at straight fee for service or creating your own internal capitated model, I am concerned you will alienate your patient base to a larger degree than anticipated (or promised by the patients). 

To sum up and discontinue with the negative, I am absolutely on board for alternative practice models, and any practice model that will allow you to operate an office with fewer administrative hurdles and connect you with your patients, however, the caution I am attempting to relay is this - make sure you go in with your eyes open having done your due diligence.  Do not embark simply on dreams of no more insurance verification calls, or not having to document referrals, or your patients' promises they will stay.  Making this switch often requires a guided approach. I recommend vetting established concierge practice models and working with the right team to accomplish the transition.

If you have made this switch and care to comment for the benefit of your colleagues, please do! 


I-STOP Implementation - Common Q&As

Looking for HIPAA and compliance forms?  
Click here to visit 
our website.

Have a question or comment for Jennifer?
Contact Jennifer at or  at (516) 747-6700 x. 302.