Now you know!

From Shirlee Zerkel, March 11, 2008

Have you ever wondered why some doctors are in a network and some are not? There are two reasons:

(1) Those doctors, who are not in the network, are not willing to practice medicine with an insurance company telling them what they can and can not do for a patient.

(2) Those doctors in a company's network get paid a subsidy for each patient of that company that they treat, but the procedure must be according to the insurance company's wishes or some of the subsidy is taken away.

Some doctors in networks are good doctors to their patients because they find a way around the rules or are willing to lose some money. Others do not want to play those games and I can understand why, so they choose not to join networks. Sometimes an insurance company drops a doctor because that doctor has refused to let a patient go without whatever care is needed.

This information comes to me from a nurse who at one time managed a GP's office and is now working for an insurance company as an investigator on providers.

Shirlee