Physicians Able to Bypass Insurers Under New Law
April 25, 2012 -- In the nearly three decades as a primary care physician, Steven Butdorf has taken care of people without health insurance who’ve earned too much to qualify for government assistance. Now that the Insurance Division has issued new rules for retainer practices, Butdorf can bypass insurance companies and offer discounts to his patients. Those rules came about following passage of Senate Bill 86 in the 2011 Legislature.
“From my vantage point in the private sector, it really provides a much needed option for working people who don’t have insurance,” said Butdorf, who runs Exceptional Health Care in Eugene. “This deserves to be part of the conversation about how we do healthcare differently in a way that’s more affordable.”
Under his retainer practice, patients pay a monthly fee that ranges from $35-$79 depending on their age, along with a $20 co-payment for visits, and receive basic healthcare services such as flu vaccinations and physical exams, but not surgeries or specialty care.
In late January, Butdorf became the first doctor certified to operate a retainer practice and now has more than 170 patients.
Oregon’s Insurance Division actually initiated such legislation following multiple requests by physicians, said Cheryl Martinis, spokeswoman.
“A lot of the people and physicians we heard from served lower-income families who couldn’t afford the cost of health insurance on their own to provide it, or the only kind they could afford had a high deductible,” Martinis said. “The bottom line is, people were interested in finding ways for people to get healthcare.”
Sen. Jeff Kruse (R-Roseburg) described this new approach as “really outside the box,” saying it brings healthcare to a more basic level where doctors and patients deal with each other face to face, and not through insurance companies.
“Basically, the new delivery systems eliminate third parties,” Kruse said. “People get healthcare, the cost will be less and doctors won’t have to have all those people filling out all those forms.”
But despite the initial success of Butdorf’s retainer practice, the new system doesn’t work for everyone. GreenField Health, an 11-year-old independent primary care practice in Portland, has decided to opt out.
According to its administrator, Steve Rallison, the rules adopted by the Insurance Division didn’t fit with GreenField’s business model, which uses a “hybrid” approach that combines a retainer fee and insurance billing. “We don’t feel that we fall within the definition (of a retainer practice) as it played out in the law,” he said.
Martinis, however, expects other primary care physicians to follow in Butdorf’s path and seek the retainer practice certification.
“It sounded like there was a lot of interest,” Martinis said. “I believe several others are on their way.”
Butdorf, meanwhile, estimates that his retainer practice is responsible for at least 80 percent of his business. “I think all of us felt good about this, and we’re setting the bar for these kinds of practices in a place that gives them legitimacy as another choice in the healthcare marketplace here in the state of Oregon,” Butdorf said.
FOR MORE INFORMATION
Consumers with questions about retainer practices should contact the Insurance Division at 888-877-4894 or visit http://insurance.oregon.gov/consumer/consumer-tips/4845-26_retainer-medi.... Physicians interested in registering can visit http://insurance.oregon.gov/insurer/retainer-medical-practices/retainer-....
For more information on Exceptional Health Care, visit http://www.exceptionalmd.com/.