Good-bye BCBS PPO

Well, that was quick. I went out to the Southfield offices of BCBSMi PPO on Wednesday (after the big snowstorm, so it took me nearly 2 hours to get there, but they were gracious enough to still see me despite my being late, though I did leave my lights on and had to push-start my car when I got back out). Friday morning, we got the letter that said they were upholding their decision to remove me from the PPO, effective march 21.
What does that mean for my patients with BCBSMi PPO? I will no longer be in the lowest tier of reimbursement: rather than just the regular co-pay (which varies from plan to plan), visits would be subject to the next tier up payment, which also varies from plan to plan. In general, it is often a 20-50% copay and subject to the deductible (which, of course, varies from plan to plan). So, it's time to dig out that benefits book you got when you enrolled and see what your plan will do for visits to doctors who participate in BCBS but not in the PPO.
Also, if you want to find a provider in the network, it easy enough: go to
the BCBSMi website and look up your plan and see who's covered.

Other interesting things from the meeting:
The fundamental issue is that I don't fit in their business model, which groups things together by objective criteria (like doctor's specialties) and then looks for places where costs are going out of the normal range for that group. Since I'm not practicing the way the average family doc is practicing (which also happens to be the reason many people seek me out), I'm and outlier and not compatible with their plan. In a way, it acts as a gatekeeper for people in their PPO: to go to Dr. Sickels, patients would have to need to see me enough to justify their going out of the PPO network.
They did bring up the previous entries on this blog about the audit, seemed a bit miffed about them, and asked me why I posted them. As I told them, the potential for them take all that money back is a big deal for me: it can put me out of business and leave my patients out in the cold. As far as I know, I didn't sign away my right of free speech when I signed up for the PPO. I think it's important for people to know what's going on and if my office suddenly closes, I want people to know why.
I don't know what this means for MiChild. I suspect this means it will no longer cover visits and they'll have to pay to see me themselves. Too bad they can't take the
thousands of dollars I've already saved them and use it for other people.