I worked for Doctors my whole life. Front office , back office and billing.

When HMO’s became a thing it looked like on paper a good idea for Doctors to sign up, but in the early days Doctors had signed a contract and then the HMO really dictated what test, referrals to specialist and medications given. And some Doctors did get a kick back for saving the HMO’s money. That did hit the fan legally and morally and a lot of that stopped.

HMO’s at the time we’re very appealing to people because in general it was cheaper than standard insurance.

Early 90’s one of the Doctors I worked for did not renew contract for any HMO’s he was sick of the low reimbursement. He lost half his patients, but soon enough his practice was filling up and he was making a good living and didn’t have to work 14 hour days anymore.

Back in the day Medicare was considered top notch great insurance a Doctor could order tests and referrals to specialist at will.

Medicare started reducing reimbursements a little at a time, at first it was like “ well okay” as far as billing and receiving payments Medicare was the quickest.

By 93-94 I believe , Medicare was still dropping reimbursement. My father’s Doctor quit accepting it, he set a very low office visit cash, which was honestly a bit lower than what Medicare would have paid. He could refer to any specialist as they would accept Medicare

I was doing billing for a Doctor late 90’s he also decided to stop accepting Medicare , he accepted PPO plans and other straight insurance plans because they paid a decent amount.

People think Doctors make millions a year .. no they don’t , maybe top notch specialist doing tricky surgeries but your general GP’s not so much, most are saddled with enormous school loans.

I recently saw a Pulmonary specialist. His new patient OV was 225.00 billed to Medicare. Medicare approved at 98.00 and I will pay the 20%

Basically a Dr could charge 500.00 for a office visit but Medicare will still only approve X dollars..

My GP accepts Medicare but to make his billing easier ( he’s a rural small town Doctor ) he has a flat fee of 20.00 per visit which is cheaper than Medicare would expect me to pay.

Medical insurance is a mess and hopefully things will improve.