HMO BACKLASH: Denver Docs Launch ‘HM-No’
Two Denver physicians have "opened a family practice that will not bill insurance," launching what they are calling an "HM-No," the Rocky Mountain News reports. To receive care from Drs. Jonathan Sheldon and Heather Sowell, patients will have to "pay for visits themselves, then submit claims to their insurance companies for reimbursement." Those without insurance will be responsible for paying the full amount. "With the onset of HMOs, there's less and less time to take care of patients in the way we're trained. That's not comfortable," Sheldon said. But success for the husband and wife pair may be difficult, according to Bette Waddington, a consultant with Denver-based Medical Group Management Association. Approximately 90% of Coloradans with health insurance are enrolled in managed care programs, which limit patients to participating physicians. Non-participating physicians are unable "to make referrals to specialists, tests or hospital care at in-network rates." Waddington said, "They'll never survive in this market. Patients may value the quality of a physician, but they're not going to pay extra to see those physicians." Sheldon and Sowell, aware of such "warnings," plan to make their business attractive to patients by "spac[ing] their patients far enough apart that there will be no waiting ... offer[ing] off-hours and weekend appointments and house calls to established patients." Sheldon said, "This was equal parts passion and business. No, more like 70% passion and 30% business. We'll keep going until we can't do it any longer. This is our commitment." The pair are aiming to "have a full practice of 2,500 patients within six months" (Conklin, 2/28).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.