| NYLCARE | ||||
| NYLCare Network | ||||
| Alias: FPA MEDICAL MANAGEMENT, CIGNA, AMERICAN MEDICAL SECURITY, PRINCIPAL, ETHIX-SOUTHWEST |
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| Current rating for PRIMARY CARE PHYSICIAN REIMBURSEMENTS--> | F | |||
| Their payments for OFFICE VISITS are--> | AWFUL! | |||
| Their payments for LAB WORK are--> | NONE | |||
| ---CURRENT RECOMMENDATION--- | ||||
| TERRIBLE. A MONEY-LOSER FOR SURE! DOCTORS WOULD BE FOOLS TO TAKE ON ANY OF THESE PATIENTS. LOOK AT THE NUMBERS BELOW! | ||||
| - | ||||
| ---COMMENTS--- | ||||
| 5/18/98 | NYLCare is going to pay for six Viagra pills a month (click) that's $60x12=$720/year; so I guess they've determined that having sex less than six
times a month is health-threatening; but getting laid more often
than that is unnecessary. They're doing this for the sake of marketing,
to keep patients happy, while at the same time paying doctors peanuts! ----------------------- |
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| 4/25/98 | NYLCare just lowered its payment for a 25-Minute Office Visit (99214) from $75 to $62.07, another drop of 17%. Remember that our standard practice model has determined that your overhead for a 10-Minute Office Visit is about $30; so that means YOUR OVERHEAD FOR A 25-MINUTE OFFICE VISIT IS $75! If you continue seeing NYLCare patients at these rates, doctor, you're a fool; and YOU DESERVE TO GO BROKE! ------------------------ |
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| 2/28/98 | AETNA is negotiating to buy NYLCare. This will be a merger of the worst with the worst. -------------------- |
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| 12/23/97 | The old ETHIX-SOUTHWEST network used to be a pretty good plan
for doctors and patients until NYLCare took it over. Ben Dover warned everyone more than two months ago (click) that NYLCare was going to smother the entire Ethix-Southwest
Network under its deplorably low fee schedule, and they have now
done just as predicted. I cannot imagine why any doctor in his right mind would want to remain contracted to a network with which he is obviously losing money on every patient. All the plans in the old Ethix network are now just shells (shills?) for NYLCare; so there will be no further updates on any of their pages. All future NYLCare changes will be reflected on this page only.. -------------- |
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| 12/17/97 | NYLCare just reduced its payment for a 10-Minute Office Visit (99212) from $35 to $23.34, a drop of 33.3%. We assume that you do 4,140 of these a year, doctor; so NYLCare just stole
another $48,272 from you and added it to their own corporate profits. -------------- |
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| 12/17/97 | NYLCare just reduced its fee for a 15-Minute Office Visit (99213) from $53 to $32.93, a drop of 37.9%. This code is not one of the "standard" ones used to compute
our annual income figures, but it's obvious that this drop of $20.07 multipled by hundreds of these visits a year adds up to BIG BUCKS! -------------- |
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| 11/25/97 | NYLCare just lowered its payment for a Minimal Service (99212) from $30 to $12.99, a drop of 57%. If you bill for five of these a day, NYLCare just picked your
pocket of another $19,562 this year, doctor, and added it to their profits. I'm expecting NYLCare's other Office Visit codes to dive into
the toilet shortly... and remember, NYLCare pays you nothing for lab work! -------------- |
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| 10/1/97 | ETHIX SOUTHWEST became a subsidiary of NYLCare several years ago but continued
to operate independently in Texas with their own fee schedule.
Now NYLCare is taking over control of the Texas Ethix operation,
and Texas doctors are going to take it in the shorts (click). -------------- |
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| 8/18/97 | NLYCare's Office Visit reimbursements were always mediocre, and now they're dropping. NYLCare pays nothing for lab work and poorly for ECG's, etc. Unless a doctor is willing to work for $14.62/hr, it makes sense to reject this plan. | |||
| ----------- | ||||
| PLEASE BOOKMARK http://home.earthlink.net/~austintxmd and check often for updates | ||||
| NET PHYSICIAN INCOME | |||||||
| NYLCARE | |||||||
| NYLCare Network | |||||||
| Alias: FPA MEDICAL MANAGEMENT, CIGNA, AMERICAN MEDICAL SECURITY, PRINCIPAL, ETHIX-SOUTHWEST |
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|
|
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| Maximum Number of Each | Click to see ASSUMPTIONS on which these figures are based | ||||||
| You Could Perform | Fee They Pay |
Totals For Year |
|||||
| ___Service____ |
Per Year
|
||||||
| Office Visits (99212) | 4,140 | 23.34 | $96,628 | ||||
| Physical Exams (99215) | 690 | 92.85 | $64,067 | HOURLY | |||
| Total Possible Income from Office Visit Charges--> | $160,694 | $139.73 | Income | ||||
| Total OFFICE OVERHEAD (click)--> | -$206,600 | __-$179.65 | Overhead | ||||
| Net ANNUAL PHYSICIAN INCOME--> | -$45,906 | -$39.92 | <-- Net HOURLY MD Income | ||||
| Hourly Physician "Wage" (based on an 8-hour day)--> | -$24.95 | ||||||
|
(including patient copay) |
||||||
| CPT Code | Description | 1995 Payment | Current Payment | CHANGE | ||
| 99211 | Office Visit, MInimal | 21.00 | 12.99 | -38.1% | Payment For <-- 4 Office Visits |
|
| 99212 | Office Visit (10min.) | 35.00 | 23.34 | -33.3% | $93.36 | |
| 99213 | Office Visit (expanded) | 53.00 | 32.93 | -37.9% | ||
| 99214 | Office Visit (detailed) | 122.00 | 62.07 | -49.1% | Payment For One <-- Physical Exam |
|
| 99215 | Physical Exam (40min.) | 92.85 | $92.85 | |||
| 93000 | Electrocardiogram | 30.24 | 28.60 | -5.4% | -$.51 | <-- What the doctor loses every time he does a thorough physical exam. See "Disincentives to Good Care" |
| 94010 | Pulmonary Function | 34.31 | 32.23 | -6.1% | ||
| 85025 | Complete Blood Count | NONE | NONE | |||
| 81000 | Urinalysis | 21.60 | 5.00 | -76.9% | ||
| 80061 | Cholesterol/LDL/HDL | NONE | NONE | |||
| 80019 | Chem-28 Profile | NONE | NONE | |||
| 88150 | Pap Smear | NONE | NONE | |||
| --------- | ||||||
| Reprinted from: http://home.earthlink.net/~austintxmd | ||||||
