The image is that of map of zip codes of your area, with each zip code area assigned a number of openings or slots to accommodate practitioners to serve in those slots designed by HMOs. Sadly, we doctors are compromised greatly as we apply for consideration of these slots. There is no guarantee the doctor will even make back the investment. Furthermore, the doctor has compromised income by accepting greatly reduced fees for services. The doctor also now has an increased load of paperwork, increasing overhead to accommodate the additional workload.
Many times there is a substantial wait for payment.
Often, with subsequent visits, the amount paid for services is paid with incremental decreases. The insurance people then do spot-check phone calls to see if the doctor is there. The front-desk person is asked a barrage of questions regarding various issues. For those doctors who are closed out in their area because there are no available slots, they are unable to serve those people in their community. We are not the only practitioners who must face this dilemma.