3rd party free for 2 weeks, and I am deeply touched by my patients’ support. A new morn, joy cometh.

Today marks the end of the second week of the rebirth of my practice as a third party free medical/ surgical practice. A new day has dawned. I am deeply touched by the patients who have chosen to stay in my care. I pledge them my all. About 75% have stayed, at least up to this point.

With insurance premiums, deductibles, and co-pays sky-rocketing, patients will discover they may actually save money if they stay with me, and most importantly, we will make the best medical decisions together outside the delays, denials, and data collecting of big government and big insurance corporations. We are seeing plans with $100.00 co-pays, which are higher than my follow up fees and deductibles of $5000.00 which would never be met using my low surgical fees. In many cases, it costs patients more to use their insurance with many of these new-fangled plans. Even Medicare premiums are going up and up.

I have a reasonable, transparent fee schedule, and patients can still to file a claim on their own with their insurance company for my services as an out of network provider if they so choose. Medicare patients can continue to use their Parts A, C, and D while opting out of Part B for my services only. They can then choose to file a claim with their secondary insurance or replacement plan for my services as an out of network provider. Tricare, for example, covers 20% when the physician has opted out of part B. In one case, the secondary covered all. Every plan is different. Other plans cover 70- 80% out of network while restrictive Obamacare HMO plans, like ones BC/BS is introducing, cover 0 out of network- just think about that for a second…this style Obamacare plan covers 0 if you chose to see anyone outside their restricted network.

But, have no fear, there are other doctors like me out there, and we are forging a new way, creating a place for patients to get care when the current mess fails them.

Only 1% of physicians have opted out of Medicare, and I think I may be ophthalmologist  #thirty-something. We are navigating relatively uncharted waters.My surgical fees are low, and I offer state-of-the -art, including laser-assisted, cataract surgery ( which Medicare doesn’t cover anyway). What I must get patients to understand is that Part B pays out very little, and laser, astigmatism, and premium lenses are not covered anyway. So, when you factor it all in, in many cases, it costs less to opt out of Part B and see me when it comes time for surgery. Worst case scenario, it may cost patients a few hundred dollars more. Maybe the patient-physician relationship is worth it to some people. Yes, I am deeply touched and blessed that to about 75% of patients, it is.

I am reminded of this piece I wrote that was published in The Washington Times’ and Dr. Ben Carson’s American Currentsee this summer. Yes, joy cometh in the morning. Keeping the faith…

Joy Cometh In The Morn

By Kris Held – – Tuesday, July 28, 2015

Published by Washington Times and American CurrentSee

This morning was glorious, as was yesterday morning. I was refreshed and blessed to operate on nine precious patients. One young man I have known since he first went into glasses in second grade, and when he starts Harvard Law School this August he will be glasses-free with excellent vision after his successful LASIK operation. His mother is my patient as well. I performed LASIK on another treasured patient back in 1999 and performed her cataract operation today, sixteen years later. I also operated on a patient whose husband I operated on last year; this dear couple and I have been through many years and four cataract operations together. My eighth patient has no medical insurance and was virtually blind because of her progressive cataracts. She cried when I told her the cost of my services. I asked, “Why? Is that too much?” She replied, “No, because it’s so good I can afford to pay for it myself. I can do it.” She cried harder at the post op exam for her first eye last week when she could see 20/20 without glasses, having been severely near-sighted her entire life. I can’t wait to see how happy she will be tomorrow. My last patient just lost her husband a few months ago and needs to see better now that she has to function independently, living on her own. I have known them for years as a couple and now her, going forward, solo. Each patient has a special story and a special relationship. I have patients who I see four generations of their family. I have patients who I have seen for over twenty years. I know them and trust them. They know me and trust me. We are a blessing to one another. The patient-physician relationship is like no other.

Before I specialized in ophthalmology and ophthalmic surgery, I graduated from college and then medical school, after which I took the Hippocratic Oath. Then I completed my internship in internal medicine, passed my boards, and became a licensed physician in the great state of Texas. This rigorous rite of passage is grueling and known to rare few. It is beyond description and can only be understood once it has been lived. After completing my residency I became board certified and spent five years on faculty at the medical school teaching medical students and residents and as director of the county ophthalmology clinic. A greatest joy of my life has been caring for tens of thousands of patients in private practice in my hometown for the past 20 years. I am privileged and humbled to be in their service.

My father is a wise physician who regards medicine as a noble profession, a calling and a privilege. I learned from him to listen to the patient intently and fully, and the patient will tell you their diagnosis; examine the patient completely, and you will confirm that diagnosis. You are a physician first, a specialist, a surgeon, second. In his path over the years, beyond all the eye diseases and injuries, I have diagnosed my patients with everything from diabetes and hypertension to brain tumors and aneurysms, thyroid disease and rheumatologic disease to infection to cancer, pregnancy and Parkinson’s to abuse and depression. One long-term patient told me I was the first to confront her about her classic signs and symptoms of depression, and that, most likely, that moment and referral for acute psychiatric care saved her from imminent suicide. I know them; I know when something is not right. We figure it out, and we fix it.

That’s why the evenings have become so horrifically hard, demoralizing and pitifully sad. I sit at my desk to do the chart work after clinic and get punched in the gut by the realities of Obamacare day after day. No, if you like your doctor, you can’t necessarily keep your doctor, and if you like your patients you most certainly can’t keep them — unless you do what the big boys say, big government and big insurance that is. Face it. They lied to us.

Here’s an excerpt from one classic requisite EHR (electronic health record) letter I just received from a colleague; the names have been changed for the sake of patient confidentiality:

“Dear Kristin: This is an update on Mr. John Doe. The following is a summary of my findings on 6/9/2015…Patient of Dr. Held for years, but now she is not taking his insurance. Send to Dr. X for care of glaucoma. Refer to Dr. X…Thank you again for allowing me to assist in the care of Mr. John Doe. Sincerely, JAB. Electronically signed by Joe A. Blow, MD.” Period.

I first saw my patient, Mr. Doe, and his wife in 1997. We have not only been through almost twenty years of medical, laser and surgical treatment together to save his vision, but we have dealt with diagnosing and seeking care for significant issues including stroke, dementia and the consequences of such that affect the health of the marriage and the spouse. They have my cellphone number. They have my trust. And now, they have a new doctor. It’s that easy. Ouch, it hurts.

The new system of government run medicine is perverse and dysfunctional. The patient-physician relationship has been sabotaged and replaced by the government-subject and insurance company- consumer relationship awash with massive rules, regulation, bureaucracy, waste, misinformation and fraud. I call one of the disastrous consequences “The Insurance Shuffle.” Every year patients are shuffled to new insurance companies whether it be by their employer, by the exchange, by their own attempt to seek lower premiums and deductibles, or whether they are forced on Medicaid or Medicare because of financial status, disability or age. Each year the “providers” for the various insurers change. So, effectively every year everyone gets shuffled to a new doctor. So, every year my patients are now someone else’s, and someone else’s are now mine. There is no continuity of care. There is no long-term relationship. It’s like a really shoddy, but really expensive online dating service. Many Medicare and Medicaid patients now can’t even find a new doctor. What a waste of time, resources and rationality. What a waste of money and lives.

So, I can sit here and sob, or I can seek a cure.

I choose to solve the problem by joining with like-minded, patient-loving, Hippocratic Oath-honoring physicians to create an alternate universe outside the insanity of Obamacare and an overbearing statist regime that values money, power and politics over the individual lives, health and well-being of Americans. Physicians must make a choice. Solve or sulk. Stand strong or surrender. Let’s join together to create a model for state-of-the-art, low cost medical care, occurring directly between the patient and doctor, third-party free. If the majority of doctors refuse to implement and comply with the Obamacare model that destroys the patient-physician relationship, and if our patients stand with us, we can do this right. We must stop enabling the implementation of socialized medicine and create the world where patients can get actual care from actual doctors instead of the false promises of phony coverage replete with restricted, regulated, rationed, expensive, impersonal government-dictated access to “eligible providers.” We must resist the tendency to sulk in the hopelessness of the current situation, instead we must act to change our circumstances. We must work together for good in hope and trust.

… in his favor is life: weeping may endure for a night but joy cometh in the morning,” — Psalm 30:5.

I used to say “coverage is not care!” Now I say “coverage is a deterrent to care!” It has come to this.

So, it has come to this… You write a prescription for your patient for a medication that has perfectly eliminated the patient’s symptoms for years, but the patient’s insurance company has hired a company to “manage” the patient’s “prescription benefit.” So, the prescription becomes nothing but a request triggering a letter that the patient must ask the doctor to call the secondary company “to arrange a review.” Under the expressed threat, quote, in bold print: “If your doctor doesn’t call and get approval, you’ll be responsible for the full cost of the medication(s).”

I love my patients. They come to me for help. I have spent my life studying, training, and serving them. The prescriptions I write for them are not subject to 3rd party opinion. But, I acquiesced and called. First, no one answered after prolonged ringing, and I got a robot message to try again later. Then I called back, and after multiple layers of prompts, finally got a human and then was disconnected. So, I called back the 3rd time enduring the multiple layers of time-wasting prompts and got back to a person who then began collecting personal data about my patient and me- what is the patient’s insurance identification number, name, birthday, zip code, diagnosis, what did I write the prescription for? Name of drug, spelling, instructions, amount, refills, what’s a vial, how is that written, what’s my name, office address, phone number, NPI (national provider identifier), DEA number… Then I had to answer questions the clearly non-medical person was reading from scripted prompts. I informed the person I don’t write prescriptions for fun; I write them when they are indicated, and who is he to intervene- effectively denying care and potentially harming the patient- which amounts to practicing medicine without a license… The person gave the classic scripted apology, that they sense my frustration… But whatever.

In all, I wasted 25 minutes that should have been spent caring for other patients. This scam is a flagrant squandering of money, time, and resources—why? So the insurance company can increase their bottom line. We are forced to buy insurance; the insurance company gets our $, they keep our $, and they increase their bottom line every time they deny our care. Imagine if the money they spent on 3rd party agents of delay and denial of care was instead spent actually facilitating access to care! This is one insane, perverse, unethical mess.

This underlying insanity, perversion, and unethical pattern of doing business is why I opted out of Medicare and all agreements with 3rd party insurers. I work solely for my patients. They can file claims for my services as an “out of network doctor” if they choose, or they can file with their secondary insurer to use those benefits instead of Part B Medicare. My fees are reasonable, fair, and less than some copays now.

Imagine paying huge premiums for plans with $100.00 copays, $5000.00 deductibles, and benefit delays and denials- from restricted networks and formularies…this is where we are. This is why we must rise up in mass resistance and say NO MORE, doctors and patients united to restore sanity and the ethical practice of medicine based on the private, individualized patient-doctor relationship. What a waste. What a screw job. I used to say over and over again, “coverage is not care,” but these days it’s worse; coverage is now a deterrent to care. We must stop bending over and stand up strong for good.

Here is the copy of the letter with private patient data extracted. This is nothing more than a scam- theft of precious medical resources that is harmful to patients:

review letter

Dear Trusted Patient, Welcome to a new era in my practice; I work for you and you alone!

October 1, 2015

Dear Trusted Patient,

A new era in my life in medicine has begun. True to the Hippocratic Oath that I took over 20 years ago, I will serve solely you, my patient, to the best of my ability maintaining privacy, dignity, and the integrity of our patient-physician relationship. This relationship is based on mutual trust and honest communication. Your medical records are yours, and I will share them with no one without your permission. I will not engage in collecting or sharing your personal information or medical data with the government or any outside agency with which it contracts. I will resist outside forces that seek to intervene in the patient-physician relationship, that restrict, delay, and deny your access to needed medical care, and that impede innovation, block the use of advanced technology, and obstruct the prescription of current medications. I will seek the highest quality, lowest cost pathway to your best outcome. This relationship exists between you and me alone, unencumbered by 3rd party influences. Accordingly, I submit to you a fair, reasonable, transparent fee schedule for my services.

I understand that most patients have existing agreements with insurance companies and are choosing to see me as an “out-of-network provider” for their respective insurance companies. Patients are free to submit claims for my services to their private insurers; however, I will not submit claims to the insurance companies, because my agreement is with you, my patient, not your insurance company. I have no agreements with any 3rd party payors, including Medicare. Medicare patients can use their parts A and D, for hospital, surgery center, and pharmacy benefits but cannot file Part B for my services- which I make surprisingly affordable for you. I believe this arrangement will result in easier access for you to me and easier acquisition of the best medications and state-of-the-art surgery when indicated, at a dramatically lower cost. Finally, I am pleased to see those less fortunate patients who have little or no means to obtain care at little or no cost during their time of great need. This is my calling and the duty of my profession, just as it is my duty to resist outside forces that seek to overtake the private practice of Hippocratic medicine.

Amidst this time of healthcare upheaval, we must become educated and engaged if we hope to achieve the best possible results for you. I am humbled and blessed to be your doctor. I thank you for choosing to continue in my care. I look forward to discussing these issues with you, seeking solutions, and continuing to be your doctor for the next 20 years.


Kristin S. Held, M.D.