WESTPORT, Conn. -- Dr. Robin Oshman sees patients in an office in her home on Long Lots Road in Westport.
About a mile away from Dr. Oshman's home and doctor's office is the former house of Martha Stewart on Turkey Hill Road.
Dr. Oshman practices in Fairfield County, where many New York executives make their homes, helping it consistently rank among the wealthiest counties in the nation.
Being a doctor in a locality of such affluence has made it easier for Dr. Oshman to be able to manage her practice without accepting insurance plans, removing the constraints and hassles that come with having insurers preapprove tests, procedures, and medication.
"I have more time to see patients than other doctors," said Dr. Oshman, a dermatologist for 20 years. "I can talk to people, and they like the attention. A lot of times I'll make a diagnosis that someone else might miss only because I'm doing the analysis of the patient and listening to what their story is."
Dr. Oshman said that by not having to work within the rules of insurance plans, she has more freedom in treating her patients than other physicians. She doesn't have to adhere to rules requiring physicians to send biopsies to particular laboratories in order for the analysis to be covered by insurance plans.
"I'm using labs that I like to use because I find that the person looking at the specimens is reliable," said Dr. Oshman, who was educated at Brown University and has more than 6,000 patients. "If I do a biopsy, it is very important to have the pathologist who reads the biopsy be an expert. If he tells me that something is malignant or benign, I can believe him."
Dr. Oshman said she bases her fees on Medicare rates and charges prices that she says aren't "outlandish." She charges about $166 for a new patient visit.
"They spend more for their dogs when they go to see the vet than when they see me," Dr. Oshman said.
Her practice, to some extent, relies on patients' willingness to go outside of their health plans to see her. The sagging economy has caused a few of her patients to think twice about footing the additional cost to see her, instead opting for doctors covered by their health plans.
Most patients in her practice, she said, will pay more for the extra attention.
"People love this kind of care," Dr. Oshman said. "This is the kind of care that people were used to before all this changed. I think they are willing to pay a little more to have someone spend the time with them."
Dr. Robert Goldberg, who practices physical and rehabilitation medicine in Manhattan, decided last year to stop accepting insurance payments after he grew weary of insurers' constant demand for additional discounts.
Since ridding himself of managed-care contracts, Dr. Goldberg said he has seen his patient volume drop but his income increase.
"When you terminate the plan, you will lose some of the patients who are shopping by price," Dr. Goldberg said. "But not everyone shops by price. Many people will come in and see you and know that they are getting the attention that they need and the time that they want."
Dr. Oshman believes that more doctors, especially those frustrated by working with insurance plans, should try running their practices without accepting health plans.
"The worst thing that could happen is that it fails and you have to go into managed care," Dr. Oshman said. "In all of my years, I was never in the red. Even when I started way back when and I just hung my shingle, I was able to meet my expenses and have some profits besides."
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Doctors avoid hassles, constraints of doing business with health plans.