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Entrepreneurs Go Where Doctors Can’t and Third-Party Payers Won’t

by John Goodman

Before you ever approach your doctor’s office, your third-party insurer has already determined what tasks will be paid for, what tasks will not and how much will be paid. As a result, doctors are not free to repackage and reprice their services the way other professionals do.

However, entrepreneurs are developing products that doctors cannot and are doing so largely outside the third-party payer system. Here are some examples provided by a CNN news story:

Over the past two years, the number of retail clinics in pharmacies, supermarkets and big discount stores has jumped from 200 to 1,100.
Nearly a third of companies have a clinic or are planning to open one by 2009, according to Watson Wyatt.
Urgent care clinics are in almost every city of any reasonable size and are usually out-of-network providers.
A relatively small number of physicians currently offer “Web visits,” but are not usually covered by insurance.


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