Experienced HIV doc says denial of insurance claims forcing him to leave his Oak Lawn practice
DAVID TAFFET | firstname.lastname@example.org
As of Dec. 15, patients of Dr. Nick Bellos will have a new primary care physician. Dr. Stockton Roberts will head the practice.
Over the last several years, Bellos, said, Blue Cross has denied or failed to pay more than half a million dollars to his practice. He said the insurance company said claims were incorrectly coded, or that they hadn’t received the claims. But the doctor said even after the coding was corrected and claims were resubmitted, Blue Cross still didn’t pay.
Unless they come to an agreement over the next few weeks, Texas Health Resources, which operates Presbyterian Hospital in Dallas, Harris Methodist Hospital in Fort Worth and 14 other DFW area hospitals, will stop taking Blue Cross on Jan. 1, presumably for similar reasons.
In July, Bellos sold his practice to Medical Edge, a physician group in Dallas with more than 450 doctors. They take care of the business operations and pay doctors based on the profitability of the practice.
But, “It became obvious it wasn’t going to work out financially,” Bellos said.
He resigned effective Dec. 15.
Roberts has practiced in Oak Cliff for five years when he took over the practice of Dr. David Brand upon his retirement. Medical Edge also employs him.
Roberts will combine Bellos’ practice of more than 3,000 patients with his own of about 2,000 patients. Four members of Bellos’ staff will remain at the Lemmon Avenue office.
Roberts said he plans to spend most of his time in the Oak Lawn office but will continue in Oak Cliff on Fridays. He said his lease in Oak Cliff will be up at the end of January and he will decide then whether to renew it.
Roberts said Medical Edge asked him to take over Bellos’ practice because he is the only other physician in that company with an HIV practice.
“I want to make sure those with HIV are taken care of,” he said. “Nick [Bellos] will be a resource for me.”
Roberts said he hopes to add another doctor to the practice soon and is looking into ways to increase profit. He’s hoping his Oak Cliff patients will follow him to the new office.
He called his Oak Cliff practice quite diverse.
“If you don’t fit anywhere else, you fit here,” he said.
Roberts said that description fits him well, too. He was married and has three children but came out about five years ago and now has a partner. They live in Arlington. He maintains an apartment in Fort Worth near his children and practices in Dallas.
Bellos is not quite sure what his plans are. He’s considering legal action against Blue Cross.
“I want to thank all the patients who have allowed me to be part of their journey for the past 30 years,” he said. “But it’s time to open a new chapter and continue to be of help to the HIV community in another capacity.”
Because of a non-compete clause in his contract with Medical Edge, he cannot practice with patients for a year. However, he’s hoping to expand the clinical trials and research he conducts at a new location. Those on his research staff will remain with him.
As one of the most experienced HIV infectious disease physicians — having treated patients with the disease since the beginning of the epidemic — Bellos is frequently invited to speak around the world. In January, he will be speaking in Australia.
Bellos’ timing of his announcement was related to some changes in law.
On Jan. 1, several new provisions of health care reform kick in. The lifetime cap for benefits will be eliminated. Denial of insurance because of pre-existing conditions will be removed for anyone under 19 years old. That will extend to everyone in two years.
Beginning in 2011, minors can continue to be covered on their parents’ policies until age 26. Wellness screenings must be included free of charge. Deductibles are increasing and co-pays no longer count toward those deductibles.
While the goal is covering more people, insurance companies are rapidly raising rates to cover these added expenses.
Along with increased coverage, however, will come decreased payments to physicians.
Medicare payments to doctors will decrease by 25 percent, unless addressed by the end of the year. Insurance companies follow Medicare reimbursements closely.
“The ability to run an office and pay a staff is going to be difficult,” Bellos said.
Roberts believes he can turn the larger, combined practice into something profitable. He plans to add at least one more physician and keep electronic medical records. He said he’s meeting with infectious disease doctors to forge new relationships to benefit his patients.
This article appeared in the Dallas Voice print edition December 10, 2010.