BANGOR – Amid all the sound and fury of the health care debate, one local doctor is taking a quiet step toward simplicity.

Dr. Karen Hover, who has practiced family medicine in the Bangor area since 1992, will open a new office in Bangor next month. For walk-in patients and those with appointments, she will provide a full range of primary care services – treatment of illness and injury, camp physicals, vaccines, annual check-ups, prescriptions and so on. In some ways, it will resemble the care available at other clinics in the area.

But what will set Hover’s medical practice apart from nearly every other practice in the state boils down to this: Payment is required at the time of service.

That means cash. Credit cards are OK, too, and personal checks. Hover won’t take payments from Medicare, MaineCare or private insurance companies, although she will help patients seek reimbursement from their insurers.

Billing insurance companies is more than a nuisance, she says – it adds an unacceptable level of bureaucracy and expense to the healing profession she practices.

“About half the staff at a standard family practice office is for billing,” she said during an interview Friday at her home in Orono. There are dozens of insurance companies, each with its own forms to fill out and its own rules to follow, she said. Each demands to see documentation from patient records. Each pays for some medications and not for others. Patients have varying coverage benefits, which alter when they experience changes in their jobs or other life circumstances. It takes a small army of billing specialists to keep it all straight.

For a large, multiprovider practice that offers comprehensive services and accepts all types of insurance, paying for billing is just part of the cost of doing business. For Hover, who will practice solo with only a receptionist for staff, it’s not worth it.

“Large offices with lots of people create complexity and get in the way of providing the best care,” she said.

While some area clinics offer income-based sliding-scale fees for the uninsured, Hover said the application process can be lengthy, overwhelming and stigmatizing. Her streamlined fee schedule – $80 for a standard office visit, $100 for a complete physical exam – will be reassuring for uninsured patients and accessible to those with high-deductible coverage plans. She estimates that 20,000 such individuals reside in the Bangor area.

Hover is not alone in looking to free herself of the complexities and inefficiencies of medical billing. Gordon Smith, executive vice president of the Maine Medical Association, said Friday that many Maine doctors are “fed up” with the billing system. Still, few are opting to drop out as Hover has, he said. Instead, more primary care doctors are going to work for hospital-owned practices or other offices where the billing is handled by a centralized staff.

Smith said support is building for doctors to provide comprehensive health management instead of the episodic care received by many Americans. “Micropractices” like Hover’s one-doctor office can serve only a limited function, he said.

“Clearly, this is not the future of medicine,” he said.

Smith said he is aware of just a few Maine doctors who are now practicing solo and most accept at least some form of insurance.

Hover will hold an informational open house at her new practice, Access Healthcare, the week of July 14. The public is invited to drop in during business hours and learn more about the services she will provide. She will begin seeing patients on July 21.

Access Healthcare is located at 205 French St. in Bangor. More information is available online at www.accesshealthcarebangor.com or by calling 942-2238.

mhaskell@bangordailynews.net

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