DOCTOR STICKS WITH CASH ONLY PHYSICIAN DECIDES INSURER PACTS ARE MORE TROUBLE THAN THEY'RE WORTH.

Byline: Evan Pondel Staff Writer

WOODLAND HILLS - The front desk at Dr. Jerel Tilton's office is unusually tidy for an internist who sees close to 400 patients.

Instead of file cabinets overflowing with paperwork destined for managed care companies, Tilton only stores information vital to his patients' needs. After almost two decades of working for Kaiser Permanente Hospital in Woodland Hills, Tilton decided to start his own practice with an unconventional twist: He no longer contracts with health insurers to provide care.

Tilton said with doctors' offices spending more time tending to bills than patient care these days, it's more efficient to do without health care companies in some instances. Though the doctor's salary may suffer a bit, his patients seem content delving deeper into their pocketbooks.

``If I had a choice between Dr. Tilton or a doctor who accepted insurance, I wouldn't hesitate to go to Dr. Tilton,'' said Jamie Gillie, who followed the doctor after he left Kaiser three years ago.

But cash or credit only hasn't always been his policy. In the beginning, he was accepting health insurance - only to realize that it was expensive culling through all of the paperwork.

``I would have to hire two extra people just to deal with the billing,'' said Tilton, 55, whose practice is in Woodland Hills. ``And health insurance goes against my philosophy by insuring against catastrophic events. I'm more into preventative care.''

So Tilton decided he could better serve his patients without health insurance, even if it meant not having a large pool of policyholders to flesh out his fledgling practice. Of course, the philosophical difference in Tilton's practice was also more conducive to doing away with health plans.

Patients are immediately greeted with the scent of eucalyptus in the waiting room. Air purifiers hum, Chinese herbs line the shelves and a waterfall sculpture gurgles. Before he retired from Kaiser, Tilton decided to learn acupuncture, which he now incorporates into his practice.

``People often find themselves in ruts when it comes to health care. Problems can be taken care of when they arise, but what about preventative care? I try to help people feel better every day as opposed to when acute pain surfaces,'' Tilton said.

Bill Simmrin is another patient that followed Tilton from his Kaiser days. He suffered from a liver condition that often left him incapacitated.

``Let me tell you, I was a skeptic of the Eastern practices at Dr. Tilton's office. But I decided to give it a chance even though he didn't accept insurance,'' Simmrin said. ``But the course of treatment has been very satisfying for me. I don't care if I have to spend a little extra money. The swelling of my liver has gone down.''

Tilton said he believes he's helping managed care companies though his practice: ``I'm keeping people healthier so that these companies may not have to spend as much on care.''

WellPoint Health Networks certainly has no objections to Tilton's work. ``It's their (doctors') decision,'' said Ken Ferber, a spokesman for the Thousand Oaks-based company. ``But it's hard to believe with health care costs, there are enough people that can afford the care.''

Tilton isn't a rarity when it comes to rejecting contracts with health insurers. The American Medical Association, a Chicago-based physicians' advocacy group, said it is hearing about more and more doctors who no longer accept insurance.

A story published by the organization earlier this year focused on a Mississippi-based internist who no longer contracts with insurers. While Tilton charges patients anywhere from $55 to $75 a visit, Dr. Todd Coulter's office in Ocean Springs, Miss., charges about $40 per office visit and tags on charges for X-rays or other tests.

Both Coulter and Tilton agree that insurance companies were taking too long to reimburse them for their work. In the AMA article, Coulter said he switched to an all-cash practice ``to maintain the solvency of the clinic. Patients would come in for an appointment and pay their $15 co-pay, and we'd file the claim, and then we'd wait 3 1/2, four, sometimes even five weeks to get the balance. It was a cash-flow problem.''

Dr. Marcy Zwelling-Aamot, a Los Alamitos internist, will stop accepting health insurance next year.

``My patients deserve quality care and in the current environment, they cannot receive that. It's a misconception that insurance provides access,'' she said. ``When I tell my colleagues what I'm doing, they are like 'Oh, my goodness. That's a risk.' But when I tell my patients, everyone is excited.''

But some consumer advocates are not certain visiting a cash-only doctor is always in the patients' best interest. ``It's certainly going to be more expensive for the consumer,'' said Earl Lui, senior attorney with the Consumers Union in San Francisco. ``It's better to try to fix the problems of health insurance than having doctors go this way.''

Evan Pondel, [phone]

evan.pondel(at)dailynews.com

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Photo:

(color) Dr. Jerel Tilton, a Woodland Hills internist, runs his office on a cash-only basis. He has about 400 patients.

David Sprague/Staff Photographer