Can Doctors Refuse To Accept Insurance?

You leave for your doctor’s office to seek medical care. But once you arrive there, you find out that the doctor refuses your health insurance policy. The money you pay out of your pocket without health insurance is considerably costly. What do you do then?

The reality is, most physicians refuse to accept different types of health insurance plans. As a matter of fact, numerous doctors currently decide to decline working with those who possess health insurance altogether and demand cash payments from the patients. For example, a mere 71% of doctors decided to work with Medicaid in 2019, as per Medicaid and CHIP Payment and Access Commission.

It is essential to comprehend and realize the reason behind rejection of health insurance plans by physicians and their requirement of cash as a method of payment, along with the alternatives you have as a patient in those situations, including basic services from primary care physicians and other facilities.

Can Doctors Decline Taking Insurance?

Yes, doctors are not bound to accept health insurance policies or the charges that these companies select for paying the practitioners. The Affordable Care Act looked for improving access to health insurance, but the matter of increasing expenses and reduced reimbursements offered by certain insurers remained unsolved.

Many decide against working with specific private or government payers such as Medicare and Medicaid who propose decreased reimbursements to practitioners. Rather they might just move to out-of-pocket medical services.

“It’s growing increasingly common. Insurance organizations are refusing claims which makes it more difficult for doctors to treat patients in their policies by decreasing reimbursements. As a result, many doctors are leaving plans,” says Lily Talakoub, MD, FAAD, a certified dermatologist in McLean, Virginia.

Reasons Doctors Choose To Go Insurance-Free

Doctors discuss the cost of disease management with insurance providers. The company then specifies the charges that will be given to the doctor. These companies may as well include quality parameters that doctors ought to meet in order to get the complete reimbursement. Insurers decide the amount; however, it is not necessary that the doctor is bound to accept the fixed amount.

Some doctors have been compelled to refuse policies and reimbursements from certain insurers owing to their decreased reimbursements.

However, reduced compensations aren’t the sole reason why health care practitioners are not maintaining ties with insurance holders.

“Doctors just dislike handling with insurers,” says Ann Martin, Operation’s director for Credit Donkey in Pasadena, California. “Not only is the paperwork and documentation too much, but these companies are infamous for looking for any possible reason to refuse coverage. Healthcare practitioners and institutes are forced into hiring additional employees to tackle these problems or deal with the insurance companies by themselves. Whatever they decide at the end of the day, it is heavily time consuming, all as a pretext of getting paid.”

When reimbursement rates are reduced by health insurance companies, Takanobu says doctors are forced to see higher number of patients, which compromises the quality of care provided to patients.

“The office of a doctor turns into a factory, consequently patients have to suffer,” Talakoub says. “Besides, insurance companies typically disapprove the prescriptions or tests recommended by doctors, making the managerial burden horrible for the doctors to tackle since they request their whatever decision they make as proponents for the particular patients.”

Increase In Direct Primary Care And Cash-Free Medical Services

Number of medical practitioners who refuse insurance is growing. It is little or no surprise that some of the doctors have made the decision to increasingly or fully accept just cash for the treatment and health care services.

Obviously, the expense has to be paid by somebody. When doctors make their mind against accepting insurance, it implies that it is the patients who have to pay up– at the minimum those who decide on doing so.

“Demanding out of the pocket payment from patients removes the insurance agent, making the process smoother for doctors by decreasing their workload,” Martin adds.

Few services ask patients a flat or lowered/sliding scale fees for visiting office or treatment. Others offer “concierge medicine,” meaning a once-a-month, trimestral or annual fees or retainer has to be paid by patients for fixed number of services or sessions.

In direct primary care program patient and doctors plan out a financial agreement, eliminating the need of health insurance. Instead of filing health insurance claims, the facility directly works with patient. This may comprise of a monthly or a membership fee.

Advantage of this program is that it does not require to deal with insurers. However, as the plan does not cover anything you might need to spend additional amount for care.

What To Do If Your Physician Refuses Your Insurance?

In case your health insurance is refused by your doctor, following are the steps you may take:

Get In Touch With Your Insurance Provider

“Talk to them and inform about your case. At times they’ll consider your request. However, if it is that the doctor is demanding cash or refusing to tackle the health insurance company, you might be required to clear the bills or move ahead,” proposes Martin.

Study What Your Network Covers

“It is possible that facilities that you need are offered by some other health care giver in your vicinity who does not refuse your insurance,” suggests Nick Schrader, an insurer with Houston-based Texas General Insurance. “If that’s the case, try to go to that provider instead.”

Inquire If Your Doctor’s Office Will Submit Your Insurance Claim

“In case your doctor is not within the network coverage of your insurance, request them the possibility of submitting an out-of-network claim out of courtesy to you,” Takanobu says. “If that’s not possible, ask them if they can offer records along with required paperwork and documents which can enable you lodge a claim by yourself.”

Ask for a lowered Fee Or Adjustable Repayment Conditions

“Doctors who refuse your insurance are occasionally willing for negotiating with patients by decreasing direct cash payment or by proposing adjustable financing,” observes Martin.

Find Out If Your Doctor Gives Concierge Medicine Options

You may get services through regular pre-payment of fee on monthly or yearly basis, if your doctor agrees.

Think Of Changing Insurance Coverage

Your physician might not refuse a new program or policy by another carrier. The type of health insurance plan acceptable to practitioner can be confirmed with the provider.

Investigate The Charity Options

“Look for the options of charity offered by facilities or hospital to either decrease or remove your bills based on your monetary needs, and see if you fulfill the requirements for that,” Schrader says. “If you are eligible, you’ll possibly need to pay a minimal amount by yourself.”

Seek Medical Help From An Urgent Care Clinic Instead

Visiting clinics that offer non-emergency services may cost significantly lesser than a private practice, hospital or medical facility.

Pay Whatever The Physician Demands

If all alternatives have been exhausted but you value the practitioner’s services, staying put as a patient may be worthwhile, hence you should pay your entire bill.

Steps To Take If Your Doctor Refuses Medicare

Majority of the doctors do not refuse Medicare. As per Kaiser Family Foundation a mere 1% of all non-pediatric physicians officially chose to move out of the Medicare program in 2020.

The program doesn’t pay as much as private companies. Medicare reimburses just around 80% of the rate private health insurance pays to the doctors. This is why some physicians refuse Medicare.

But if you find out that your doctor doesn’t accept Medicare, look for other options you may avail. Probably you could discuss a reduced fee or sliding scale fee. Possibility is that the practice provides flexible financing alternatives. As a last hope, be ready to look for another physician who takes Medicare; request for a recommendation from your doctor to another doctor who does.

Can Doctors Refuse Insurance Of Unvaccinated People

Growing number of unvaccinated patients are being admitted to hospitals or are dying due to COVID-19 in the United States.
This has opened a debate of whether the doctors can refuse care for patients who decide to remain unvaccinated.
Although some doctors can decide which patients they will see, refusing to treat certain groups considered unethical.
Doctors are also responsible for not discriminating on the basis of gender, race or faith, among others.

Presently when vaccines are readily available and accessible across the United States, most healthcare professionals experience compassion fatigue when people who knowingly decide to not vaccinate end up being hospitalized with fatal COVID-19 complications which would not have resulted if they been vaccinated.

Private Providers Can Decide Who They See

As per Laser, individual providers including physicians, dentists, and dermatologists can choose who they see.

Healthcare professionals do not have the right of discrimination on the basis of an individual’s gender, gender identity, race, faith or sexual orientation.

Refusing care to unvaccinated individuals could result in consequences from payers they are deal with, licensing boards, and their public reputation.

The staff of healthcare who work on behalf of healthcare system or an organization possibly cannot exclude patients.

Under the Emergency Medical Treatment and Labor Act (EMTALA), treatment of a patient going to an emergency room, whether vaccinated or not and regardless of their insurance status and ability to pay is mandatory.

According to Laser it is the moral and ethical duty of healthcare professionals to treat patients, irrespective of their vaccination status.

“While it is a physician who decides the person they want or don’t want to provide services to in various situations, I am of the belief that there is a fine line on this matter,” Laser said.

Key Takeaways

Most of the doctors refuse certain types of health insurance and few even never accept any insurance.
Doctors may quit accepting insurance if they think that health insurance company is offering very less compensation.
In case a doctor does not accept health insurance, you have some options, such as requesting for discounted fee or provision of flexible payment conditions.