Do doctors reject patients that offer to pay out of pocket?

[tvguy]

That post was written in 2011.

And the Affordable Healthcare Act went into effect in 2010, so it still applies.

 

[Genie+]

A tangled mess decades in the making. Multiple very complex issues where often correcting one collapses another. There is no magic wave of a wand to tackle the dysfunction. It’s going to take layers of adjustments. The enormity is beyond what any one individual or group is expert enough to fix. It can only be evolved back into a system that is efficient and functional.

 

[backformore]

The affordable care act was horrible for everyone. It is the reason healthcare is getting worse, not better. Insurance companies should not be allowed to not insure someone or cover something due to a pre-existing condition that you may not even know you ever had. For example you could have a birth defect that you don't discover until you are 30 or 40 and so they say well we aren't going to cover you?? That is ridiculous.

The affordable care act was great in that it said that you CANNOT be denied coverage due to a preexisting condition. Before that, people with employer based policies would be stuck at the same job, because changing jobs would mean changing insurance, and any preexisting conditions wouldn't be covered. The best thing about the affordable care act was changing this. As long as you had some continuity of coverage, preexisting conditions had to be covered.

 

[tink2424]

As to the original question, a doctor might be reluctant to take a cash patient because if tests are needed, the patient might not be able to afford the additional cost. Once a doctor takes a patient, they have an ethical obligation to provide care. A doctor doesn't want to be in the situation where insured patients get a higher standard of care than uninsured patients. I'm thinking of expensive tests like MRI, but also follow up appointments and referrals to specialists.

Some doctors will accept cash from everyone and then give patients the paperwork to file their own insurance claim. That way they don't need to hire someone to do billing.

As to whether it's legal, yes doctors are not required to take on a new patient and can refuse for any reason.

This does not sound reasonable. The doctors job is to assess the patient for THAT VISIT ONLY... If the patient can't afford other test they should help see what they can afford and go over what the risks are for not getting testing done. This excuse would be a cop out.

I think some doctors are lazy and just want to have things be easy for them or to not be questioned or to have to explain themselves. SMH...

 

[tink2424]

The affordable care act was great in that it said that you CANNOT be denied coverage due to a preexisting condition. Before that, people with employer based policies would be stuck at the same job, because changing jobs would mean changing insurance, and any preexisting conditions wouldn't be covered. The best thing about the affordable care act was changing this. As long as you had some continuity of coverage, preexisting conditions had to be covered.

Maybe it was great for that but it was horrible for everything else. So many lost really good coverage or any coverage as those plans were deemed too good. And also requiring every American to have insurance or have to pay a penalty goes against how this country was founded. It made the entire system worse for everyone but insurance companies who made tons of money on this nonsense.

 

[momz]

Uninsurable? That makes no sense to me. The affordable health care act said that insurance companies can't refuse you for pre-existing illness as long as you were insured at the time of diagnosis/illness.
At 21, you can apply for medicaid if you are low income, or healthcare.gov .

Insurance companies want you to show that you have continually been insured. Buying insurance after you're sick is like buying car insurance after an accident, and expecting the accident to be covered

When a person has pre-existing disease, they may be eligible only for the high risk insurance plan which is very expensive. Each states does this a little differently. So while the poster used the word "uninsurable", that's not exactly true. however, it is true that she likely cannot afford the cost of the premium.

The best solution is for her to get a job with a company that offers health insurance benefits. Her premium will be the same as all other employees, as she will not be lumped into the state high risk pool if it goes through the employer.

 

[momz]

I will attempt to explain why, in some cases, a provider cannot accept cash for services.

If a person is insured through a government program i.e. medicare or medicaid, that person may NOT pay out of pocket for services and the provider may NOT accept payment in cash.

In the case of medicaid...if a person can afford to pay out of pocket, then that is considered an indication that they are able to afford to pay for their own healthcare services. So, why should the collective population be responsible to provide insurance if they can pay on their own. (don't shoot me, I'm just the messenger).

In the case of medicare...all services must be billed through medicare. Medicare requires that patient data is fully available to them. If paying out of pocket, it appears as though something is being hidden. This is because Medicare uses this data to predict future expenses.

Hope this helps.

As for private insurers. I cannot speak as to why a person with private insurance could not pay out of pocket, other than to say that perhaps the provider's contract with medicare/medicaid prohibits accepting cash for services if a person is fully insured regardless of who the insurer is...maybe?

Still, medicare/medicaid fraud is something to be avoided at ALL costs. So i suspect the reasoning has something to do with the provider wanting to avoid being accused of trying to hide certain diagnoses.

 

[tvguy]

The affordable care act was great in that it said that you CANNOT be denied coverage due to a preexisting condition. Before that, people with employer based policies would be stuck at the same job, because changing jobs would mean changing insurance, and any preexisting conditions wouldn't be covered. The best thing about the affordable care act was changing this. As long as you had some continuity of coverage, preexisting conditions had to be covered.

Yes and no. Yes you can not be denied coverage. But is it an insurance plan that any Doctor in your city takes? We have a friend who lives in a small city, population 90,000. She has health insurance for the first time since she was a kid, and she's 62. Not a single Primary Care Physician within 150 miles of where she lives takes that insurance.
She only has healthcare if she travels 150 miles. So with her cancer diagnosis, the insurance was a Godsend in the big picture, but now that is a huge hassle because even a routine Doctor's appointment requires a 6 hour round trip.

 

[NotUrsula]

I don't know how common it is, or if it is still true, but I was once told by an oral surgeon's office manager that the reason they insisted on running everything through insurance before taking cash was because they were able to write off the part of the bill that insurance did not cover, even though they were in-network. Since that was dentistry-related, I would think that probably half of their patients did not have insurance that covered the care, but for those who did, that tax write-off was a cost-savings they counted on.

If what she told me was accurate, I would think that would go a long way to explaining why apparently overbilled amounts can be so incredibly high.

(BTW, the unethical bit almost surely refers to a practice called balance billing, where a provider agrees to accept an insurance plan's reasonable & customary cost limits, gets paid by insurance, but then turns around and tries to bill the patient for the remainder of the originally invoiced cost. It's not only unethical, but actually illegal in several states.)

 

[mom2rtk]

Sure. There’s still the consideration of which to get and how much they cost. There are often significant cost differences in options. An insured person may say give me what you feel is the best option that insurance will cover. A cash person may not want to pay triple for a test that is only slightly better than cheaper option.

So the doctor may be asked to provide all the different options, their costs, their differences. Same thing with Rx etc…

How dare a patient ask questions about how much something will cost.

 

[momz]

I don't know how common it is, or if it is still true, but I was once told by an oral surgeon's office manager that the reason they insisted on running everything through insurance before taking cash was because they were able to write off the part of the bill that insurance did not cover, even though they were in-network. Since that was dentistry-related, I would think that probably half of their patients did not have insurance that covered the care, but for those who did, that tax write-off was a cost-savings they counted on.

If what she told me was accurate, I would think that would go a long way to explaining why apparently overbilled amounts can be so incredibly high.

(BTW, the unethical bit almost surely refers to a practice called balance billing, where a provider agrees to accept an insurance plan's reasonable & customary cost limits, gets paid by insurance, but then turns around and tries to bill the patient for the remainder of the originally invoiced cost. It's not only unethical, but actually illegal in several states.)

I agree, there are some shady practices when it comes to "balance billing". How it works: Your insurance company has a contract to pay a certain price for services, for example, The visit is priced at $120, but the insurance contract says it will pay $80. The medical office accepts that $80 from insurance and then proceeds to bill you for the remaining $40.

This is unethical because the contract with the insurance company says that $80 is the max they will get. now...you will be on the hook for you co-pay. But that should be included in the $80 total, not in addition to the $80 total.

Some hospitals get around this by having you sign a "balance billing agreement" at the time of care. This is a document that says you agree to pay the amount that is above what the insurance pays. sneaky if you ask me. People just sign stuff without know what it means.

 

[mom2rtk]

How do hospitals stay in business then?
Seems from the chart that at least 67% of al hospital patients at most hospitals are Medicare or Medicaid. My billing worked out to over $6,600 an hour for the time I was there.

https://www.aha.org/fact-sheets/202...pital-payments-dependent-medicare-or-medicaid

By overcharging the customers that aren't on Medicare/Medicaid.

 

[Genie+]

How dare a patient ask questions about how something will cost.

It’s not a s simple as that. These are costs the doctor isn’t even supplying the goods. Should the doctor have to price out all the different labs along with all the various options. You can go on this Rx which costs x, y and z at pharmacy p,d and q, or try starting with this Rx that costs x, y and z at pharmacies p, d and q. You can get a less precise test for a, b and c at d, e and f, or this more intricate test at all these various prices at all these places. Updated and current no less. And then patient chooses x, doesn’t work and needs to go to more expensive option and questions Dr why didn’t they push the better option to start.

My niece is having digestive issues. There’s a whole gamut of options trying to single out what this issue is and also get some relief. I can’t even imagine the specialist trying to give price options on everything while trying to focus on the parient.

 

[tvguy]

By overcharging the customers that aren't on Medicare/Medicaid.

These days with the Affordable Healthcare Act, everyone has insurance and insurance companies often have more frugal reimbursements than Medicare.

 

[tarheelmjfan]

Maybe it was great for that but it was horrible for everything else. So many lost really good coverage or any coverage as those plans were deemed too good. And also requiring every American to have insurance or have to pay a penalty goes against how this country was founded. It made the entire system worse for everyone but insurance companies who made tons of money on this nonsense.

The Affordable Care Act was a God send for people who didn't have employer subsidized insurance, as well as those with preexisting conditions. It allowed many people to have insurance that otherwise couldn't have afforded it. It was most definitely not horrible for everyone.

 

[yeahdisney]

Had a patient want to pay cash with a license with one last name and they did that. Then one week later viola a different last name and public aid card.

We were not taking any new public patients and they knew it.

 

[mom2rtk]

It’s not a s simple as that. These are costs the doctor isn’t even supplying the goods. Should the doctor have to price out all the different labs along with all the various options. You can go on this Rx which costs x, y and z at pharmacy p,d and q, or try starting with this Rx that costs x, y and z at pharmacies p, d and q. You can get a less precise test for a, b and c at d, e and f, or this more intricate test at all these various prices at all these places. Updated and current no less. And then patient chooses x, doesn’t work and needs to go to more expensive option and questions Dr why didn’t they push the better option to start.

My niece is having digestive issues. There’s a whole gamut of options trying to single out what this issue is and also get some relief. I can’t even imagine the specialist trying to give price options on everything while trying to focus on the parient.

Just more proof that the system in irrevocably broken. You should have access to the numbers before you decide whether to avail yourself of a service. It's insane that you can walk through the door and spend thousands of dollars without knowing that's what you're about to spend.

 

[Genie+]

Just more proof that the system in irrevocably broken. You should have access to the numbers before you decide whether to avail yourself of a service. It's insane that you can walk through the door and spend thousands of dollars without knowing that's what you're about to spend.

Broken for sure!

 

[Starport Seven-Five]

Maybe it was great for that but it was horrible for everything else. So many lost really good coverage or any coverage as those plans were deemed too good. And also requiring every American to have insurance or have to pay a penalty goes against how this country was founded. It made the entire system worse for everyone but insurance companies who made tons of money on this nonsense.

The rest of us pay for the uninsured so I think the fine was more than fair. That provision was removed at a federal level in 2018 anyways so it's a moot point.

As someone with a pre-existing condition, my health insurance options prior to the ACA were an employer provided plan or medical bankruptcy. No insurance company would touch me due to recent surgery and a chronic disease. The ACA was far from a perfect law but it was what was politically possible at the time and moved the needle in the right direction by allowing people like me to get coverage.

Also, many who "lost good plans" during that time were the victims of corporations increasing profits. I watched as my own employer tried to blame the ACA for our health insurance costs going up... but I had saved the previous year and the actual premium didn't change. They just had us paying 40% of the premium that year instead of 30% the year before while blaming the government.

And the Affordable Healthcare Act went into effect in 2010, so it still applies.

Many aspects of it were phased in over time. For example, the health insurance exchanges did not open until 2014.

Here is a timeline:
https://www.ehealthinsurance.com/re...-act/history-timeline-affordable-care-act-aca

 

[Robbie Cottam]

Oddly enough, I have one doctor’s office that will cancel your appointment if the can’t verify your insurance 72 hours prior.

I have another doctor the ONLY accepts cash, or credit cards….

Payment is due at the time of service ….

The one the requires insurance can have bills between 500 and 5000 in an office visit…..
So I could see why they want to have insurance back stopping the visit….

The other always charges a straight 250 dollars and when that changes she give 30 days notice….

I can see both approaches….

My PCP has also started to refer patients to the local urgent care, for anything that would other wise be classified as a sick visit….
She simple doesn’t have the time on her schedule for a cold, or a stiff back…..

But back to your original question not insurance not appointment is a real thing