topic Re: Medical Ins. Is This Legal in Community Chat

Medical Ins. Is This Legal

luvdoodles — Thu, 17 Nov 2016 11:56:01 GMT

I see a doctor, has his own private practice. He no longer accepts any form of medical insurance from any insurance company. Is this legal? Now I have to pay $80 for each visit. I realize some drs only accept some networks, but not to accept any just doesn't seem legal to me. Has anyone else come across this. He just changed this a few months ago.

Re: Medical Ins. Is This Legal

Caaareful Shopper — Thu, 17 Nov 2016 12:00:42 GMT

There's nothing illegal about it, in fact, depending on the part of the country, it's happening more and more lately. The doctor will most likely accept a payment plan from his patients, on a case by case basis. It's entirely up to you to either stay with this doctor or go elsewhere.

Re: Medical Ins. Is This Legal

happycat — Thu, 17 Nov 2016 12:02:31 GMT

Not sure if it is legal or not, but I have heard about this before. Several years ago, I heard about a physician who specialized in thryroid issues. I called and the receptionist informed me they didn't take any form of insurance and all the tests that would be needed were rather expensive. I decided not to go.

Re: Medical Ins. Is This Legal

CelticCrafter — Thu, 17 Nov 2016 12:05:34 GMT

It's no different than a dentist that doesn't accept any form of insurance.

Our retired dentist did not, we were fortunate enough that our plan is a PPO and we were reimbursed for some of the costs.

If you have a PPO you can file a claim with your medical insurance carrier and will be reimbursed for something after you meet the requirements of deductibles. If It's an EPO and you go out of network you are responsible for the entire cost.

Re: Medical Ins. Is This Legal

jackthebear — Thu, 17 Nov 2016 12:14:53 GMT

@luvdoodles wrote:
I see a doctor, has his own private practice. He no longer accepts any form of medical insurance from any insurance company. Is this legal? Now I have to pay $80 for each visit. I realize some drs only accept some networks, but not to accept any just doesn't seem legal to me. Has anyone else come across this. He just changed this a few months ago.

yes, he does not have to deal with the Bull s of the insurance companies

Re: Medical Ins. Is This Legal

I am still oxox — Thu, 17 Nov 2016 12:27:22 GMT

There are many single practice providers that do not take insurance, it is up to them and it is legal.

Re: Medical Ins. Is This Legal

GSPgirl — Thu, 17 Nov 2016 12:17:27 GMT

@luvdoodles wrote:
I see a doctor, has his own private practice. He no longer accepts any form of medical insurance from any insurance company. Is this legal? Now I have to pay $80 for each visit. I realize some drs only accept some networks, but not to accept any just doesn't seem legal to me. Has anyone else come across this. He just changed this a few months ago.

Yes. It's legal. We have a few doctors here that don't accept insurance. I have a PT that doesn't accept insurance, but will file my insurance for me. I usually get a check from my insurance company 3 weeks later. Or you may have to file your own insurance claim. It's only going to get worse according to a doctor I know.

Re: Medical Ins. Is This Legal

151949 — Thu, 17 Nov 2016 12:29:37 GMT

Our chiropractor does not take any insurance so we just get a receipt and then turn it in for reimbursement. Basically the patients do the paperwork for him, keeps his costs down.

Re: Medical Ins. Is This Legal

CalminHeart — Thu, 17 Nov 2016 12:42:09 GMT

I've had to change my doctors and dentists just a couple of times in my life. I've been with my doctor and dentist for 20 years and would hate to change but would if they stopped taking my insurance. I realize this may not be an option in some towns though.

Re: Medical Ins. Is This Legal

luvdoodles — Thu, 17 Nov 2016 13:33:08 GMT

Thank you all for your all your speedy replies. I have an appt this morning. Thank goodness I only need to see him every four months.

It's ironic though, we are all required to have ins now or pay a penalty. Just doesn't make sense to me.

Re: Medical Ins. Is This Legal

luvdoodles — Thu, 17 Nov 2016 13:37:26 GMT

It's so agravating, all this ins stuff. But I would not fool around with thryoid issues. My daughter has that issue and is on a med. It's a very important to address. Hope you stay on top of it. She is only 28 and will have to deal with it for the rest of her life.

Re: Medical Ins. Is This Legal

KathyPet — Thu, 17 Nov 2016 13:44:10 GMT

Nothing illegal about it. Doctors are free to accept or reject any insurance plans they want to or to not accept any. Many practices have started doing this because of the low reimbursement rates and all the hassle involved in dealing with the insurance companies and their bureaucracy. Medical practices have to have staff whose sole job is to deal with the insurance companies. Many practices have decided this is no longer economically feasible for them.

Re: Medical Ins. Is This Legal

millieshops — Thu, 17 Nov 2016 13:55:49 GMT

Unless your own state has a law that makes his opting out of insurance plans illegal, it's totally legal.

I would assume you can file with your own insuirance company for some reimbursement, but you need to check with them to find out what their percentage of reimbursement might be.

I know my company would pay me far less than if the doctor were in my network. Also, you need to find out how the billing will be done; I'm on Medicare and pretty much all the paperwork for both Medicare and my supplement is done for me. I check it carefully and pay my co-pays - not too difficult for me to do --at least not yet. How will his office handle yours is a question to ask.

Re: Medical Ins. Is This Legal

sgraham30 — Thu, 17 Nov 2016 14:28:12 GMT

@KathyPet wrote:
Nothing illegal about it. Doctors are free to accept or reject any insurance plans they want to or to not accept any. Many practices have started doing this because of the low reimbursement rates and all the hassle involved in dealing with the insurance companies and their bureaucracy. Medical practices have to have staff whose sole job is to deal with the insurance companies. Many practices have decided this is no longer economically feasible for them.

This is exactly why more & more doctors are starting to not accept insurance. My insurance company takes at least 2 months to pay a "clean" claim (one that has all of the necessary info submitted on it) If there's a problem with the paper submission & more info is requested, it could take up to 6 months for the doctor to receive their payment. If it's submitted EDI (electronically) it takes at least 3 weeks.

Depending on the plan, there could be a reasonable & customary provision or a fee schedule is used to determine the allowed amount of the charge that is being billed.

Here's an example. Let's say the doctor accepts insurance. They charge $100 for an office visit. For this example the reasonable & customary amount is $80, as is the fee schedule allowed amount & the policy reimbursement rate is 80/20. The payment to the doctor would be $64, with the patient responsible for the remaining $16 as their out of pocket cost. (the doctors' payment of $64 & the $16 owed by the patient total $80) Since $20 was over the allowed amount, the doctor has to write off that $20. Using insurance, the doctor is reimbursed 80% of the actual billed amount.

If the doctor doesn't accept insurance, the reasonable & customary & fee schedule allowed amounts aren' t applicable. The doctor bills $100 & receives $100 from the patient at the time the service is rendered. In this scenario, some doctors will submit their bill to the insurance company on the patient behalf. All benefits due are assigned to the patient so that the patient gets the reimbursement check. The doctors that I've dealt with have given me an itemized bill with all the necessary info on it & I've had to submit it to my insurance myself.

I don't like it but I understand why more & more doctors are starting to refuse insurance when treating their patients.

Re: Medical Ins. Is This Legal

sidsmom — Thu, 17 Nov 2016 14:05:26 GMT

As an individual, what's the process to submit a claim?

Are there forms online?

Re: Medical Ins. Is This Legal

LTT1 — Thu, 17 Nov 2016 14:05:52 GMT

@luvdoodles

Yes it is. Doctors now are charging a fee, $1500 just to be a patient!

I believe they profess to give you their own personal phone number to use in case of emergency at any hour on some plans.

The fee may also include a certain number of free visits.

Doubting any of the initial fee would be insurance reimbursable, though.

And my friend's doctor charges this fee PER YEAR.

Re: Medical Ins. Is This Legal

bri20 — Thu, 17 Nov 2016 14:07:04 GMT

It's completely legal.

He's free to run his practice the way he wants to and he's not beholden to insurance company regulations...

Re: Medical Ins. Is This Legal

SahmIam — Thu, 17 Nov 2016 14:11:03 GMT

Absolutely legal. If I were in private practice, I would do the same thing: you pay me my fee up front and you handle filing the claim with your insurance.

This is very common in the mental health field as well as with plastic/reconstructive surgeons. A breast reduction may be covered 100% under your insurance but the best doctors in my area will NOT take it; you pay them and all costs up front and then file the claim with your insurance.

One doctor I know said it's a huge eye opener for patients when they discover that it may take 6 months or so before the patient is reimbursed. She (the doctor) said "Now, imagine me trying to run a practice and telling my employees they have to wait 6 months to get paid. Would you work and wait 6 months for your paycheck?"

My primary care and the doctors in his practice have been asking long-time patients if we are willing to stay with them if they change to a concierge practice; I said yes. According to my PCP, the vast majority (85%) have said yes. I am waiting for a letter in the mail......

Re: Medical Ins. Is This Legal

beckyb1012 — Thu, 17 Nov 2016 14:07:40 GMT

It was always a hassle way back in the day filing our own insurance claims, but cannot say as I blame some Dr./Dentist offices now. What a mess it all is even now.

Re: Medical Ins. Is This Legal

sgraham30 — Thu, 17 Nov 2016 14:11:36 GMT

@LTT1 wrote:
@luvdoodles
Yes it is. Doctors now are charging a fee, $1500 just to be a patient!
I believe they profess to give you their own personal phone number to use in case of emergency at any hour on some plans.
The fee may also include a certain number of free visits.
Doubting any of the initial fee would be insurance reimbursable, though.

And my friend's doctor charges this fee PER YEAR.

Sounds like this is a concierge practice.