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

[RitaZ.]

Do doctors reject patients that have no medical insurance and that offer to pay for services upfront?

I was told by a family member that when her adult grand-daughter needed medical care, she called her doctor for an appointment and was told the doctor wouldn't see her grand-daughter unless she had medical insurance. The family member told the office staff that she would pay for the doctor's visit before her grand-daughter was actually seen. The doctor's staff said they wouldn't accept that.

I had a hard time believing this family member because I have paid out of pocket many times to see doctors that I really like, but that weren't on my medical plan. I have never been denied medical care when I've paid out of pocket.

Is this true? Do some doctors reject patients that offer to pay out of pocket?

 

[The_Alice]

I have had it happen. Same thing, offered to pay for the visit up front, etc. Nope, sorry you must have medical insurance or they had to be on my plan. No OOP.

 

[The Mystery Machine]

The situation you describe is weird so I can believe they said "no".

1) Doctor's offices are not "urgent care" or for drop-ins.

2) Why would you accept seeing someone in your practice who you know has no money or insurance to pay for services, meds, etc?

Person should probably look into county health dept.

 

[happygirl]

I would have been taught in Medical Billing classes that Dr.prefer cash patients less hassle then doing paperwork. In fact Dr. like it so much better they will give discounts if you pay in cash

 

[Tink415]

Yes. Our insurance covered a child checkup every 2 years age 5-10 or something like that. I asked what the cash price was for a checkup visit so my DD could continue to get a yearly check-up. The office staff could not tell me a price and would not give me an appointment.

 

[clh2]

I really wonder if the doc described in OP's post is an employee of a clinic or of a hospital. Might make a difference in them wanting to take on new patients.

Perhaps - the doc is just busy and cash or insurance - maybe they just do not have the time to see an additional patient. A full schedule is really a full schedule.

Drs right now are under extreme pressure to see a bjillion patients in a day. (My BIL is a family practice MD.) He really could care less how a patient pays - he is only paid "X" per day. He is employed by the hospital/clinic system.

 

[RitaZ.]

Yes. Our insurance covered a child checkup every 2 years age 5-10 or something like that. I asked what the cash price was for a checkup visit so my DD could continue to get a yearly check-up. The office staff could not tell me a price and would not give me an appointment.

How bizarre! I would think that they make more money out of patients that pay cash vs. negotiated fees.

This happened last year. The story made no sense to me, so I thought it couldn't be true. The GD went to the ER to get treatment and the family member doesn't know if the GD paid the bill. This story came out of a discussion with the family member about the need for universal health care.

 

[RitaZ.]

I really wonder if the doc described in OP's post is an employee of a clinic or of a hospital. Might make a difference in them wanting to take on new patients.

I don't know. Maybe that was the reason behind it.

Maybe they just have more patients than they can handle.

 

[Abbie]

Never heard of such a thing. As a pp mentioned, it's less hassle than dealing with insurance. And with some insurances, the dr. can actually wind up getting more profit from a cash patient.

It is, however, difficult to estimate how much any given visit will cost ahead of time, although I can't imagine denying an appointment, especially to an existing patient. I can give a range, but until a patient is seen there are too many variables. Our office will bend over backwards to make a visit as inexpensive as possible and offers a discount as well if there is no insurance.

 

[Belle0101]

I wonder if it depends on the practice?

I live in an area with a large Amish population. Traditionally they don't subscribe to insurance. I know that they go to English doctors and hospitals though.

Also, DH was in an accident last year. It was the other driver's fault and auto insurance is covering the expenses. The hospital DH went to, ER visit, discounted the bill because they, the hospital, considered it a "self pay."

 

[Agri]

It definitely happens. A lot of doctors/practices don't want to deal with the complications that can arise from agreeing to treat someone without insurance. Sure, you pay this one time, but what about the next? And the one after that?

My last PCP dropped me as soon as I told her that my COBRA was ending. To her credit, she ran bloodwork and a few other tests that visit, but still, she basically dropped me because I was possibly going to be without health insurance. (I am without it now, but I did have a plan after COBRA was exhausted for a couple of years. And yes, I could have gone back to her after I had my new insurance, but it really got my goat that she dropped me before I was even officially without insurance.)

My neurologist's practice also used to work the same way, but they make exceptions for long-term patients now that the local clinic that they participated in closed.

There aren't a lot of option here as there isn't really a county health clinic. The department of health will see people on a sliding scale basis for basic things like vaccinations and TB treatments, but for the most part its either urgent care or you're out of luck. The mental health services board only provides for you if you're documented as being bipolar or schizophrenic or if you've been determined to be an addict by the court system. So again, if you're just plain depressed and suicidal, you're out of luck.

The Urgent Care near me is very understanding and they have a full private practice on the side, but they will still treat plenty of patients if they come in. I have high blood pressure and I stop in every few months to get my pressure checked and get a refill on my medications. I'd love to have a regular PCP, but that's just not possible here if you're paying OOP.

 

[3boymthr]

yes, they can and they do. It's an odd situation, but may apply in the case you are referring to. By law, Doctors cannot provide certain services that are not eligible for medicare/medicaid payment to medicare/medicaid eligible patients. If the doctor does they can lose their eligibility to take patients on Medicare/medicaid.

 

[RitaZ.]

yes, they can and they do. It's an odd situation, but may apply in the case you are referring to. By law, Doctors cannot provide certain services that are not eligible for medicare/medicaid payment to medicare/medicaid eligible patients. If the doctor does they can lose their eligibility to take patients on Medicare/medicaid.

What kind of services? The two people involved are adults, but they don't qualify for medicare or medicaid.

 

[Traveliz]

The situation you describe is weird so I can believe they said "no".

1) Doctor's offices are not "urgent care" or for drop-ins.

2) Why would you accept seeing someone in your practice who you know has no money or insurance to pay for services, meds, etc?
Person should probably look into county health dept.

Not having insurance does not mean they don't have the money to pay for the services or meds.

Liz

 

[disfan07]

I have heard of doctors doing that.

But I also know some doctors that don't accept ANY insurance. They ONLY accept OOP payment.

I don't think any of my doctors are like that. I know that my primary, dermatologist, allergist/immunologist, neurologist and GYN all accept patients with private insurance, medicare, medi-cal and OOP payments. But they are part of the medical group staffed by the hospital itself so they basically go by hospital rules and the hospital accepts all insurance (including medicare and medi-cal) and OOP payments.

I know my cardiologist accepts insurance but one of the other doctors in her office (it's not a "practice" per se...just various doctors sharing space) ONLY accepts cash payments.

I think a lot of it might have to do with where the doctor is and what type of practice. Private practice docs. can pretty much do anything they want regarding types of payments. Doctors staffed by hospitals and medical groups most likely have strict sets of rules set forth by the hospital or group that they must follow.

 

[disfan07]

Not having insurance does not mean they don't have the money to pay for the services or meds.

Liz

Agree. I only have insurance because I am 21 and still under my dads insurance. Otherwise, private insurance companies consider me uninsurable so I would have no health insurance because I would not have that option. So what should I do? County health would not be adequate for my needs.

Many of the people who don't have insurance don't have it NOT because they can't afford it, but because no insurance company will cover them so they have no choice.

 

[RitaZ.]

The situation you describe is weird so I can believe they said "no".

1) Doctor's offices are not "urgent care" or for drop-ins.

2) Why would you accept seeing someone in your practice who you know has no money or insurance to pay for services, meds, etc?

Person should probably look into county health dept.

I'm not sure that you read my entire post. I understand and agree that doctors' offices are not urgent care centers. The family member that called her doctor has insurance and offered to pay for her adult grand-daughter's office visit out of pocket. She wasn't expecting her to receive free treatment from her doctor.

 

[Piecey]

Yes. Our insurance covered a child checkup every 2 years age 5-10 or something like that. I asked what the cash price was for a checkup visit so my DD could continue to get a yearly check-up. The office staff could not tell me a price and would not give me an appointment.

How bizarre! I would think that they make more money out of patients that pay cash vs. negotiated fees.

This happened last year. The story made no sense to me, so I thought it couldn't be true. The GD went to the ER to get treatment and the family member doesn't know if the GD paid the bill. This story came out of a discussion with the family member about the need for universal health care.

I needed my gallbladder out, desperately. I went through the last 5 months of my pregnancy having gallbladder attacks constantly, in and out of the hospital, etc... wouldn't take it out until I had my baby.

I had two forms of insurance. Saw my surgeon again, scheduled a surgery center for something like 4 days later and then got a phone call from the surgery center that they canceled me...

Primary wouldn't commit to my having a benefit, kept saying I had a pre-existing condition clause because I had been without insurance for 3 months after I got married. Insurance told me they weren't telling the surgery center that my gallbladder was preexisting (swore to me it wasn't, it would be covered) but said they had to quote the clause to the surgery center when they called for a benefit amount.

So I called secondary. They said even though my gallbladder was diagnosed before I got coverage through them, and even though I'd gone that 3 months without insurance, they would cover whatever primary didn't. Said if primary even kicked it back as pre-existing, they'd cover it.

So I called the surgery center back. They flat-out refused to schedule my surgery because their policy is not to take secondary benefits. I offered to pay cash (I was DESPERATE to have this surgery) and they told me NO because I had insurance and it would be "unethical".

So yeah, just saying... sometimes, if they know you have insurance, that might be why.

Sorry that was so long

(eta, they still never gave in. I ended up scheduling it for 2 months later at a hospital that didn't care whether I had insurance or not and then my surgeon got a cancellation for just 2 days after the original was scheduled so all ended well.. especially since insurance came back and paid 100% because it was done in a hospital. Taught me to read my booklet thoroughly!)

 

[LoriABil]

I would have been taught in Medical Billing classes that Dr.prefer cash patients less hassle then doing paperwork. In fact Dr. like it so much better they will give discounts if you pay in cash

Physicians (and most health care professionals) prefer cash based business. The front office/receptionist staff often does not know this. At least, this has been our experience.

 

[LoriABil]

I needed my gallbladder out, desperately. I went through the last 5 months of my pregnancy having gallbladder attacks constantly, in and out of the hospital, etc... wouldn't take it out until I had my baby.

I had two forms of insurance. Saw my surgeon again, scheduled a surgery center for something like 4 days later and then got a phone call from the surgery center that they canceled me...

Primary wouldn't commit to my having a benefit, kept saying I had a pre-existing condition clause because I had been without insurance for 3 months after I got married. Insurance told me they weren't telling the surgery center that my gallbladder was preexisting (swore to me it wasn't, it would be covered) but said they had to quote the clause to the surgery center when they called for a benefit amount.

So I called secondary. They said even though my gallbladder was diagnosed before I got coverage through them, and even though I'd gone that 3 months without insurance, they would cover whatever primary didn't. Said if primary even kicked it back as pre-existing, they'd cover it.

So I called the surgery center back. They flat-out refused to schedule my surgery because their policy is not to take secondary benefits. I offered to pay cash (I was DESPERATE to have this surgery) and they told me NO because I had insurance and it would be "unethical".

So yeah, just saying... sometimes, if they know you have insurance, that might be why.

Sorry that was so long

(eta, they still never gave in. I ended up scheduling it for 2 months later at a hospital that didn't care whether I had insurance or not and then my surgeon got a cancellation for just 2 days after the original was scheduled so all ended well.. especially since insurance came back and paid 100% because it was done in a hospital. Taught me to read my booklet thoroughly!)

Sorry, don't know how to multi-quote on my phone!

It is actually illegal to accept cash payment from patients with Medicare, Medicaid or Tricare (govt insurances). We could get shut down for accepting cash, even if Medicare refused to pay (which is often with physical therapy - somehow quality of life doesn't matter. But that's another rant for another day)

I don't see how it's unethical to accept cash when insurance refuses to pay. But maybe the insurance could drop the provider from their network? So Dr. X could no longer accept anyone with Insurance A because they dropped him from their list of approved providers. I could see that happening. The whole system is messed up. If physicians, hospitals, and the rest if us could (would) charge what it actually cost and get paid what it actually cost, we wouldn't be in this mess. But we all know we get paid about 30% of what we bill. So they raise the prices so that the 30% we are paid is equal to the actual amount we need. It costs $100 for a procedure. Medicare will only give us $30. So we can charge $300 to get our $100 we need. That's fine, except for the fact you now have to charge insurance companies the same amount. And for many years, insurance companies reimbursed the $300 billed, passing the cost off to consumers. So coincidence and deductibles go up while people are priced out of healthcare. It's a mess. The only way to fix it is to go back to charging what it cost and getting reimbursed what it cost.

Sorry about the rant. Frustration got the best of me!