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

[RitaZ.]

It seems like that are no set rules. Some of it makes zero sense. Some of us have no experience with this particular situation and others have BTDT. So, patients are rejected even when they want to pay cash.

Piecey~ That must have been awful while you were pregnant. When you have that kind of pain, you want relief NOW! The last thing you want to be doing is fighting with your insurance company and begging them to take your cash. I have heard a lot of stories from others that have had to fight with their insurance companies to have the surgery. My story was the opposite.

I had my gallbladder out after one single attack that landed me in the ER. The doctor wanted to order an MRI (he suspected it was my GB) and I asked why that was necessary. He said that he would order an ultrasound instead. I was out of it most of the time, but I remember him coming in to tell us that I needed to have my GB removed and that the surgeon would be in to see me to discuss it. I had DH call our doctor to ask about the surgeon. He gave DH the thumbs up on the doctor. This was an early Sunday morning and my GB was out Monday morning. After the surgery, I wondered if the decision to have my GB removed had been made too quickly. Everything had moved so fast. Then, the thought of having another painful attack made those doubts disappear.

I think there is a genetic predisposition for GB problems in my family. Several of the women have had them removed and we didn't fit the typical profile for GB problems.

 

[Aisling]

I see a psychiatrist once a month. She charged my insurance company $165 for each visit with no co-pay. That was when we had "cadillac" medical insurance. Well, my husband's company changed policies and now mental health isn't included at all. My doctor still sees me and I pay $104 OOP every month.

I've never heard of a doctor refusing OOP patients. That's crazy.

 

[Piecey]

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!

The surgery center was out-of-network for ALL insurance companies (which upon discovering this really irritated me that it's where the surgeon immediately tries to schedule people for operations! )...

I get what you mean, though. When my OB billed my primary (United Healthcare) she billed for $4k. They paid $1850. For my entire prenatal care and delivery (18 hours into a csection, she never left me) I felt like I needed to send her a fruit basket or something because she got ripped off! They then billed secondary and I guess their "allowable" was more but they didn't pay anything because they said they got primary's write off, too.

Luckily when she delivered DS #2 I only had 1 insurance, the secondary policy mentioned above, and she got $3700! Crazy the difference in the two.

It seems like that are no set rules. Some of it makes zero sense. Some of us have no experience with this particular situation and others have BTDT. So, patients are rejected even when they want to pay cash.

Piecey~ That must have been awful while you were pregnant. When you have that kind of pain, you want relief NOW! The last thing you want to be doing is fighting with your insurance company and begging them to take your cash. I have heard a lot of stories from others that have had to fight with their insurance companies to have the surgery. My story was the opposite.

I had my gallbladder out after one single attack that landed me in the ER. The doctor wanted to order an MRI (he suspected it was my GB) and I asked why that was necessary. He said that he would order an ultrasound instead. I was out of it most of the time, but I remember him coming in to tell us that I needed to have my GB removed and that the surgeon would be in to see me to discuss it. I had DH call our doctor to ask about the surgeon. He gave DH the thumbs up on the doctor. This was an early Sunday morning and my GB was out Monday morning. After the surgery, I wondered if the decision to have my GB removed had been made too quickly. Everything had moved so fast. Then, the thought of having another painful attack made those doubts disappear.

I think there is a genetic predisposition for GB problems in my family. Several of the women have had them removed and we didn't fit the typical profile for GB problems.

In my family only my Aunt and I have had them out.

My OB suspected it was my pregnancy mixed with my cravings of Long John Silvers...

The ER doc that diagnosed it (by ultrasound) said if I wasn't pregnant he'd of called the on-call surgeon and had me in the OR that night. I was 20 weeks and in so much pain, I thought I was dying! I had actually had an attack the day before and called the on-call OB who told me "pregnancy is painful"... the next night I didn't bother calling. I remember trying to wake up my DH who was like a rock, so I ended up hitting his foot (hard) to get him to drive me to the ER.
I was in and out of L&D to get shots of demerol, it was a MESS.

The surgeon refused to touch me until I delivered. Said the risk of causing me to go into preterm labor was too high and he'd personally gone through a miscarriage and could never take the risk that he'd cause me to lose my baby.

Then I had a csection so he made me wait even longer.

 

[RitaZ.]

I was in and out of L&D to get shots of demerol, it was a MESS

.

The surgeon refused to touch me until I delivered. Said the risk of causing me to go into preterm labor was too high and he'd personally gone through a miscarriage and could never take the risk that he'd cause me to lose my baby.

Then I had a csection so he made me wait even longer.

I can only imagine. My cousin's daughter was in her late 20's and pregnant when she had her first GB attack. She was close to term and, like you, had to wait until she delivered.

 

[The Mystery Machine]

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

Liz

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.

Yes I read your entire post. You stated that the adult grand-daughter was not able to pay for the visit.

Why would you take on a patient you know is not able to pay.

How nice that the grandma wanted to pay however she was not the patient and this was an adult not a child. Just because grandma said she would pay does not ultimately make her responsible for the bill. That is a sticky situation to put yourself in as a practice.

So grandma pays for this and then granddaughter comes back and claims grandma is going to pay however they had to do this test or that and now the bill is HIGH and grandma won't pay.

Taking on someone who you know cannot pay is a risk that they rejected. Plus I do not know all the other legal mumbo jumbo with medicad or medicare. Or maybe even their own business insurance.

Why didn't she pay for an urgent care visit instead? Or did she end up going that route?

 

[punkin]

he'd personally gone through a miscarriage[/B] and could never take the risk that he'd cause me to lose my baby.

Then I had a csection so he made me wait even longer.

Wait....HE personally had a miscarriage? Now there's a medical miracle.

 

[RitaZ.]

Yes I read your entire post. You stated that the adult grand-daughter was not able to pay for the visit.

Why would you take on a patient you know is not able to pay.

How nice that the grandma wanted to pay however she was not the patient and this was an adult not a child.

Why didn't she pay for an urgent care visit instead?

I'm not going to get into what is right or wrong about the situation. All I wanted to know is if this happens because I didn't believe the story at first. Why should it matter whether it's an adult or a child? As long as the doctor's services are paid for that shouldn't matter. What about other adults, like SAHMs or housewives, that have their husbands pay for any costs that they incur? It's one adult paying for another adult.

Actually, she did say that she paid for her GD to go to an urgent care center, but the antibiotic they prescribed wasn't doing the job. The GD then ended up going to the ER.

 

[The Mystery Machine]

I'm not going to get into what is right or wrong about the situation. All I wanted to know is if this happens because I didn't believe the story at first. Why should it matter whether it's an adult or a child? As long as the doctor's services are paid for that shouldn't matter. What about other adults, like SAHMs or housewives, that have their husbands pay for any costs that they incur? It's one adult paying for another adult.

Actually, she did say that she paid for her GD to go to an urgent care center, but the antibiotic they prescribed wasn't doing the job. The GD then ended up going to the ER.

I know that in your situation your grandma is on the up and up however you cannot assume that any longer.

A private practice has to protect itself from liability.

The grandma openly admits her granddaughter can't pay and does not have insurance. So they turned her away.

It stinks no doubt, but people these days screw over anyone for anything. And that is why our life has come to this. Get them before they get us.

 

[RitaZ.]

I know that in your situation your grandma is on the up and up however you cannot assume that any longer.

A private practice has to protect itself from liability.

The grandma openly admits her granddaughter can't pay and does not have insurance. So they turned her away.

It stinks no doubt, but people these days screw over anyone for anything. And that is why our life has come to this. Get them before they get us.

That's true.

 

[Megan_J]

I didn't have insurance when I needed surgery to fix my diviated septum and the doctor I was seeing let me pay in cash for the surgery and gave me a discount. He as an older guy and even gave me a little toy afterwards.LOL I have found that the older doctors will usually work with you more in terms of payment.

 

[GAGirlInVA]

Wait... don't most offices still require you to pay upfront for a non-emergent office visit no matter if it is a copay or an office visit fee?

I had an issue once where my DH's work "accidentally" dropped all dependents off of their insurance coverage. I found out when my coverage was verified.

So I paid out of pocket. Wrote a check, got a receipt and the insurance company reimbursed me.



I have friends that do "cost sharing" instead of insurance, and they are all self pay. Some of them are even billed instead of paying up front.

 

[The Mystery Machine]

Wait... don't most offices still require you to pay upfront for a non-emergent office visit no matter if it is a copay or an office visit fee?

I had an issue once where my DH's work "accidentally" dropped all dependents off of their insurance coverage. I found out when my coverage was verified.

So I paid out of pocket. Wrote a check, got a receipt and the insurance company reimbursed me.



I have friends that do "cost sharing" instead of insurance, and they are all self pay. Some of them are even billed instead of paying up front.

Nope. It depends on your insurance. I have no copay so I pay nothing.

When I was checking around for dermatologists I found some that ONLY do OOP. Actually they are more than a few practices that are going that route, which I cannot understand how that would be successful.

 

[RitaZ.]

Wait... don't most offices still require you to pay upfront for a non-emergent office visit no matter if it is a copay or an office visit fee?

I had an issue once where my DH's work "accidentally" dropped all dependents off of their insurance coverage. I found out when my coverage was verified.

So I paid out of pocket. Wrote a check, got a receipt and the insurance company reimbursed me.



I have friends that do "cost sharing" instead of insurance, and they are all self pay. Some of them are even billed instead of paying up front.

It seems to vary. The majority of our doctors don't collect payment before services are rendered. Our pediatrician is the only one that requires co-pays/payment as soon as you walk in. They began doing this sometime around 1994 or 1995 because parents would leave the office without paying.

 

[GAGirlInVA]

Nope. It depends on your insurance. I have no copay so I pay nothing.

When I was checking around for dermatologists I found some that ONLY do OOP. Actually they are more than a few practices that are going that route, which I cannot understand how that would be successful.

Well obviously if you have no copay you'd pay nothing. Just like governmental programs...

They can get rid of most of their billing staff and save the headache of fooling with insurance. I used a large office once that had several employees that just dealt with insurance. Wages plus benefits add up.

 

[Piecey]

Wait....HE personally had a miscarriage? Now there's a medical miracle.

I stumbled around over how to write that and in the end just left it alone and figured everyone would know what I meant

 

[IrisDS]

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?

This is happening to me all over Texas. I have the money to pay out of pocket. I don't understand why doctors refuse to see me. This seems like its illegal to me. My symptoms are worsening and they specialists are being unreasonable and assuming that bc I do not have health insurance that I won't pay, which is far from the case. I even have an HSA plan with a regular Visa that will pay for all the services up front. It makes no sense. Does anyone on this thread know the legal stand point to this?

 

[IrisDS]

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!

This is happening to me all over Texas. I have the money to pay out of pocket. I don't understand why doctors refuse to see me. This seems like its illegal to me. My symptoms are worsening and specialists are being unreasonable and assuming that bc I do not have health insurance that I won't pay, which is far from the case. I even have an HSA plan with a regular Visa credit card that will pay for all the services up front. It makes no sense. Does anyone on this thread know the legal stand point to this?

 

[Marrila]

Thread is from 2011.
Welcome to the DIS iris.
I suggest walk in urgent care.

 

[IrisDS]

Thread is from 2011.
Welcome to the DIS iris.
I suggest walk in urgent care.

Hi Thank you for your response. I have done all that. They just prescribe me antacids or ppi's and I am well past that point. None of that works and it has caused the inability to digest foods bc of low acid so when I obtain any of my acids back it comes back up. It's a double edged sword. I even got a really bad case of aspiration pneumonia due to this and did not think I was going to make it. I was diagnosed with Hypercapnia (high CO2 and low oxygen) in blood, I have a Hiatal hernia, and esophagus feels like its hanging like a noodle and very tight and can barely swallow. I need to see a good Gastric at this point.

 

[Minnie1222]

Does anyone on this thread know the legal stand point to this?

Offices can refuse to see or accept new patients. Do you have a primary care physician? They can refer you to the appropriate specialists.

If you're in severe discomfort, you may have to go to an Emergency room.