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

[Karin1984]

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

I would ask someone in Texas who works in the legal field, preferably with a specialty in medical issues.

But if multiple doctors reject you for this, chances are... it is allowed.

 

[_19disnA]

Some doctors may not be accepting new patients. Doctors generally won't just randomly treat you for something if you aren't their patient. To become a patient, most want to review your medical history, perform a physical, note what other medications you are currently taking, BEFORE they will prescribe something to you. Some medications can adversely react with other things you are taking, so it is for their safety as well as yours. I think they are also wary of those who might be 'doctor shopping' trying to get certain prescription drugs from multiple doctors, paying cash with no insurance could be a type of red flag they watch out for. If you don't have insurance and aren't in their system, it is harder to track what others doctors you may be seeing.

 

[Dan Murphy]

Welcome to the dis, Iris.

I saw @RitaZ.'s name as the op and had to open. Hadn't seen in so many years. But alas, another oldie. Nice to see some of the old names again, missing so many.

And nothing from me to add, Iriis, good advice given already.

 

[waltonmkb]

My mom has been going to the same dermatology practice for 15+ years. She's had several cancerous growths removed so she goes every 6 months. When she retired and got on Medicare, they didn't accept it so she paid out of pocket. Just recently, they told her that she can no longer pay out of pocket and they still don't accept her insurance so she had to find a new dermatologist.

 

[tarheelmjfan]

When we didn't have insurance, I was turned away or eventually dropped by several doctors. One doctor dropped everyone that didn't have Medicare or Medicaid. While that isn't common, doctors refusing cash patients are very common, where I live.

 

[tvguy]

When we didn't have insurance, I was turned away or eventually dropped by several doctors. One doctor dropped everyone that didn't have Medicare or Medicaid. While that isn't common, doctors refusing cash patients are very common, where I live.

That makes no sense to me. One of my Doctors gives a 15% discount if you pay cash.

 

[tarheelmjfan]

That makes no sense to me. One of my Doctors gives a 15% discount if you pay cash.

I agree. It didn't make sense to me either. It was very disheartening to be turned away repeatedly.

 

[Genie+]

Specialist visits often involve costs for labs, tests, Rx, etc. Maybe doctors find trying to treat OOP is hard if each step of the way the patient wants to know all options and costs. Understandably. For both sides.

 

[tvguy]

Specialist visits often involve costs for labs, tests, Rx, etc. Maybe doctors find trying to treat OOP is hard if each step of the way the patient wants to know all options and costs. Understandably. For both sides.

At least here, labs, texts and prescriptions are not part of the Doctor's fee. They only order those from a third party.

 

[Genie+]

At least here, labs, texts and prescriptions are not part of the Doctor's fee. They only order those from a third party.

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…

 

[tvguy]

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…

The costs billed often are now where close to what they will actually accept as full payment.
I had an ablation. The hospital bill was $198,000. Medicare paid $30,000. My Medicare supplement paid $1,600. Amount the hospital is allowed to charge me, ZERO. So what was billed at $198,000 was considered paid in full for $31,600. They over billed by over $160,000.

 

[Genie+]

The costs billed often are now where close to what they will actually accept as full payment.
I had an ablation. The hospital bill was $198,000. Medicare paid $30,000. My Medicare supplement paid $1,600. Amount the hospital is allowed to charge me, ZERO. So what was billed at $198,000 was considered paid in full for $31,600. They over billed by over $160,000.

Wow that’s insane. Glad you didn’t have to make up the difference!

 

[Marrila]

Wow that’s insane. Glad you didn’t have to make up the difference!

Medicare and Medicaid are well known for being poor reimbursers. The actual cost was very likely more than what was paid, but less than the full bill amount.

 

[backformore]

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.

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

 

[tvguy]

Medicare and Medicaid are well known for being poor reimburses. The actual cost was very likely more than what was paid, but less than the full bill amount.

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

 

[Marrila]

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

Many don't. Small to medium community hospitals have closed at record rates primarily due to poor reimbursements.
The big institutions generally have handled the shortfalls better, but even some of them are hurting with the billing imbalance.

 

[SirDuff]

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

That post was written in 2011.

 

[lanejudy]

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.

Most healthcare providers want to be reasonably assured that they will receive some reimbursement. Unfortunately most are not set up to do a financial check for each patient, nor does having money in the bank guarantee a patient will actually follow through with payment. I don't mean this to put you into that category because it does sound like you fully intend to pay. But I'm sure you can understand why the medical practice needs to protect themselves in such situations. Office visits, procedures and treatments often add up much more than patients expect (and I won't get into whether these are inflated prices, but it is the amount billed).

I second the recommendation to find a primary care physician, who can then refer you to HCPs who will accept uninsured patients.

They over billed by over $160,000.

How do hospitals stay in business then?

I agree with the PP that most likely the hospital "settled" for what they've agreed to accept from Medicare. They either accept Medicare's reimbursement rates or no Medicare/Medicaid patients for them. It doesn't mean that fully covered all expenses associated with your treatment and in-person stay. Many small hospitals have had to either join with larger conglomerations and/or close completely. Most often, hospitals are trying to raise rates that get billed to 3rd party insurance (non-Medicare/Medicaid). My employer health coverage likely would have paid more than twice what your Medicare paid for the same bill, so the hospital makes up a bit there with other patients.

 

[tink2424]

Specialist visits often involve costs for labs, tests, Rx, etc. Maybe doctors find trying to treat OOP is hard if each step of the way the patient wants to know all options and costs. Understandably. For both sides.

Even with insurance you may not be covered for everything and you really should be presented this information as well. Most doctors offices are not good about being transparent and they should be whether you have insurance or not.

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

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.

Overall we need to take the power away from insurance companies and put it back in the hands of doctors. Only they can determine what is needed and how to treat you but if they spend 5 minutes with you that is a lot. Most diagnosis are determined by your medical history & your symptoms and the current insurance policy limitations on doctors make this impossible.

My experience is that doctors & other healthcare providers that don't take insurance are much more successful at keeping their patients healthy.

 

[backformore]

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.