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

[tarheelmjfan]

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.


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

I was in the same situation. We couldn't buy insurance for me at any price.

 

[Robbie Cottam]

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...

Why do you believe that?
Like it or not the Dr. job is to make money for their practice….

Most Dr.’s work in private practice

 

[Southernmiss]

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.

Do you know how much a good gastric series of tests and treatments actually costs, especially if you'll need surgery?

You could be looking at 10s of thousands of dollars.

How did you get diagnosed and treated for pneumonia, hypercapnia, and know that you have a hiatal hernia without insurance and seeing a gastric doc? Did you pay out of pocket for those or did you have insurance at the time?

I know there are primary care doctors who don't do insurance and have a concierge service where you pay a few thousand a year to be guaranteed they'll see you for basic care. But they will have to refer you to specialists to treat cronic conditions.

Use some of your $ to buy insurance at the Affordable Care Marketplace so you can see the doctors you need.

 

[backformore]

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.

That's actually not true. The AMA code of ethics says that the doctor-patient relationship is a unique one and once a doctor accepts a patient they have an obligation to continue to provide care for as long as the patient needs it. Doctors have to avoid patient abandonment, which is an ethical violation.

 

[Minnie1222]

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...

I don't think this is true at all. If they were lazy, they wouldn't have chosen medicine in the first place.

 

[lanejudy]

I even have an HSA plan with a regular Visa that will pay for all the services up front.

Use some of your $ to buy insurance at the Affordable Care Marketplace so you can see the doctors you need.

According to the OP her funds are in an HSA. Maybe she has other cash available as well in which case buying insurance is a good suggestion. However typically an HSA cannot be used to pay for insurance premiums except in certain cases (Cobra or while collecting unemployment benefits). And since she has an HSA - at one point in the past she must have had an HDHP (high deductible health plan), which is probably how she got her original diagnoses. It would have made sense to follow up with a Gastro at that point so she was an established patient, but it seems that didn't happen.

 

[Pooh2]

My friend has MS and wanted to pay out of pocket to see a neurologist who did not take Blue Cross and was refused as a patient despite offering to pay cash for the office visit.

I see the same neurologist and that office could not tell me how much a visit was until it was run through my insurance.
I have a $6,000 deductible so wanted to know what I was in for.

Neurologists are very hard to get in with in this area for a new patient so I went ahead not knowing how much it would cost me.

 

[mi*vida*loca]

Continuity of care. It becomes a problem if they diagnose you with something and you can no longer pay. They can’t just drop you as a patient when you are sick because you can’t pay. They are morally and ethically obligated to treat you.

 

[lanejudy]

I see the same neurologist and that office could not tell me how much a visit was until it was run through my insurance.
I have a $6,000 deductible so wanted to know what I was in for.

They should have been able to tell you the max the charge could be, though unfortunately the front desk staff doesn't usually know the billing info; you'd need to contact the billing office staff. It is true that they need to submit it through your insurance to get the agreed-upon "member" rate and what your share of that might be (100%, 50%, 20%, etc.).

 

[sam_gordon]

DW had a doctor's appointment a week or so ago. Office called Monday and said "he wants you to get an electrocardiogram". We'll have the hospital call you to schedule.

When the hospital called to schedule, DW asked how much. $4k AFTER insurance. I suggested she call around. She found a 3rd party lab that would cost $400 OOP.

Not sure what my point is, or how it exactly relates to the thread, but wanted to get it out there

 

[tink2424]

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.

In a way you are correct. But those with employer based insurance it raised prices and decreased coverage and even kicked some people off (like retired spouses). These are the people that are also paying to subsidize those that didn't have insurance before so it is another kick in the teeth.

Furthermore now retirees that had good employer based healthcare are required to go on Medicare once they turn 65 which further takes away from what Medicare can provide for everyone as well as shifting the burden from the employer to the tax payer.

So yeah, good for everyone around...

 

[tink2424]

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.


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

Yes, in a way we all paid for the uninsured before but in a lot of ways that was covered by charity care as well as hospital write offs. I know as I was uninsured for a long time when I was a teenager until a got a job that covered me.

Let's not pretend that ACA didn't get rid of "Cadillac plans". It did as it cost too much for employers to sustain and they were subject to penalties for having them. This was a move that was to benefit insurance companies and very few else.

And yes I am aware that Trump fixed the tax penalty for not having a plan when he was in office.

 

[tink2424]

Why do you believe that?
Like it or not the Dr. job is to make money for their practice….

Most Dr.’s work in private practice

I just don't believe that a doctor won't accept cash as they are worried that a patient can't afford tests or treatment afterward. That is ridiculous to me. As it should always be the right of the patient to know the options for testing and for treatment before they accept them regardless or whether you have insurance or not.

 

[tink2424]

That's actually not true. The AMA code of ethics says that the doctor-patient relationship is a unique one and once a doctor accepts a patient they have an obligation to continue to provide care for as long as the patient needs it. Doctors have to avoid patient abandonment, which is an ethical violation.

That is laughable... They are not required by law to treat anyone except in an emergent situation and even then they only have to stabilize.

 

[Skip Coffee for Rope Drop]

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?

A doctor should not not see a first time patient without health insurance because you never know what tests will need to be conducted or administered, blood work, lab work, ekg's, x-ray prescriptions and follow ups..etc...and you can't put a price on that beforehand until vitals are checked the consultation. She is better off going to an urgent care, med school facility or a clinic for care.

If there is a doc in the house, please respond, this is what my sister-in-law told me who is a nurse.

 

[tink2424]

A doctor should not not see a first time patient without health insurance because you never know what tests will need to be conducted or administered, blood work, lab work, ekg's, x-ray prescriptions and follow ups..etc...and you can't put a price on that beforehand until vitals are checked the consultation. She is better off going to an urgent care, med school facility or a clinic for care.

If there is a doc in the house, please respond, this is what my sister-in-law told me who is a nurse.

So how do the doctors who don't take insurance and only take cash work??

 

[tarheelmjfan]

In a way you are correct. But those with employer based insurance it raised prices and decreased coverage and even kicked some people off (like retired spouses). These are the people that are also paying to subsidize those that didn't have insurance before so it is another kick in the teeth.

Furthermore now retirees that had good employer based healthcare are required to go on Medicare once they turn 65 which further takes away from what Medicare can provide for everyone as well as shifting the burden from the employer to the tax payer.

So yeah, good for everyone around...

As someone who now has employer subsidized insurance, through DH's job, I'm more than happy to pay a little more & have benefits reduced marginally, if it means those who were previously uninsured can also have access to health care. We'll never agree on how much others were affected, because I know too many people who grossly exaggerated the impact on their insurance, until the truth came out.

PS: I don't know anyone who had their insurance taken away, so I can't really speak to that. That said, if it happened, they at least had another option. The same wasn't true for many people previously.

 

[Genie+]

There are many slices of this dysfunctional pizza. I think we all personally know cases where bills rung up in the hundred thousands and covered by insurance. I know many cases where a family had bills over a million and still not done yet. I could count a dozen right off the top of my head on the prior.

How are these costs so high when our collective health is not really any better for it?

How can those costs be managed back into reality without regulations or crashing the stock market and retirement funds?

 

[Robbie Cottam]

I just don't believe that a doctor won't accept cash as they are worried that a patient can't afford tests or treatment afterward. That is ridiculous to me. As it should always be the right of the patient to know the options for testing and for treatment before they accept them regardless or whether you have insurance or not.

That get thing about a private business is that they can refuse services to anyone, provided that they don’t use a protected class to do it….
Uninsured is not a protected class…
Frankly, it is not up to you to accept someone else business model.

It is not worth the financial risk to some doctors do business with uninsured…..

Just like Amex doesn’t issue black cards to everyone !

Can you believe that Amex won’t issue a black card to someone regardless of how high their credit score is, unless that person meets all the other requirement

 

[Starport Seven-Five]

Yes, in a way we all paid for the uninsured before but in a lot of ways that was covered by charity care as well as hospital write offs. I know as I was uninsured for a long time when I was a teenager until a got a job that covered me.

“Hospital write offs” are just transferring the cost to the rest of us. The hospital’s “charities” are often the same thing where they just assume a percentage won’t be paid so it is written off automatically. This combined with how health insurance works is why we get charged astronomical amounts for relatively simple services.

Let's not pretend that ACA didn't get rid of "Cadillac plans". It did as it cost too much for employers to sustain and they were subject to penalties for having them. This was a move that was to benefit insurance companies and very few else.

The "Cadillac plan" penalties were never enacted. They were delayed a couple times and finally repealed in 2019. If someone was blaming the ACA for your Cadillac plan disappearing they're not being honest.

The Patient Protection and Affordable Care Act(PPACA, as amended by the Health Care and Education Reconciliation Act of 2010),would have imposed an annual 40% excise tax on plans with annual premiums exceeding $10,800 for individuals or $29,500 for a family starting in 2020, to be paid by insurers.[4][6] The tax was originally set to take effect in 2018. However, in December 2015, a law delayed the start date to 2020.[7] In January 2018, the implementation was postponed until 2022. In December 2019, it was repealed entirely.[8]

https://en.m.wikipedia.org/wiki/Cadillac_insurance_plan

And yes I am aware that Trump fixed the tax penalty for not having a plan when he was in office.

Personally I don’t see how the law works without a mandate of some type but oh well. What is done is done and hopefully we can move forward on bettering the system from here as the private market has failed us tremendously.