Going to a doctor that does not take your insurance

[dtr_angel]

Anyone ever done this? My primary care doctor just retired so I'm looking for a new one. I live in a small town so it's hard to come by many that are even taking new patients. I'm a nurse so I'm also picky The physician I planned on going to is taking new patients but when I called they informed me they only take medicare. I guess I would have to pay out of pocket for the visit and then submit the paperwork to my insurance myself? I do not know anything about insurance. After calling a few more offices to see if they are taking new patients I am back to square one. Either go to a practice I don't want to go to or go to the physician I want to and deal with the insurance.

 

[Happyinwonerland]

You need to check with your insurance and make sure the doctor you are using is an in network doctor.

 

[dtr_angel]

The doctor is in network for us.

 

[Pooh2]

Our company just changed to a different health insurance carrier so we had to change doctors to be in-network. If we had stayed with our current docs, the cost would have been even higher.

 

[pryncess527]

The doctor is in network for us.

This may just show my ignorance on health care issues, but that seems confusing. The doctor is in-network for your insurance, but does not accept the insurance? Then what does "in network" mean? I thought that to be an in-network doctor, that meant they had an agreement to accept that insurance company's plans.

 

[Ranger111]

This may just show my ignorance on health care issues, but that seems confusing. The doctor is in-network for your insurance, but does not accept the insurance? Then what does "in network" mean? I thought that to be an in-network doctor, that meant they had an agreement to accept that insurance company's plans.

I agree, very strange. If the doctor ONLY accepts MediCare that is even stranger, since MediCare payments are lower than even the negotiated insurer rates so many doctors while accepting various private insurance plans, REFUSE Medicare patients.

Sure seems that something is mixed up in this scenario.

 

[robinb]

This may just show my ignorance on health care issues, but that seems confusing. The doctor is in-network for your insurance, but does not accept the insurance? Then what does "in network" mean? I thought that to be an in-network doctor, that meant they had an agreement to accept that insurance company's plans.

I am also confused. If the doctor is 'in network' they have already agreed to a price with that insurance company.

 

[HM]

It sounds like they have an agreement with the network but don't file on behalf of the patient. The patient has to file.
I've come across this with chiropractors and dentists, but not physicians. I can see that it could happen though.

 

[richmo]

It sounds like they have an agreement with the network but don't file on behalf of the patient. The patient has to file.
I've come across this with chiropractors and dentists, but not physicians. I can see that it could happen though.

That's what it sounds like to me too. I know our drs. office has at least one person on staff full time to deal just with insurance issues, referrals, etc. I imagine small practices might not be able to afford that. Still, seems unusual...

 

[pryncess527]

It sounds like they have an agreement with the network but don't file on behalf of the patient. The patient has to file.
I've come across this with chiropractors and dentists, but not physicians. I can see that it could happen though.

Yeah, my dentist works this way. I love him though, so I'm perfectly happy to pre-pay, file the claim, and let insurance send me a check. Plus, doing it that way I earn 2% cash back

 

[barkley]

there are some doctors in network in our area that haven't taken new patients for our plan in years (and no longer maintain a wait list). that might be the issue. We also have doctors in our area that our plan shows as in network, but it's strictly because they are somehow in some far flung affiliations with a medical group that actively accepts our insurance (and the individual doctor's practice makes patients direct pay and self submit receipts to the insurer).

before picking a doctor, if insurance coverage-ANY- is of importance-check with your insurance company to see if there is ANY COVERAGE for an out of network provider, and if there is (1) does the deductible apply and/or (2) what is the coverage vs. a network provider. if we go out of network, between the difference in the percentage insurance pays plus the fact that the in network provider has an agreed upon billing amount-we end up paying about 70% of any bill (vs. a $10 co-pay). some plans now pay zero for out of network, or the entire individual deductible must be met (several thousands of dollars) before they pay their pittance of coverage.

 

[Ranger111]

How does the OP KNOW the doc is in-network.

If you are relying on the doctor's office telling you that...well....and if you are relying on something on your insurance companies Web site says or a printed booklet....well....

I would want something in writing from the insurance people dated this month to me telling me yes, doc is in the network.

That whole thing about the office telling you they "only take Medicare...."

 

[puffkin]

My DH sees an endocrinologist 4x a year for his Type 1 diabetes. The doctor is in-network but they do not accept insurance payments. DH has to pay upfront, submit the form and then get reimbursed by our insurance company. It has been that way for quite a few years now. The pediatric dentist my kids use also works the same way.

 

[dtr_angel]

Sorry the quotes aren't showing up. I checked on my insurance website and I called to double check that the doctor IS in network. It seems as though the doctors office only does the billing/paperwork for Medicare and I'd have to pay up front for the visit and then submit the paperwork myself to my insurance company to get reimbursed.

 

[nunzia]

Anyone ever done this? My primary care doctor just retired so I'm looking for a new one. I live in a small town so it's hard to come by many that are even taking new patients. I'm a nurse so I'm also picky The physician I planned on going to is taking new patients but when I called they informed me they only take medicare. I guess I would have to pay out of pocket for the visit and then submit the paperwork to my insurance myself? I do not know anything about insurance. After calling a few more offices to see if they are taking new patients I am back to square one. Either go to a practice I don't want to go to or go to the physician I want to and deal with the insurance.

Something similar happened to me. Since my great insurance was cancelled because the gov't deemed it not great, I was forced into a plan I hate with much bigger deductibles and ridiculous premiums and sucks as far as providers. Whee... Anyway, my usual doctor doesn't accept that 'wonderful' new plan the Gov't forced me into. It assigned me to someone I've never heard of. OK. So, since I like my doctor and want to keep my doctor, I will now go to my doctor and pay out of pocket, and these visits of course will not be applied to my 6K deductible. I find I am going to a doctor far less with ACA then when it was supposedly not affordable. I figure since I'm still out the 6K anyway doctor visits won't be covered so may as well pay out of pocket. I guess the assigned doctor wouldn't have any charges for what the gov't mandates are 'free' but I'm so disgusted I'm going in for the 'free' stuff as yet. So essentially I'm paying more for a service I don't use and am out more for what used to be cheaper for me.

 

[pryncess527]

Sorry the quotes aren't showing up. I checked on my insurance website and I called to double check that the doctor IS in network. It seems as though the doctors office only does the billing/paperwork for Medicare and I'd have to pay up front for the visit and then submit the paperwork myself to my insurance company to get reimbursed.

In that case, I'd probably go through the trouble for a doc I liked. I do go through the trouble for a dentist I like.
Doctors visits could be a lot more than dental though, so it might require you to be able to cover large charges for a period of time. I'd want to be sure I could do that without paying any interest before i committed to it.