Why do some doctors not take ANY health insurance?

debodun

debodun

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Location
way upstate in New York, USA
I could see why they may not accept certain private pay insurances if they have had problems with them in the past, but why not Medicare? I thought EVERY doctor was obligated to accept MEDICARE.
 

I can't say that I blame them. So many rules and red tape, and most of it changes every year.
 

my buddy takes no insurance's .for most insurance companies to list you as a provider you must take all their patients that want to use you . as he says once the insurer dominates your office with their insured you are no longer self employed and have to answer to them . if mrs jones is unhappy about something you have to answer to the insurer as to why you said or did what you did .

they also pay reduced rates and once those patients dominate your practice you can have full paying patients go elsewhere if they have to wait for an appointment.
 
Years ago, a doctors office had a nurse/receptionist to prepare the patient to see the doctor. Now, there are 2 or 3 people on staff just to handle the paperwork and insurance claims....and costs to go see the doctor have risen substantially, as a result. There is virtually Nothing in our present system that can be called "efficient and cost effective".
 
I worked in medical billing and doctor's offices for years and even though they may bill Medicare or any private insurance, the insurance company and Medicare will only pay what's right and customary. It always cracks me up that our doctor will charge Humana $304 for a visit but he's only going to get a little over $100. Our co-pay is $10 and the rest is written off. Our doctor sees at least 30-40 patients a day and even if they all don't have a co-pay he's making a bundle from insurance.

It IS a hassle to collect from insurance companies. If it's not submitted within a certain number of days (which depends on the company) or if it's coded wrong, it gets kicked out and just sits there unpaid until someone working for the doctor calls and finds out why it wasn't paid. Doctor's use to get an EOB with all patients paid or rejected with their payment. I don't know if that's changed. Probably has since everything is electronically done these days. I know I hated calling certain insurance companies because they were notoriously slow or delayed payments for as long as they could and used every excuse in the book why it wasn't getting paid. United Healthcare use to be one of the biggest offenders and I hated calling them.

The "rules" for billing have also changed. It use to be that if you saw a specialist, for example a dermatologist, to have a cancerous mole removed and there were stitches involved in the procedure, you had to go back in a couple weeks and have it re-checked. This was considered a follow-up visit and was not charged because it had already been "bundled" with the initial procedure. That's all changed. My husband had to have this done a few months ago. The visit to the specialist was $50. His "follow-up" visit was also $50!! I said to the girl in the office that this should be included with the procedure and she told me, "It's your insurance company." When I got home I called Humana and they said, no...it wasn't them...the rules had changed and it was up to the doctor if he wanted to charge another $50!

So...it's NOT always the insurance company that's ripping you off.
 
I worked 15 years in a Rehab Hospital as a collection specialist. When we got the EOB from a claim we had to be sure it was paid correctly according to the contract or Medicare allowable. We then billed the patient's secondary for the balance or the patient if they were responsible. We would arrange payment plans with the patient without charging interest and according to their means to pay. Those that demonstrated no ability to pay were written off and not sent to the collection agency. We monitored the payment plans and called patients if they missed payments. Patients that refused to pay their bills were sent to our collection agency. But that was only after many conversations with the patient or whoever was responsible for the bill. I had a patient who called and said they were moving to Japan but would continue their payments. The office manager told me they would not pay but I knew better. I had developed a friendly relationship with them over the phone and they continued to pay the account. I tried to work with patients as I had been there and knew what a toll medical bills make on a person.
 
Years ago one of my young sons fell out of a tree and broke his arm. The doc let us pay on a time plan. We made our payments on time and some we doubled up on. Our final payment we doubled up on and the doctor returned the doubled payment and thanked us for being a good patient!!
 
terry123 said:
I worked 15 years in a Rehab Hospital as a collection specialist. When we got the EOB from a claim we had to be sure it was paid correctly according to the contract or Medicare allowable. We then billed the patient's secondary for the balance or the patient if they were responsible. We would arrange payment plans with the patient without charging interest and according to their means to pay. Those that demonstrated no ability to pay were written off and not sent to the collection agency. We monitored the payment plans and called patients if they missed payments. Patients that refused to pay their bills were sent to our collection agency. But that was only after many conversations with the patient or whoever was responsible for the bill. I had a patient who called and said they were moving to Japan but would continue their payments. The office manager told me they would not pay but I knew better. I had developed a friendly relationship with them over the phone and they continued to pay the account. I tried to work with patients as I had been there and knew what a toll medical bills make on a person.
Click to expand...

I also did this collection specialist work when I lived in TX. It was horrible! What a hassle to get companies to pay or trying to find where people had gone to just to duck out of paying. We worked for hundreds of doctors and facilities in several states. I was the oldest one that worked there (and the only non-Hispanic) and it was a VERY stressful place to work because not only trying to get people/companies to pay...there was no respect shown to me from the other "girls". They would NOT help me in any way. I developed high blood pressure while working there and went home many times crying. After three years, we relocated to PA where we had family and I had one girl come up to me and say..."It's a good thing you're going back where you belong". I retired right then. That was in 2008. I have never worked with such lazy, rude girls in my life and decided I didn't need the strain of going back to work any more.
 
Psychiatry is a specialty that is moving away from accepting any insurance/Medicare/Medicaid. Supposedly it's because of low compensation rates...especially Medicare & Medicaid, but often private insurance doesn't pay them enough either. They really do save on employee salaries that way.
 
As mentioned by Colleen...doctors don't get paid what they bill from Medicare and if there's $0 or $10 or even $25 co-pays they are certainly not winding up with anywhere near what they charge per visit.
 
Colleen said:
The "rules" for billing have also changed. It use to be that if you saw a specialist, for example a dermatologist, to have a cancerous mole removed and there were stitches involved in the procedure, you had to go back in a couple weeks and have it re-checked. This was considered a follow-up visit and was not charged because it had already been "bundled" with the initial procedure. That's all changed. My husband had to have this done a few months ago. The visit to the specialist was $50. His "follow-up" visit was also $50!! I said to the girl in the office that this should be included with the procedure and she told me, "It's your insurance company." When I got home I called Humana and they said, no...it wasn't them...the rules had changed and it was up to the doctor if he wanted to charge another $50!
Click to expand...

I found that out after my cataract surgery. The opthamologist scheduled a post-procedure follow-up and I was billed a co-pay for it. When I called the office the woman I spoke with said they consider follow-ups as a separate office visit and are not included in the procedure.
 

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