Doctors Are “Cherrypicking” Their Patients – Story
Long story short, I am looking for a pcp for my boss that is in his network with his insurance company. There are 154 doctors within ten miles of him all of which have a contract to accept his insurance.
Every doctor out of the 154 doctors have said they will not accept his insurance plan because it is part of the marketplace ObamaCare. Some have deny an appointment for him all together, others have said there will be a fee of 200 plus dollars at the time of the appointment and he will be considered a patient with no health insurance. They also refuse to submit any bills to the insurance company.
The insurance provider states they will cover the doctor bills as if they are in network although the doctor’s are stating they will not accept the insurance plan, however I will need to submit all the claims.
The doctors are “cherry picking” who their patients are because they do not want to have to charge less for their services and do extra paperwork such as referrals for their patients. The bottom line is these doctors are more concerned with their pocketbooks then caring for patients!
Are these type of discriminatory practices legal? Do doctor’s have the right to deny medical care solely on insurance information? Do doctor’s have the right to deny filing an insurance claim to his insurance company? What is the consumer supposed to do regarding this issue? It appears to be a huge loophole in the system.
Sherri
The only place and time your health insurance doesn’t matter is when you have an emergency and show up in th Emergency Room. They are required by a law called emtala to provide life saving and stabilizing care and if you are in active labor deliver your baby.
Otherwise no provider has to take a particular insurance or file a claim for you. A provider can actually charge cash upfront and give you the bill and you can file and be reimbursed. It is very hard to get an insurance company to pay a claim. Providers cannot work for free. They have overhead such as malpractice insurance, student loans, office rent, receptionist, biller. If seeing and taking care of the ot was the only part to it, it b.c would be much less stressful.
Plumbers and electricians charge and people pay for their service. A lot of ladies pay more to get their hair done than a provider gets reimbursed for the appointment. He about how much it cost to get your niks done. But nobody wants to pay for their healthcare. What is more important.
ObamaCareFacts.com
It is legal to not accept an insurance carrier. Insurers set up networks by coordinating with healthcare providers, a provider can choose not to accept an insurance type. However, once a doctor accepts an insurance type they shouldn’t be turning away a patient based on whether or not that plan was purchased on the health insurance marketplace.
If a plan isn’t good enough for doctors to accept, then it shouldn’t be sold. A rule for creating even a narrow bronze HMO is that it must have X providers in the area who will take it. This is laid out in the law for instance Section 1311(c) of the ACA discusses “network adequacy”. If no doctors take it, the network is inadequate and thus the plan shouldn’t be sold and certainly shouldn’t be subsidized by tax payers.
On the other side of this, if a doctor doesn’t want to accept an insurer’s plans than they shouldn’t join an insurer network in the first place. If they join and thus an insurer can sell a plan, backing out later and not taking it is just passing the buck to the customer and taxpayer. If that isn’t illegal, it should be. If it’s a loophole, it needs to be closed. If it’s about politics, then shame shame shame on these providers.
As a rule of thumb private healthcare providers are more likely to turn people away than public ones. Ideally in American we can have a quasi-private health insurance system with quasi-private health care delivery… but if private providers and private insurers feel that they want to pull a fast one on the American public we can all speak with our dollars and choose public providers and hospitals that don’t turn away people in need when we can.
Please feel free to post any further information on this and we will continue to research the legality of this. In the meantime we suggest calling your insurer and perhaps even contacting the Better Business Bureau and Health and Human Services.
http://www.naic.org/documents/committees_conliaison_network_adequacy_report.pdf
Jim Geisling
Their is certainly some flexibility a doctor has when it comes to accepting certain patients depending on where he or she bought their insurance plan. In Michigan, Blue Cross specifically asks if the plan was purchased on or off of the exchange in determining which doctors are acceptable