All of my physicians have notified me that are no longer accepting my Ohio Obamacare insurance. The office personal said I must find another physician as they cannot accept cash payment (which I was willing to pay) since I am covered under Obamacare. I am still under the care of my surgeon and physical therapist for shoulder replacement. I needed prescriptions from my general physician and was told the same thing, which has left me without medications while I try to find doctors that will accept a new patient and one with Obamacare. Thank you


Answer

If a doctor doesn't accept ObamaCare (doesn't accept Medicaid or a private Marketplace plan), then you shouldn't use that practice. Private practices can turn you away in non-emergencies but public practices can't. Furthermore, a provider and services must be in-network for your cost sharing for non-emergency services to count.

A doctor can turn you away based on your insurance type, even if you are willing to pay out of pocket, as long as it isn't an emergency and they are a private practice... This isn't a legal thing where your doc really wants to help but can't, this is your doctor refusing you because you have "ObamaCare". If that feels like discrimination to you... that is pretty reasonable actually. Just remember, they aren't discriminating against you, but rather just the insurance type.

The above said, this isn't a simple issue. You should always contact your healthcare carrier to clarify this.

We have heard stories of clinics across America "discriminating" against "ObamaCare patients", so always glad for insight into what is actually happening. Would love to get more points of view on what is happening and what these means below.

"The Hippocratic Oath is one of the oldest binding documents in history. Written in antiquity, its principles are held sacred by doctors to this day: treat the sick to the best of one's ability, preserve patient privacy, teach the secrets of medicine to the next generation, and so on." - PBS

You can see legal advice on being turned away from care here.

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judith raymer on


Answer Rating:

I am told by my doctors as well that they can not accept private pay if I have insurance. They say it is a legal thing. NOT ONE of our doctors accept our insurance!

ObamaCareFacts.com on

All insurance plans must maintain a basic network. You can ask your insurer for this network. If the insurer hasn’t met the requirements they may even be breaking the law. So first and foremost get on the phone with your insurer and find out where you should go for in-network care.

Karen on

Still not accepting obama care marketplace insurance at my physicians office at the end of 2016. Attempts to find another physician who accepts obama care marketplace has been in vain. My premiums and deductibles are high. If I choose to go to a urgent care it will cost me $250.00 because no one accepts my marketplace insurance. I am confused here! I am paying my monthly premium so I have health care insurance. If, I go to an urgent care and pay $250.00 I can see a docor who knows nothing about me or my health.

karmen on

I honestly do not think that the doctor is trying to “discriminate” against Obamacare. They told me today that it is, and i quote; ” illegal to charge me for a visit if i have a good health insurance” so my response was “well the doctor does not take my insurance which means it must not be good enough, so i would like to pay out of pocket for my visit” and the response was “we can help you see another doctor who works with your insurance at this hospital, but it is illegal for us to charge you for a visit if you already have insurance even if the doctor does not accept it”. So basically Obamacare is taking away my freedom of choice, to visit whichever Doctor i want. Being that once I am locked into an insurance i can not change it, even if i find out the my doctor does not accept it, then i can not pay to visit him because it is “illegal” so i end up having to visit a doctor i do not want to visit because Obamacare is forcing me into it! My question is; Is it true that it is illegal for a patient who has an Obamacare Plan that is not accepted by a certain doctor to pay out of their own pocket for their visit, and if it is true then how is THAT legal?

ObamaCareFacts.com on

So generally, if you have coverage that covers a free wellness visit and the doctor takes that coverage then your insurer would pay the claim submitted to them. As for the legality and rules, that is far beyond “ACA related” advice and it gets into legal and medical advice. So best advice then is to contact your insurer for clarification.

Any professionals out there who have insight, please feel free to comment.

E on

This just happened to me today. I have been a cash patient for about five years now with my primary care physician that I have been seeing for nearly twenty years. At my appointment this morning I was told that since I now have insurance through the state (CA) it is now illegal for them to accept me as a cash patient and in order to continue seeing my doctor I must have a PPO (that I can’t afford) or be uninsured.

Sandy on

The cash only doctors are the ones breaking the law because EVERYONE SHOULD HAVE SOME TYPE OF INSURANCE the Dr’s know that and still are excepting CASH ONLY !!!!

Elizabeth Kendrick on

Sorry to break the news to you sweety, but the plans are breaking the law left and right. They add doctors to their handbook that don’t exist, add doctors that not only don’t accept their plan, but never have accepted their plan, continue to list doctors that aren’t accepting any new patients, and continue to operate even though they don’t have a single specialist in the county that still accepts their plan. I know of one health care clinic that provides care for the indigent that had to stop taking a major ACA plan because they NEVER got paid. I also know for a fact that our doctors still have bills that haven’t been paid dating back to March of 2015 – not a single bill has been paid. Why should a doctor accept a plan that doesn’t pay? Do you work for free?

L j s on

This situation happened to my son yesterday and I am looking for answers. My son has been seeing a dr for over 8 years . For the last 3 years he has been insured by the healthcare marketplace. He called yesterday to make an appt and was told that the dr did not accept his insurance so he opted be a private pay client. Then he was told that it was illegal for them to see him since he had marketplace insurance. This was quite upsetting. He called the agent that sold him the insurance and she said that she had never heard such a thing. We then called the Texas Insurance Board and they said that this was not true, that the dr office was lying to us. They told us that a dr can choose or or refuse to see anyone for any reason, but to tell us it was illegal to see him was just not true. I reintegrate, we were never asking this office to see him for free nor at a reduced price!

Cam on

Actually if you are a member of a Healthcare Sharing Ministry, then you are considered self pay, but backed up with an insurance type plan. The doctors are not breaking the law, because the ACA makes room for Health Sharing Ministries to operate. The patient will pay out of pocket cash up to a certain agreed amount and the ministry pays the rest.

Tammy Podos on

We have a Christian health share plan – and we were flat out refused services and told that they are not accepting cash or self pay anymore. Now we are being forced to use the emergency room. I’m getting frustrated because the whole point of this plan was for us to be able to choose the best qualified doctors. Now we are encountering expensive emergency room visits with people we don’t know. Our health share plan did say they would follow up and speak to the doctors office, but I don’t think they are going to get anywhere.

Carlo B on

You must not pay for your own insurance and get it from your employer or a retirement plan. It is impossible to find a doctor in a 40 mile radius that will accept Medi-cal here in California. The rates for Covered California are astronomical and the yearly deducible are the price of a new car! My rate is now going up 22% for 2017 and my income will not change!!! HOW IS THIS affordable!

Healthcare used to be much better before this stupid program and it will be getting much worse due to greedy politicians that don’t have to use the same insurance as us plain folks.

They all should be on the same plan as they forced us to get on. I bet you this mess would be cleaned up in a month or two.

Disgraceful.

Craig on

I have insurance but I want to see the doc of my choice. So I am willing to pay cash… Should not be illegal.

c.g. on

Dr.s don’t have to except every insurance. O.C. SUCKS

Cy on

Obama Care has caused much confusion. As a practicing physician here is how we address the issue.
Our office does not take medi-cal, medicaid, or any plan that is affiliated with Obama care. They still advertise that we do, but we never have and don’t plan to, and asked them to stop lying by listing our name….but they still do it. Patients are livid.
Patients with Obama Care, as any other insurance we do not accept, are welcome to come here and be cash patients. It violates nothing. They pay us cash, and when they need services that are better paid for by their insurance they go to their contracted Obama Care provider.
If your doctor has a contract with medicaid or medi-cal then it is a crime to charge cash or accept cash from you. If your doctor has a contract with an insurance company and he takes cash and does not bill your insurance then your doctor is in breach of that contract.
That should solve the legality question. Doctors are obligated to not take cash instead of insurance payments, even if you want them too. So it is easier to just say it is illegal.
On the other hand if you just say “I have no insurance, will you take cash?” many doctors will say yes and even charge you a very low fee. But the second they know you have an insurance that they are contracted with, they will have to come into compliance with their contract. This is a very sticky situation, and why doctors avoid it.
Some doctors do not take cash patients at all, and only take patients from contracted insurance companies. Cash patients can be troublesome for the following reasons, they may not be able to pay for tests or medications that are needed, they may not be able to pay for their office visits, and the needed follow up care, devices, or referrals needed. When this occurs in our practice we (Ironically), advise them to sign up for Obama Care.
Our reasons for not accepting Obama Care are purely due to its flawed coverage and payment systems. It did not make economic sense from the out set. Patient deductibles are too high, patients fall on and off the plan depending on if they can pay their premiums in any particular month. The ACA, Affordable Care Act, “you must pass it before you can read it”, 2000+ page plan was the train we were all railroaded on. Now, that we have it, we can see it, and feel physically, mentally and inour pocket books.
Let us hope and pray that the new administration does a better job with repeal and replace.

Andy on


Answer Rating:

Doesn’t tell me why doctors hate sick , old and black or poor people so much and system still doesn’t cover people with preisisting conditions that require surgery . A women in 50 with previous health problem whether a natural problem or car accident involve internal problem that was not found prior to January 14/2015 (so maybe Pcip could have covered it ) has to stay healthy for one year with pain till new enrollment to find the problem as a new problem and then has to find a doctor in network that knows what he is doing to fix the problem with special procedure . Good luck with that and it took at least 6 months to find a doctor that diagnosed the problem . So doctors pic and choose who they care for .

Uncle Sam on

Phew. What a racist, insulting comment. Do you really think doctors hate sick, old, and/or black people? Are those the only people with obamacare? Because as a healthcare provider, I have seen younger, healthy, and/or white/hispanic/asian/etc. people with obamacare. So I guess one of us must be mistaken.
Healthcare providers who refuse to take obamacare-insured patients do so because obamacare reimbursement is crap (if they get paid at all). And before you call me greedy, would you work for free? Our healthcare system needs a lot of work, but the problem is not the doctors/physician assistants/nurses. The gov’t has created this problem over the last 50 years, and obamacare has only made it worse.

Margaret Carter on

I can’t walk into the grocery store and walk out with a loaf of bread and peanut butter. And I need to eat. That truly is a necessity, far beyond getting my pap smear. And the cashier that yells at me and the security guard who chases me get a paycheck, right?

Eileen on

But of you are willing to pay cash how are they not getting paid????

Christeen Landno on


Answer Rating:

If the doctor has opted out then these insurance companies should not be listing them as “in-network preferred doctors” in their provider information. I’m stuck now cause I paid the first months premium because the doctor does not take any Obamacare plans and my husband is in dire need of specific neurosurgeon because no others will touch what another has done. Seems like my only option is to take the $653 penalty and go in through ER and then ask for Charity department to pay bill. Thank god for them.

ObamaCareFacts.com on

Networks are important to keep costs down, but it really hurts the customer when insurer change their networks around on customers. Not sure what to say. You would call your doctor, ask what insurance they actually take and plan on taking, then you would look for plans offered by that insurer for your next plan.

Obviously your plan of fees and charities is in jest, that would not be a good idea as a rule of thumb.

RONNIE on

Seems to me, we,re all being forced to pay for insurance that we can,t even use, or are forced to pay a penalty…toss a coin, we lose either way…Oh, that’s right, someone does win, Obama and the insurance companies….Imagine that!!!!!!!!!!! Been that way for many years….The rich get richer, and the poor get poorer….There even managing to take the middle class out of the picture…..Next year the penalty gets even higher… that being said, HAVE A GOOD DAY, but truly am sorry for our governments wisdom, or lack there of…

Hal on

The answer did not answer the question.

The patient is willing to pay with cash up front, but some doctors are turning patients away because these doctors do not want to get caught into the Obamacare regulations about Obamacare patients.

The question is this: Can a doctor fully opt out of medicaid and Obamacare and still see a patient who is covered by Obamacare without incurring any involvement at all by the doctor in Obamacare’s regulations.

For example, let’s say Obamacare sets the patient visit price at $44. The doctor has opted out of Obamacare and normally charges $80, and the patient wants to pay out of pocket or have a relative pay. Can the doctor go ahead and charge the Obamacare-registered patient $80 out of pocket?

Or is it impossible for a doctor to opt out of Obamacare and still see Obamacare patients without effectively getting involved in Obamacare?

ObamaCareFacts.com on

I want to tell you that you should just be able to go to a doctor and pay cash, but private doctors get to make individual choices it seems. Not sure what to say, so let’s leave this thread open and see if we get feedback.

Marjorie on

I’ve had a PC for 15 years. My husband died and my income is no more. I’m back in school pursuing a degree to be able to find employment. A few weeks ago I returned to my PC who is just over the border from my state of Washingtin and was told because I had Medicaid under Washignton State I could not be seen there anymore. I offered a out of pocket payment and the financial administrator threatened to call Washington State Medicaid and report me for being able to pay out of pocket but being on a Medicaid program. Prior to going to my doctor I was told by Washington States insurance line that it was fine to see a doctor in a bordering state and that many accepted Washington patients. I was also told that I could sign an opt out form from both states which were emailed to me in order to relieve the doctors office of any worries they might have regarding Medicaid liability. The financial advisor in Oregon told me it was illegal an there is a Washingtin State law that does not allow any Medicaid patient on any of their plans to opt out and pay out of pocket. She said doing so could land me in jail. I contacted Providence Health Insurance Billing and spoke with a gal who spoke with her supervisor. She reported they had never heard of such a law. I called Quality Contril to get to the bottom of the issue but after promising to return my call after looking into the matter, no one called back.
I reached out to the Care team that works under my doctor and Anna claims that they spoke with Washington Heath and there is no opt out plan and it would be illegal under the law to see me. I requested the code number and the name of the person so I could contact them myself. She couldn’t or wouldn’t provide me with her contact name or number. I spoke with Oregon and Washington Insurance Commusdioners who both told me they had never heard of such laws but did know clinics and offices can make up their own rules of who will be seen and who won’t be seen based on their own desires unless they are under contract with a provider.
My doctor means the world to me. I’ve been under her care 15 years. We have a great doctor patient relationship. How can this be remedied so I can see her again? She provides a great deal of comfort to me knowing my long history. Establishing a new physician is painful. To be turned away seems heartless. To be threatened that I’m breaking the law and Medicaid patients who can pay out of pocket should not be on Medicaid and she was calling to turn me in, felt demeaning. I felt humiliated and in hostile territory. When I had my own private insurance I was treated there with dignity and respect. Now the office staff is keeping me from seeing my friend and trusted provider.
Is there anyone who can help me uncover the truth in this matter? What are the laws? Is it illegal for someone with Medicaid to pay out of pocket for a visit to her usual PC of 15 years? Does the opt out form protect the physician and keep them from liability?
I’m grieving over this matter heavily.

ObamaCareFacts.com on

I don’t know the answer to this. But obviously for you and others being told they can’t pay out of pocket is causing some issues. We will research this and try to get back to everyone with an answer. In general Medicaid rules can differ between states. That being said, i’ve never heard of putting Medicaid recipients in jail for paying for healthcare out of pocket… that seems a little fishy, but I believe recently they were drug testing welfare recipients at our neighbors in Idaho, so perhaps they are referring to Idaho or perhaps WA has such a rule. In the meantime, you are on a WA financed Medicaid program so to some extent it would make sense to try to find a PC in your region who works with Medicaid.

Hope this works out for you and you can get to the bottom of this.

Larry Stephens on

My friend was just told by her doctor’s office that she can’t see him anymore, even if she will pay cash, they be her doctor anymore because it would be illegal. This is in Tennessee. Is it that confusing or are they lying? Surely, this is not the law!

Andrew on

Sorry to hear what you are going through. I am dealing with a similar situation. I live in California but I also have been seeing my PC for 15 years and now they tell me the same thing about paying for a cash visit. If you happen to find out more on this could you please let me know anything you find out? It would be very much appreciated. Thank you

Sandy on

Seems to me everyone in America should at this point have some type of insurance via Obamacare , Medicare, Medicade, or insurance through there employer , so all these pain management doctors WILL HAVE NO PATIENTS THAT DON’T HAVE SOME TYPE OF INSURANCE! which in turn if any pain management doctor charges cash only THEY WILL BE BREAKING THE LAW because in turn everyone in America should have insurance if they don’t THEY SHOULD so the PM is still breaking the law by knowing the patient by law should have insurance! Its the PM cash only drs. breaking the law !

April on

I have a question. If the doctor stops accepting Medicaid but they still pay for the medication because its in their formulary and its been PA’ed would that even matter? If you pay out of pocket for the visit, you can still use the insurance to pay for the meds right?

ObamaCareFacts.com on

That is a question for your local Medicaid department.

Sandy on

No because I was told that is illegal if you can pay cash for your visit you don’t need medicare or medicade , you can take that money you paying cash with and buy Obamacare and get off medicade/medicare ! Crazy right!

Ryan M on

This page is a joke, no true knowledge and far too much of “as far as I know” and “not sure what to say” … if you’re truly a “facts” pages, perhaps you should be aware of the facts before you attempt to dispense advice to people seeking it! Working in the healthcare field, I can tell you that there is A LOT of misinformation on this page and it is being portrayed as “knowledge”. The best step is to inform yourself through your healthcare carrier and medical providers’ offices.

ObamaCareFacts.com on

I agree, although I think you are misreading the page.

The top part of the answer is correct and good advice and I doubled checked EVERY comment of ours and I think I found the one instance where advice was off.

Seriously though, your comment is overly harsh. I’m going to leave it here so others can better understand that we aren’t offering professional legal or medical advice and, as you say: “The best step is to inform yourself through your healthcare carrier and medical providers’ offices.” Agree with that… but would have loved more insight instead of critique.

Heather Bean on

Your comment is absurd. You obviously are completely unaware of how complicated the medical the “laws” are at this point. Maybe you should grow a brain before you make ignorant comments such as these. This site is trying to serve a purpose and shed light, despite a very complicated and obscure medical system.

Elizabeth Kendrick on

None of our doctors are on the plan and the only doctors taking new patients are located in the public health clinic which has a four month wait and no specialists. There are NO specialists taking our plan (Partnership Health Plan [also knows as the plan of “No”]) taking new patients. We are currently using our local emergency room to get prescriptions and life-sustaining medical treatments. The hippocratic oath is a joke at best. In California the new oath is, “what’s my bonus this month?”

Manu Mathews on

Im sure that all of you are paying everything you can afford to get onto these obamacare plans. But these plans pay the doctors very little if at all. So doctors have to incur huge losses to see the patient. In addition to that, they deny everything that the doctor orders including medications and procedure, many will not talk to office staff and insist that physicians hold on line for an opportunity to talk to someone who has not completed high school and explain why the patient needs a treatment, often with their “rep” concluding that the patient doesnot actually need it after you have spent 30 mins on the phone. They always follow it up with ridiculous disclaimers like “this is not medical advise” and “you should do what is best for the patient”. This whole thing is a joke on the American people.

So rather than blame the doctors, call your senator and congressman. The chances are that they will do nothing cos they accept money from these companies to allow this to happen. On every obamacare or medicaid patient I see, It costs me about $50 more to provide the care than what these companies will pay. If you see 10 obamacare of medicaid patients a day, that’s over $500 in losses that you have to makeup from other sources.
Do any of you guys go to work so you can pay your employer?

Rb on

Hi, can we talk? I looked at my EOB and saw my doc doesn’t get anything for seeing me. He’s very gracious about it and I’m thankful for that. Here’s the thing…I have Aplastic Anemia and its variable and life threatening….I’m considering paying the fine and going non insurance because the hospital doesn’t take this plan yet one does but my doc is in Dallas this Hospital is an hr away. I can’t reasonably expect him to go get privileges and to drive to see me if heaven forbid I end up in there. Stepping out on a limb here but in this situation as a patient if the the rolls were reversed what would you do? Hypothetically of course.

Lisa on

Went to the ER IN Network. Was admitted. Attending Drs. don’t accept Obama Care and I am being billed thousands of dollars. I need surgery and not ONE Dr. listed in the insurance companies book accepts Obama Care, this whole thing is a scam.

Vickie Buxton on

I called numerous sources today trying to find some legislation that protects me from this very thing. I went to an ophthalmologist appointment today at Ocala Eye in the The Villages, FL to see Dr. Morris intending to pay cash. The first thing the receptionist requested was my insurance card and drivers license. Upon providing them, she informed me they do not take my insurance. I told her I intended to pay cash and she said they would not see me. I asked if they take cash customers and she said, “yes, but we already know you have BC/BS so we will not.” I called their business office and spoke to Sonya which confirmed this. This is discrimination. I have since verified that they took cash from other clients.

Kathie McQueen on

Our Hospital and maybe 2 Dr in our town will accept HMO Insurance. Why should my daughter have to pay to have this and then pay cash out of our pockets to get medical help? This is like a scam.

Jessica on

I was told after I was paying cash 4 years+ that it is illegal for them to accept cash because I have medical. I cancelled Blue Cross when the monthly payment was $700+/-
It was more affordable than paying $700, plus co-pay for Dr.visits & prescriptionsave.
I was told it’s the Dr’s. choice..but his billing Co told him it was illegal…after 4+ years?
I couldn’t find a Dr that accepted Medical years ago when I cancel my Blue Cross & can’t now.
Horrible to feel so helpless, and I take mess for depression, anxiety, ptsd, insomnia and chronic pain from several breads and surgeries to my rt arm. I will withdrawal..I can have seizures stroke even death. The CA Medical system does not have answers and im scared what will become of me and my kids as I’m a single mom. Thank you for your time

ObamaCareFacts.com on

I tried to answer this question once, and someone claiming to be a doctor said it was irresponsible to try and people should call their insurer.

I still don’t get the “illegal to pay cash thing”, but hey, good reminder I need to dig out the policy for this one and figure out what actually is going on here.

In the meantime public hospitals always accept state insurance, so start there.

Mark on

Here is some more reality check from Arizona. I had Healthnet PPO as of May 1 2016 they have left the state. I signed up for HealthChoice on healthcare.gov. Hardly any doctors will accept this insurance. Ironwood cancer and research informed me yesterday as of May 31 they will not accept HealthChoice insurance. Luckily I am on follow up care, others in middle of treatment not so are devastated. The people in reality are being left with No Choice.

Brett H on

I have insurance through Humana and the same thing is happening to me in Washington State.
Humana switched to a narrow network and now they have more policy holders than there are doctors to see them.

I cannot find a doctor in my network accepting new patients and even though Humana themselves called around their small network trying to find a doctor for me and could not find any accepting new patients, Humana is still taking money from me each month and will not stop until the next enrollment period.

A company taking money for services that they cannot provide is fraud and there needs to be new health insurance reform to stop this practice of over selling policies that there are not enough doctors to see all of their customers that bought one of their plans.

W on

I encountered the “illegal to take cash” thing also! In NYC for doctors in the Hospital for Special Surgery. It is the #1 hospital for orthopedics and I’m hearing none of their doctors take medicaid in the private practices. Their billing department also said if someone finds out they took cash, they will incur a “fine”. Is this true?! How can the system allow discrimination against low income people like this? This is so wrong!

Frank G. on

Anyone seeking help from a doctor for narcotics will most likely be told they only accept cash. People taking buprenorphine to either come off of narcotics or as a maintenance prophylactic as well as pain medication will be told by doctors they DO NOT take insurance. My doctor recently passed away I was with him over 25years right away the others in the office went to cash only. I not only pay for my Medicare but seeing the doctors blight as they describe it I bought a supplemental policy that cost me over $500.00/ quarter but even that isn’t enough. These guys are making $125.00 to $200.00 for a 10 min visit isn’t that enough? NO $2000/ hr isn’t enough. How can I afford to pay a doctor $200.00 a month and a prescription that cost me $100.00. Shame on those doctors that demand you pay those high fees to pay for their education….. their whole lifetime. I hope nurse practitioners take over and perhapds we can go back to patient care.

kyle on

Please correct me. It is my understanding the consierge fee pays for no service, it is the ante. Is that right?
So for $1800 per year, I have a doctor. Then I pay $970.00 month for my one female adult Obama Care. I have a $6000.00 a year deductible. Plus I pay at least $10.00 per covered doctor visit and prescription.

And ILLEGALS are free?

susie on

I worked for a provider and we were told by Medicaid that patients are committing Medicaid fraud when they go to an out of network provider and pay cash. Their reasoning is that the patient was enrolled into Medicaid because they have told Medicaid they were unable to afford their medical visits. If that patient is paying out of pocket then they do not need Medicaid. And furthermore, Medicaid stated that they are not able to track patients doctor visits or medications if they are paying cash for everything which could lead to doctor shopping especially for the ones seeking opioids.

Carol on

If I pay cash from a donation from friends and family to go to a specialist to get their opinion on my cancer diagnosis, can I loose my medical?

ObamaCareFacts.com on

Insurance can only be dropped for non-payment, but the specialist may reject a cash offer. Think that is the basics.

Shanis on

I was insured with Medicaid and Cigna during pregnancy, then took my newborn to a doctor for a sick visit a few days after birth. Cigna didn’t cover that visit since I didn’t enroll my newborn under my plan, I enrolled her for Medicaid at the hospital. I found out that the doctor does not accept Medicaid, but it was after services were already rendered. Can I pay the bill out of pocket and Medicaid re-imburse me? Or should Cigna have paid the bill since newborns are automatically covered within 30 days of birth? Does a newborn need to be enrolled within the first 30 days in order to have coverage for their first 30 days of life? I’m a little confused at what I should do about this bill. Any advice would be greatly appreciated.

Katy Snyder on

I have to drive over an hour for my pain management doctor, and general, because the Drs. 8 minites away will not insurance through the marketplace. Ohio Health owned facilities are guilty of not accepting obamacare plans.

Pam Ronemus on

If a private practice clinic does not accept medicaid and aren’t signed up with any Obama Care insurances, can they legally accept cash from the patient and can that patient file the claim themselves.

Joann Somers on

What if the insurance company dropped my doctor and I don’t want to find another physician? My doctor opted out of Medicare and they punished him by taking him off of ALL the nonMedicare plans

Christopher Stanley on

My lawyer based my whole trust settlement from workers comp on Obama care. Without previous conditions covered, I’ll have to pay cash. This will ruin many peoples retirement plans, including mine.

Brandon on

Anyone with an insurance plan purchased on the marketplace that is not accepted by a provider can pay cash as long as the provider gives them a written notice that they sign stating that their benefits will not cover the service and they are solely responsible for payment prior to receiving the service. I am a health care provider and I called the number on the healthcare.gov website to inquire about this. The representative had to ask his superior as he was unsure of the rule, but got confirmation that this was in fact the case.

This is consistent with Medicare’s policy for non-covered services, in which case the patient needs to sign an Advance Beneficiary Notice. It is also consistent with the policy of Medicaid in Wisconsin. I cannot speak to the policies of other states.

Brandon on

Any person with an insurance plan purchased on the marketplace that is not accepted by a provider can pay cash as long as the provider gives them a written notice that they sign stating that their benefits will not cover the service and they are solely responsible for payment prior to receiving the service. I am a health care provider and I called the number on the healthcare.gov website to inquire about this. The representative had to ask his superior as he was unsure of the rule, but got confirmation that this was in fact the case.

This is consistent with Medicare’s policy for non-covered services, in which case the patient needs to sign an Advance Beneficiary Notice. It is also consistent with the policy of Medicaid in Wisconsin. I cannot speak to the policies of other states.

Cathy Wieseler-Myers on

2 1/2 years ago A provider made me pay up front while I was waiting to get approved for Medicaid.
Once I was approved I called Medicaid about getting reimbursed.
I was told at that time I would not get reimbursed for PAID office visits and prescriptions. I have an outrageous credit card bill. It’s gonna take me 50 years to pay off that bill.

I don’t know what to do !

Mary Stafford on

First of all, PLEASE stop calling Health Care Reform “Obama Care” and understand that this is a derogatory title Republican Strategists came up with to incite greater resistance to health care benefits for the poor.

I have Medicaid and there are so many obstacles to quality care, I would not know where to start. I’m sorry and angry that we were not able to get Single Payer benefits. I’ve been refused all corrective or curative care and am really stuck now, since my providers are just treating symptoms and not even trying to improve my life through quality care: Just take a pill, honey…

P W on

This article gives a broader perspective of the inner workings of Obamacare, insurance companies, and the doctors that see ACA patients…

http://m.huffpost.com/us/entry/us_57b39cf6e4b014a587fbb6d6

Ashley on

This whole insurance system is a joke!!! Not a single one of my doctors accepts the plans available and the only decent one costs a mortgage

Michelle Seaver on

What a bunch of BS.

Michele McKechnie on

I was also notified this morning that my doctor in Texas will not even let me pay privately due to the fact that I’m covered by BCBS of TX with Obamacare. If I had not insurance, no problem. Disgusted and scared because there are so few doctors willing to take BCBS TX Obamacare. Will have to spend the rest of my work day calling to see who can possibly see me. This is scary!

Proud Beckham on

FROM CMS.GOV in TEXAS – Here you go folks!
Q2. We are a doctor’s office and heard that we cannot bill people with both Medicare and Medicaid, even if we do not participate in Medicaid. Is this true?

A2. For services that are covered under Medicare, you cannot bill a Qualified Medicare Beneficiary (QMB), even if your office does not accept Medicaid. A QMB is someone whose income does not exceed 100% of the Federal Poverty Limit and who is eligible for Medicaid paying Medicare premiums, deductibles, and coinsurance for both Part A and B.

Even if the person signs a document accepting liability for any treatment costs, you still cannot bill them, as QMBs cannot waive this right under Medicare. Providers who bill a QMB for costs above the Medicare and Medicaid payments (even when Medicaid pays nothing) are subject to sanctions.

ObamaCareFacts.com on

Good findings. So we can confirm there are rules for Medicaid and Medicare.

Jill on

I’m kind of in the same situation. Today I had to get the insurance to avoid paying the fine for taxes. But I have had my doctor for 20+ years, and I don’t want another doctor. I am friends with his family and I am comfortable with him and his nurse practitioner as my providers. So if my insurance is not part of his plan, I cannot just pay out of pocket to continue seeing him? I will not go see another doctor, so I guess that means that I will be without healthcare until Trump is able to do away with Obamacare and I can see the doctor of my choice.

Bryon Miller on

Discriminating against obamacare? Let me translate that for you. Some of these useless insurance providers like Health Net deny everything and don’t pay the doctors. Then the doctors have to send their patients to collections in order to get paid. Some idiot in a suit decides my medical fate over the very doctor that went to school and devoted his life to the practice. The suit shouldn’t be denying the procedures that the experienced doctor says is required but they do.

I have no idea why they can’t take cash payment, that just means I won’t tell my GP I have insurance until the end of the visit. It doesn’t matter anyway, they don’t take the only provider the exchange had available for me. Neither does the only Hospital in the City with a Trama center. Don’t get shot or do anything that requires an ambulance and the trama room in Tucson az, your Insurance won’t be accepted and you’ll be paying a HUGE bill. I just hope I don’t die waiting the ridiculous timeframe to see my doctor about my sudden Hi BP and chest pains. The price is also a ripoff, I only pay a small portion but the government forces others to pay $280 a month for me and I STILL pay on top of that. How is this affordable?

Mike on

Unfortunately, this very thing happened to me in a doctor’s office so I can verify that it does occur.

I’m on Medicaid but wanted to see an ENT doctor that does not accept my insurance for a second opinion and told them over the phone I would be paying in cash. They said that would be fine. When I arrived, the receptionist put my name into her computer and then said that they see I’m a Medicaid patient and they cannot legally accept cash patients from people that are on that plan. I was so frustrated. I asked them why they didn’t tell me this before heading out to the office at 8am? She apologized and said the woman who booked my appointment was new and didn’t know all the policies. I told them that I feel this is an emergency (doctor’s are required by law to see you in an emergency, regardless of what insurance you have and are willing to pay cash), because it feels like my throat is closing up. They just told me to go to the ER. I felt like if I stayed any longer they were about to call the police to have me physically removed.

Fortunately, I was able to call my insurance and get an emergency authorization to see the old ENT I was seeing. But the overall situation was very humiliating

Meghan Fitzpatrick on

Absolute crud. My body. I am not going to have my rights taken away because I need help having health coverage right now, yet everyone else gets to choose?! Seems to me like discrimination….I should have a say in who I see and who I trust for medical needs. The government shouldn’t get to decide because I’m low income right now. BS!

ObamaCareFacts.com on

Fair point. Some would argue that if you need assistance you shouldn’t get to choose, but I don’t see it that way. I think liberty is all about letting people make their own choices and morality is all about helping people to do that.

Mike Aubuchon on

My wife pays $300 a month for obamacare she has had it for about two years now. This past year the plan changed with that changing she is now unable to see any of her Dr.s . The nearest Dr. that will take this insurance now is 3 hours away. How can the insurance company think this is okay? When the president started this he said “people will be able to keep the Dr they have” that was a lie!!! So what can a person do ?

Dr Jennica Jenkins on

What about the penalty/fine for up to 10% of private practice revenue for not being on panel and charging cash pay? Please report the whole story.

ObamaCareFacts.com on

I would love to present this all as honest as possible. It is not a subject that I fully understand actually.

It would be great for you to offer some articles, but let me present what I found:

http://www.medscape.com/viewarticle/862642

http://www.nejmcareercenter.org/minisites/rpt/8-ways-that-the-aca-is-affecting-doctors-incomes/

Each article above offers insight into how the ACA has helped or complicated private practices. I couldn’t find anything on a 10% fee, but I would be very interested to know more. If anyone is on the provider side of this, any information would be very helpful!

Patricia on

http://nslawservices.org/wp/wp-content/uploads/2011/03/MA-Provider-and-hosp-resp.pdf

The above link is to the NYS guidelines for physicians billing medicaid patients. It lists several stipulations including the following: “A provider may charge a medicaid beneficiary,
including a medicaid or FHplus beneficiary enrolled in a managed care plan, only when both parties have agreed prior to the rendering of service that the beneficiary is being seen as a private pay person. This agreement must be mutual and voluntary.” The guidelines also suggest that the provide keeps a written/signed agreement on file. I intend to show this written guideline any doctor who refuses to accept out of pocket payment from a patient/family member. Doctors probably don’t want to charge poorer patients high fees so I am guessing they just prefer to bill through insurance so that their bill can be inflated in order to offset the low reimbursement amounts that insurance offers. It’s all about business these days…and unfortunately the only winner is the insurance company.

Pat on

A family member is on medicaid and many specialists will not accept or treat that patient because they say it’s illegal to bill that patient. However, even though a family member is willing to by pass medicaid and pay out of pocket for that patient, the doctors still refuse to accept the patient. It is mind boggling that a cash payment doesn’t qualify a patient for treatment…always thought cash was king! It makes me wonder why the doctor prioritizes between profit and patient and usually chooses the first. Their hyppocratic oath is to do no further harm…well not treating an individual who desperately needs medical intervention, is certainly doing more harm in my book. What ever happened to their original ideals that made them become doctors in the first place…or perhaps they were counting their potential for profits way back then too.

Bethany on

Why would a doctor refuse to let you pay cash when they don’t accept your ObamaCare Insurance?

Jane C. on

A doctor is NOT ALLOWED per regulations to accept cash from someone covered by ObamaCare. Ever. They can be accused of fraud if they do! They have to use the insurance. So if they have dropped that plan ( lots of reasons to do so) they CAN’T just decide take cash from a patient still under that plan. Complain to the folks that design these insurance plans!

Anna on

That answer is not really true. With state Medicaid’s they don’t always get paid. And if they aren’t contracted with the ins and they see a patient they will have to eat the entire bill. Plus the state does now allow their clients to self pay either or the office will get in trouble. It’s a sticky situation for the offices so most can only take select Medicaid’s. It’s not about “discrimination” at all. Most of the time it is quite easy to change to a Medicaid plan that is accepted at the office of interest or if you can afford to self pay then you probably don’t need Medicaid ins.

Laura on

We basically said I can give you a 10,000 dollar deposit. We were refused. Why. Who the heck would refuse to see a patient for cash?

tim koss on

My dermatologist takes ACA exchange’s Ambetter in Texas., for kids or Medicaid or something restrictive. I went and had an examine and biopsy and a pathology report. I did not even consider whether she would honor my insurance. I wanted a quick and simple examine,. usually about $120. with ACA Ambetter in Texas its tough to find a Doc so I knew this Dermatoligist , she was local . I didn’t anticipate any cancer or need for anything other than an exame.

I went and had an examine and biopsy and a pathology report. Melanomic cyst. Eureka.

they were all set to remove a melanomoic cyst when they called and said they couldn’t treat me. they said the Ambetter policy they accepted only applied to Medicaid patients’. I thought and said, “we have come this far, I have a cancerous cyst, I will pay cash”

they said ‘they cannot take cash and I must find another Doctor’.

Rochelle Holsworth on

If our doctor doesn’t accept Obamacare then we should find a new doctor?? Seriously? Finding a good doctor isn’t easy. I’m in this same boat and it’s total crud! Obamacare is ruining health care and the doctors ability to be a doctor!

Fred Hensley on

Idiot. Why not cash? How do you not get it!