How can doctors refuse to take any insurance

[AliPasha1]

That's why we have the greedy lawyers.Greedy lawyers for greedy doctors.lol

[HerMajesty]

Ali,

I would also like to dispute that Dr. Filler "does not take insurance".

He is OUT OF NETWORK for all insurance, meaning that for the procedures he provides, such as doing open MRI photography during injections while the usual and customary is to only to do fluoroscopy, he apparently could not come to a satisfactory in-network price negotiation with any insurance provider.

However, he still employs a full time insurance staff. When I went to see him the staff got pre-approval for my MRN, billed my insurance, and only billed me co-insurance by mail after my insurance had paid their part. I pay 30% for out-of network. My total bill for office visit and MRN was $1350, meaning my insurance paid $3150 before I was ever billed.

I would hardly call this "not taking insurance". That would be defined as a provider whose staff does not work with insurance companies, but takes cash on date of service only. Then if you have out of network benefits you would need to submit a claim yourself.

Dr. Weiss's office is halfway in between; they do demand cash upon service, but then submit the claim so that the patient gets a reimbursement check without having to do their own paperwork.

[Emily B]

Let's be clear. Dr. Filler does not accept insurance. Dr. Weiss does not accept insurance. Niether doctor is contracted with any insurance provider. The patient is 100% responsible for the full amounts charged, whether up front or billed later.

If a patient has health insurance that covers out-of-network expenses, staff at these doctors' offices will send in the necessary reimbursement paperwork to the out-of-network insurance on the patient's behalf. They are not billing the insurance. They have no contract with any insurance provider, so they can't bill them. They are only sending in the request for reimbursement paperwork on behalf of the patient so the patient doesn't have to do it.

The patient's insurance will then send a reimbursement check to either the doctor or the patient. If the patient has paid in full, the reimburement check will go the the patient. If not paid in full, the reimbursement check goes to the doctor's office. The remaining balance is then billed directly to the patient by the doctor's office.

Either way, in the end, Dr. Filler and Dr. Weiss get paid 100% of the charges made to the patient, no matter how outrageous the amount may be.

Sending in the reimbursement paperwork to the patient's insurance company is a self-serving courtesy. It's not done out of the goodness of the doctors' hearts. It's being done because it brings in more money and it encourages more patients who have out-of-network coverage to be seen and treated by the doctor.

Hope this helps explain it.

Emily B.

[Quilter 2]

Everyone;
The bottom line for me is the paperwork you sign before you see whomever. Out of network, in network, filing papers, not filing papers, THE PATIENT IS STILL RESPONSIBLE FOR THE COST. I don't pay, my credit rating gets lowered, so I pay. United Health Care has me on their speed dial as far as paperwork goes and in the end, it's me and my husband that has kept a 900 plus credit rating since we've been married that gets the kick in the butt if the bill isn't payed.
This illness has kicked all of us in the butt one way or another.
Happy holidays to one and all;
Doreen

[JeanieC]

I agree with Ali, we desperately need Obamacare in the USA. I was delighted about the passage of the Affordable Health Care Act and just hope we don't repeal it or see it watered down too much. In a single payer system like they have in Canada, the UK, and many European countries, patients do not have to worry about losing their homes and cars to pay their medical bills. Here in the US, if you don't have a job, you don't have insurance, unless you have Medicare or Medicaid. It is a total disgrace that 45 million plus citizens of one of the richest countries have no health insurance and lack access to care.

I also have medical doctors in my family, who practice in the UK, where I grew up. They are middle class citizens who earn a very comfortable living but are certainly not filthy rich. I have also been impressed, in reading the posts on here from UK patients, that there are so many services available under the National Health System and all at little cost. Of course I do realise that higher taxes must be paid to cover this.

There will always be doctors under any system who practise "Boutique" Medecine just because it is legal and they can do it. And patients who will seek it because they can pay and do not wish to sit in the same waiting room with people they consider beneath them. I am not in any way referring to PN patients here as there is such a small choice in doctors, but I am very upset about surgeons who charge huge amounts for surgery knowing that the patient will have to pay out of pocket.

[AliPasha1]

Hi Jeanie C,

I couldn't agree less with you.

Thank You,
Ali

[calluna]

Actually all services under the NHS are not 'available at little cost' - they are free. No cost at all. That includes GP appointments, consultant appointments, surgery, physio, all tests, psychology services, all medications when you are in hospital - the lot.

The only things that we have to pay for are medications when you are not in hospital - and not everyone has to pay. Children, pregnant women, people with certain medical conditions (not PN) and people over 60 get free prescriptions. For everyone else, each item listed on a prescription costs £7.40 - that's USD 12.35. However there is a prepayment scheme available, which I use because it saves me so much money. I pay £104 a year (USD 173.50) and that covers all of my meds. I don't even have to pay that all in one go, I pay monthly and it is interest-free.

Yes we do pay for it in the long run with higher taxes, but it is very much worth it. And doctors are not trying to make money from their patients - because they get paid a salary, that isn't a consideration.

There is private health insurance available here, but it is really a perk that people get as part of their salary package - if you don't work, it just isn't affordable. And not all doctors choose to do private work, there are many who only take NHS patients.

Although we love to complain about the NHS (and it does have its faults) it is pretty good really.

[AliPasha1]

Hi,
I tend to agree that US Heath systems need major reform and I am greatly impressed by the Europeon Heatlh system.I have had two surgeries so far in Europe in the last two years.

Kind Regards,
Ali