Why Does My Doctor Not Accept Health Insurance?
Healthcare expenses can quickly add up, and many people are unable to pay for the cost of medical care. In order to ease the financial impact of medical costs, many people purchase health insurance either individually or through their employers. Unfortunately, health insurance is not accepted by all medical providers, and a patient’s treatment options may be limited depending on what type of insurance the individual has.
How Health Insurance Works
Whenever you have an insurance policy, you pay monthly premiums in exchange for coverage. You will be responsible for an annual deductible and co-payments; other costs will be paid by the insurance company directly to the medical provider. Every time medical services are rendered, the doctor or hospital will send the bill to the insurance company. The insurance company will then negotiate the cost of healthcare and determine how much they will cover.
Because of these negotiations, some doctors refuse to work with certain insurance companies. Simply speaking, some insurance companies refuse to pay a doctor what the doctor believes his services to be worth. Because the insurance company will not budge, the doctor’s only choice is to turn down that particular insurer in the future.
Most doctors will accept at least a few health insurance providers, but some doctors will turn down all forms of insurance. Additionally, insurance companies may exclude certain doctors due to the cost of their services. In order to ensure that your care will be covered, it’s imperative to make sure that the doctor and the insurance company will work together.
Health Insurance, Doctors and the Cost of Healthcare
As medical technology improves, healthcare costs increase. Doctors must pay for expensive equipment, medications, diagnostic procedures and staffing costs. The doctor must also be paid for their time and expertise. Additionally, many people are treated who are unable to pay; they may visit the emergency room after an accident or spend substantial time in the hospital due to a serious illness or injury but be unable to cover the cost.
Although many doctors will set up payment plans for this situation, some patients will never fully pay the cost of their healthcare. Because these patients represent lost profits, the doctor must compensate by raising costs elsewhere. This results in higher costs for other patients and is one reason why healthcare is so expensive.
Health insurance companies are in the position to negotiate with doctors on prices; individual patients usually do not have any room to negotiate. This means that insurance companies play a vital role in determining the cost of healthcare. Doctors who work with insurance companies are often forced to charge lower rates; as a result, they must either increase the rates for other patients or cut costs in other areas.
All of these factors represent a major problem facing healthcare: affordable healthcare often is not as good as services provided by more expensive doctors. Patients are faced with the choice between selecting a doctor inside of their insurance network or paying high fees to visit a doctor who does not accept insurance.
Choosing a Doctor that Accepts your Health Insurance
If you have health insurance, the best way to make sure you find a doctor that will accept your insurance is to check with your insurance provider. Most insurers provide a list of in-network doctors, which are clinics and hospitals that can be visited for the best rates. Some types of insurance, called HMOs, operate entirely on this system; the insurance company works directly with medical care providers to provide insurance at a flat rate for any specific type of treatment.
Going to an in-network doctor is usually more affordable than venturing out of network. Depending on the type of insurance you have, you may not have the option of using a doctor outside of your network at all; in other cases, it will simply cost you more out of pocket to use a doctor who is not preferred. Either way, you’ll want to know before visiting the doctor whether the care will be covered or else you may risk an insurance claim denial; this will lead to you being sent to collections for the remaining balance.
If you already have a doctor and do not have insurance, selecting an insurance company that is compatible with your current doctor is a wise choice. Unfortunately, this is not always possible; most people obtain insurance policies through employer-provided group plans, which greatly limit a patient’s flexibility in choosing a doctor. In these situations, it’s up to the insured to decide whether to find a new doctor or to pay more for a flexible individual policy.