Cash Only: What Happens When Your Doctor Doesn’t Accept Insurance?
Interesting stuff over at Fox Business, where there is more:
Why doctors decide to go insurance-free
To understand the insurance-free paradigm, you need to understand how health insurance pays the doctor.
Each year, doctors negotiate the price of treatment with health insurers. For example, a doctor tells the insurer that when a patient visits his office, he charges $135 for an office visit. The insurer says, “We can pay you $95.” The doctor might counter offer and ask for $120. The insurer agrees to $100.
That negotiation takes place with each insurance company for every service your doctor performs. Ultimately, the insurance companies are the ones in control. They set the rates they will pay the doctor.
When a doctor doesn’t agree to those rates he can stop accepting that insurance or go insurance-free if he feels he is not getting fair reimbursement. It doesn’t help that some insurers aren’t timely in sending their payments to physicians and other health care providers.
“We used to submit a claim and two or three weeks later we got reimbursed. Then it became five weeks and six weeks, and then they said they never got that claim even though it was sent electronically,” says Craig Koniver, an insurance-free primary care physician in Charleston, S.C., and author of “Connected: The New Rules of Medicine.”
“Then we got notification they needed office notes to support the visit,” says Koniver, “It was little things that built up until we were spending a whole lot of time chasing down insurance reimbursements, which took away time from the patient.”
What’s more, doctors’ offices must purchase expensive software to bill insurers and hire a coding specialist to handle claims. If services are coded incorrectly, the insurer refuses to pay.
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