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[also_not_a_prof]

"Our practice does not accept re-assignment of benefits from any insurance companies...Our practice does not participate in Medicare."

I currently have health insurance, but lately I've noticed an increase in health professionals who do not accept ANY health insurance. I think this is a tremendous hardship for patients who have to pay their insurance premiums, then pay the health provider's bill in full, with probably only a fraction of the cost being reimbursed.

I find this disrespectful. Are there any websites that provide information on health professionals who DO accept patients' health insurance? I realize the issue is low reimbursement rates, but I still have a problem with this practice and, yes, I'm venting about it.

[zharkov]

Insurance companies typically have a directory of providers who accept their insurance.

[polly_mer]

OP, why did you choose a health insurance that isn't accepted by the doctors in your area and doesn't reimburse you for most of what you spend?

I've been in the situation where none of the doctors in town take insurance for various reasons, but why would you buy insurance that doesn't cover anything to reimburse at a reasonable percentage of typical costs in your area instead of putting those monthly premiums in a useful account and buying catastrophic insurance?

Why didn't you check to see the provider list before you signed up for insurance?  That's part of what legitimate insurance companies will provide before you hand over your first premium.  Usually, you can get that information from the insurers' websites.

[goldenapple]

You only suffer the "hardship" of paying full price if you have already deliberately ignored the fact that the physician does not accept your insurance.

As for doctors and dentists who don't accept insurance: I don't blame them. Many of them have ceased to operate a private practice just because of the enormous burden of dealing with the insurance companies. You made a calculation when you chose your medical and dental plan and these physicians are making a calculation when they choose not to accept those plans. You didn't care how much trouble your plan would be for them; you did what you thought was best for yourself. They are doing the same.

Another note: you can usually opt to have a lower-cost, high-premium insurance plan and put as much as you like into a health savings account. If there really are no providers on your plan in town, this will save you some money.

[zharkov]

Where I live, there are something like 3 to 5 larger insurance companies, and they are accepted pretty widely, at least by physicians in group practices and clinics.  Perhaps physicians in private practice don't accept all these kinds of insurance, but I wouldn't know, not having seen a physician in private practice since I was a kid.  A group practice or clinic will always have staff who just take care of the insurance stuff, which could be burdensome to a lone wolf.  So OP, perhaps check with larger practices about finding one that accepts your insurance.

[also_not_a_prof]

Thanks, Zharkov, for your helpful reply. I am lucky that most of my life I have enjoyed good health and had primary care physicians who took my insurance. Unfortunately, my health needs have changed as of late. Yes, I can page through directories for anonymous names of providers in the specialty I now require, but I have usually relied on word of mouth for health care referrals. In some specialties, most of the health care professionals do not appear to accept any insurance at all.

And yes this is a hardship (not quotes required) for me. I have had an extended illness that has almost wiped me out financially, yet I need to go to a specialist. Fronting the cost is sometimes not really possible. My own father and brother were primary care physicians and they accepted their patients' health insurance. In many cases, they wrote off the difference between the reimbursement rate and their fee.

Oh, by the way, I chose the best health insurance provided where I worked. I currently am on COBRA, which is not cheap, since the temporary position I now have does not provide any benefits.

[polly_mer]

Fronting the cost is sometimes not really possible.

So work out a payment plan with your provider.  Many large practices will do this as a matter of course.

My own father and brother were primary care physicians and they accepted their patients' health insurance. In many cases, they wrote off the difference between the reimbursement rate and their fee.

That's a reasonable business practice when the difference is 10-15% with negotiated rates that nearly always go through the system and many other people will be paying full freight.  That's not a viable business practice when the reimbursement rate is less than 50% of the true cost and the insurance company fights making all payments so that the provider may get practically nothing months after the services were rendered.

Oh, by the way, I chose the best health insurance provided where I worked. I currently am on COBRA, which is not cheap, since the temporary position I now have does not provide any benefits.

So go find out what resources are available to people in your position.  Obviously, your current healthcare situation isn't working and something needs to be done.  Find out from the social services people in your area what can be done and for what you may be eligible as a hardship case.  Whining about the system is just wasting your breath.  Go work the system to get what you need.  Who volunteers their services for the needy and what do you have to do to get on the list?  Who has free or reduced services and how do you get on those lists?  Who will front you the money so that you can pay back that entity as you are able instead of waiting until you save up the money and your condition worsens?  Would you be eligible and willing to try medical tourism by vetted people?  This is your problem so figure out how to solve it instead of waiting for a fairy godmother to show up.

[pigou]

Yes, I can page through directories for anonymous names of providers in the specialty I now require, but I have usually relied on word of mouth for health care referrals. In some specialties, most of the health care professionals do not appear to accept any insurance at all.

Is there a specialty where NO specialists are covered? If not, it sounds to me like you're making a simple tradeoff. You pay a fortune to get a "known" provider, instead of someone from a list. The question is whether you really end up with a better physician. Just because Joe recommended Dr. X doesn't mean that X is better than Y.

Take someone from the list and stop paying out of pocket.

[navelgazer]

Since when is the answer to problems to "not question the system"?

Maybe this is because my current location (a mid-sized city) has shockingly few specialist practices, but I think many of the posters on this thread are being cruel and deliberately obtuse. If you have chronic fatigue or Lyme that remained undiagnosed for a long time, there is not one specialist who takes *any* insurance. They are small practices and do not negotiate rates. They do payment plans, but in the case of a chronic condition that is no good. If your child has a serious GI issue--one that your pediatrician tells you they cannot handle--the wait to see the two specialists (in a city of 700,000) is often 60 days. (These specialists do take insurance.)

I have had to balance underemployment and buying insurance. I do not have a chronic condition. Once, the rate for a very good COBRAwas 150 dollars out of my price range (as in my monthly food budget was sometimes 200 or 300 dollars). I got a managed care plan that I was quite happy with, but they would not allow me *any* access to infertility treatments or testing. (They had corporate contracts and an in-house fertility center.)

In my state, you have to be destitute to get any government assistance. And they are about to drastically cut that program. Medical tourism?!?! for a chronic condition? Why would someone be able to "Front" the money?!?!

[navelgazer]

Since when is the answer to problems to "not question the system"?

Maybe this is because my current location (a mid-sized city) has shockingly few specialist practices, but I think many of the posters on this thread are being cruel and deliberately obtuse. If you have chronic fatigue or Lyme that remained undiagnosed for a long time, there is not one specialist who takes *any* insurance. They are small practices and do not negotiate rates. They do payment plans, but in the case of a chronic condition that is no good. If your child has a serious GI issue--one that your pediatrician tells you they cannot handle--the wait to see the two specialists (in a city of 700,000) is often 60 days. (These specialists do take insurance.)

I have had to balance underemployment and buying insurance. I do not have a chronic condition. Once, the rate for a very good COBRAwas 150 dollars out of my price range (as in my monthly food budget was sometimes 200 or 300 dollars, I know how to cook rice and beans, but that is not a 50 dollar a month option). I got a managed care plan that I was quite happy with, but they would not allow me *any* access to infertility treatments or testing. (They had corporate contracts and an in-house fertility center.)

In my state, you have to be destitute to get any government assistance. And they are about to drastically cut that program. Medical tourism?!?! for a chronic condition? Why would someone be able to "Front" the money?!?!

[georgiaprof]

In my case (at my previous position at Middleofnowhere State), I was on the state plan  there was only one state plan that I could get (there were others, but not for employees at my institution - due to its location).  They had hundreds of approved doctors on the list.  95% of them were in Atlanta which was a 5-6 hour drive for me.  There were two doctors locally who were on the list.  Neither was taking new patients.  The insurance company said that they would work with me to find an off-the-list doctor if and only if I could get letters from every doctor within 50 miles of Middleofnowhere State indicating that they were not taking new patients.  Fortunately for us, we got a recommendation from a friend to a doctor who was on the list and not taking patients, except, apprently, by referral. 

So sometimes, there are no options other than to take the insurance plan with no local doctors who will see you.  It is incredibly frustrating.  Sorry that you are having so much trouble, OP.

[polly_mer]

All right, Navelgazer, question the system.  

Spend all day every day for a week sitting in your chair in your living room questioning the system.  

Or spend that same all day every day on the phone, the internet, and with the local charities figuring out how to get the care you need.  People will indeed pay for treatment or loan the money for treatment, but you have to be proactive in doing the searching and making the case.

Tell me which one pays off first.

Also tell me how useful it is to accept that the wait to see the specialists in your freakin' city is 60 days without starting to call all the specialists you can find in an ever widening circle until you get one who will see your kid in a reasonable amount of time and every day call back to the closest specialists to see if an earlier opening has happened.  I'm willing to do that for my kid for the serious conditions.  I fail to believe that the condition is that serious if you are willing to accept a wait.

I'm an engineer.  I solve problems for a living.  Yes, the American healthcare system is broken, but whining about the system (or the more euphemistic "questioning the system") isn't going to help the OP nearly as much as pointing out actions that the OP can do right this second to get necessary care in a broken system.

[wilbrish]

Maybe everyone can see the middle option.  Which is to help but not blame the OP.  Some of the replies do seem a little glib to me.

[polly_mer]

Maybe everyone can see the middle option.  Which is to help but not blame the OP.  Some of the replies do seem a little glib to me.

O...K... So we should never ever provide feedback about decisions that could have been made so that readers not yet in the position won't find themselves there?

Some people may not have any choices like Georgiaprof mentioned.  Other people just don't know any better and could learn from the mistakes of others to not end up in the situation, but only if the mistakes are pointed out to them.

[dellaroux]

Patience and empathy for someone in a different context than oneself are generally not wasted.

I would also encourage ANAP not to give up or lose heart, and to keep expanding her/his reach in seeking affordable options but the choices for those in marginal situations are quite difficult and deserve respect, not derision.

Negotiating the increasingly labyrinthine pathways between primary care, referring, and specialist caregivers can be frustrating and difficult, not to mention expensive in time, money, energy, and focus. Having worked in healthcare at a couple of points as a transcriptionist and staff assistant, there are care providers whose attitudes towards their patients are exemplary, and then there are the others.

I hope you find one whose attitudes are helpful towards your situation, as best you can within the limits constraining you.

There are, for certain conditions (cystic fibrosis is the one I know best, from doing tape transcriptions a long back for a longitudinal study) online communities whose sites have fora structured somewhat like this one, on which people share resources and information and support.

You might want to check those out and see if they include physician/caregiver referrals or local support groups from which to get more helpful specific information, also.

I think fertility coverage varies by state mandates, so your state of residence will probably dictate whatever coverage you can expect as a bottom-line definition. Some require coverage for x number (3, usually, if I recall correctly) IVF tries, etc. (I did temporary transcription/reception for a repro-endo office for a bit, then, too). 

Others don't require anything so the levels can vary widely.

Good luck.