What to Do When a Doctor Refuses to Accept Insurance

Most people in the United States have private insurance, usually through an employer, according to the Families USA website. Under the private insurance system, doctors can legally refuse to work with some insurance companies based on a company's reimbursement policies. But if your doctor won't take your insurance, all is not lost.

Rationale for Refusal

• If your doctor will not take your insurance, it is not because he does not want to treat you. It is because your insurance company has not agreed to reimburse the doctor at a level he feels is fair. In other words, accepting your insurance would cost the doctor money, as he can choose other patients whose insurance companies pay more.

Immediate Care

• If you need medical services right away, the best thing to do if your doctor won't take your insurance is to go to a free or sliding-scale clinic. These clinics usually are funded either by government grants or by private donors. They may take the insurance you have. If not, you may be able to pay cash. This is a temporary solution until you find alternate, more permanent medical care arrangements.

Boutique and Concierge Practices

• The assumption that all doctors work with some insurance companies is incorrect--some doctors run "concierge" practices and don't accept any insurance. This is either because they believe they can make more money independent of insurance companies or they want to eliminate the hassle of seeking reimbursement. Costs likely will be low because concierge practices tend to limit their services only to primary care (e.g., physicals, basic blood tests).

Negotiation

• You can approach your physician and ask if she'll reconsider taking your insurance, says Dr. Mehmet Oz of New York Presbyterian and Columbia University. You also can lobby the insurer to offer your physician a competitive reimbursement. This may be the best option if you do not want to use any other doctor. You are more likely to be successful if you get other people to join you in the request.

Respect

• If your doctor turns down your insurance, do not take it personally. Remember that the bottom line is the doctor's income, and not all the money a doctor makes is take-home pay. Treat your doctor with respect and have a calm, intelligent discussion of why he won't use your company. He may convince you that there are better alternate companies with similar premiums.