Insurance Denied Coverage - Doctor Doesn't Take Cash

[anewbb 0]

:smile2: Congrats on getting the insurance coverage straightened out. I wish mine had the medically necessary clause. Instead they have paid for a heart cath, 3 hospitalizations, stress test, lung scan, 1 er visit, a CT scan & ultrasound of GB and carotid(Sp), CPAP (can't use) nearly monthly visits to heart, lung & kidney drs, plus thousands of dollars for meds in the last 1 1/2 years. All with no real diagnosis. That is not counting 6 days in CCU, heart cath, & 3 echos for congestive heart failure in Oct 06. Payment for WLS, ZERO.:mad: Sorry bout the rant

[WASaBubbleButt 41]

I have been told that some doctors aren't taking patients without insurance any more -- that it was some sort of trend in the industry -- but this is the first time I've heard about it happen to a real person. It's kind of scary if this is a trend.

Considering that most in the US who needs WLS do not have Bariatric coverage, one has to wonder how long this will last that docs require insurance. Seems as though they'd have to turn away most people. They won't be able to do that for long.

[MacMadame 81]

The person who told me this was a trend wasn't talking about WLS, just regular medical care. Honestly, I didn't believe her. But if a bariatric surgeon -- someone in a very cash-oriented field of surgery -- isn't accepting non-insured patients, it makes me wonder.

I think the US health system is such a mess. Nothing about it surprises me any more.

[triser72 0]

I have a student whose stepdad is a PS and they are going cash only b/c health insurance companies are paying them "pennies" for procedures. The insurance cos. discount all the rates, so the docs inflate the prices....and so it goes....

My husband's psych is charging him $5 for every prescription refill that has to be written - they call it medication mgmt and the insurance co. said they can't prohibit them from doing it. If we want the meds, we pay $5 for a med tech to write the prescription on a pre-signed piece of paper.

Insurance on a Conveyor Belt......good times.

[leelanau 0]

Well, due to the fact that the insurance seems a go, I went ahead and scheduled with my doctor to star the six month supervised weight loss today, along with several blood panels that the endocrinologist ordered. I will definitely post updates later should the insurance company decide that I do not qualify for medical necessity - even though I've been diabetic since age 29. My doctor was supportive during the exam today, and encouraged excercise and wanted my past visits with the dietician sent to his office. In all, I am hopeful that this will work out, but whether I decide to have the surgery or not, we have got the process started.

[leelanau 0]

I meant 'start' instead of star... oh well....

I forgot to mention that the doctor was interested in the fact that the clinic was requiring nutrition training as well as a psych eval, as he didn't realize that was required. As he was the original referring physician to a particular surgeon in the group, he wanted to warn me that the surgeon was 'meticulous' which I inferred meant picky. My PCP definitely likes the time frame required by the group before surgery, as it will give me time to make the best decision, and the doctors plenty of time to make sure this is the right choice medically. In all, I feel it was a good day.

On another note, my PCP no longer accepts cash payments, as he HAD to join a larger medical group/hospital in order to retain his client base during the latest insurance dustup. The main employer in our area changed services to BCBS after ConnectCare, and that meant that all area doctors had to take a pretty steep reduction in payoff. He wanted to retire, but is still too young, so he felt he had no choice but to change his practice to reflect the area. He said his projections are that he will need to work at least two extra years longer than planned just to save enough for his retirement. It's sad that insurance has such pull that it can change a very good doctors life plans overnight by reducing his income. Now that he is a member of the 'group', he can no longer accept patients without insurance either - which does seem to be the newest trend.