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Unblievable Doctor Policies

by Gabby
July 28, 2008 6:08 PM
50 Replies
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I have been saving up some $$ to go to an Endo to get my diabetes officially diagnosed and hopefully get the help and guidence I need. I decided to call around to get some pricing for visits so I knew what I needed to take with me. You know what I mean...money, cash, dinero??
This dropped my jaw. The voice on the other side of the phone told me "We don't accept self-pay patients."
I was astounded. I called the other Endo (I live in a small town and we only have two) The same thing came out of her mouth. I couldn't believe it.
All this time I thought I wouldn't be able to go to a doctor because I couldn't afford it without insurance. Now I find I can't go because I only have CASH to pay with. What is wrong with these people? I have been denyed my choice of helthcare professional not because I couldn't pay, but because I don't pay with inusrance.
Is there some kind of recourse I have?

Tags: insurance, self-pay patients

From	Replies
Rita	Rita replied July 28, 2008 6:20 PM Hello Gabby. The same thing happened with me at the ob/gyn. when i was pregnant.I told them upfront i do not have insurance,set up an appointment, we talk over everything what and how to do etc. Then they put me on the billing department to discuss the payment. And when they ask what kind of insurance i have and found out i don't the lady said sorry, but we are overbooked and i should try an other dr. Basically the same story with different dr. Is there a Health Department in you're area? I'm seeing an ARNP at the healt department, and they much cheaper then a regular doctor. Especially the blood work. So far i got a good care of my diabetes for half the price. Add your reply Flag as Inappropriate patti replied July 28, 2008 7:04 PM Hi Gabby, First try calling and asking for the office manager, ask then what is wrong with cash? Also ask your primary care doc to call and talk to the doctor he/she may not be aware what the staff is telling patients. Many docs give a 10% discount to patients with no ins. Hope this helps! Add your reply Flag as Inappropriate Gabby replied July 28, 2008 7:24 PM My primary doctor is the one I am going to use for now. Since I lost my job and insurance back in 06, I have not visited a doctor. My primary is a good guy, and I like him a lot. I just wanted to go to a specialist to get the best care I could get. It is going to be close to $200 just for my primary and I figured my money would be best spent with a Doctor that studies Diabetes... When I called my primary to get prices from his office, I explained my perdiciment, and they told me that specialists often work that way. That is just so very wrong on so many levels. Add your reply Flag as Inappropriate
JP	JP replied July 28, 2008 8:08 PM Gabby, that is deplorable behavior on the Endo's part, the actual doctor probably doesn't even know the business office does that. I've heard of it happening before though. They probably don't know how to deal with cash, but I wouldn't let it stop there. I would call them again or write a letter to both of them and send a carbon copy to the Medical Society of your state. But that's just me (trouble maker lol). Honestly, I can't believe that they would do something like that. I think you'll be ok with your regular doctor though. My main doctor is a family doctor and he's very aware of everything new that comes through for Diabetes. I give him articles about everything when I come across them. I always tell him "I'm not trying to tell you how to do your job, just found this interesting and thought you might too". When I go in, I have my blood sugar readings in an Excel spreadsheet for him for the month before my appt. They are human and can't know everything but as an active participant in my own health care I question him if I don't understand something and I voice my opinion when I disagree. (nicely!! LOL). He appreciates my perspective as I've been dealing with this blood sugar picture in my life longer than he's been alive!!! Good luck hon... Judy (JP) Add your reply Flag as Inappropriate Gabby replied July 29, 2008 4:11 AM* I will just have to try that. I too am a trouble maker when it comes to things like this. I will write a letter this week and see if anything happens. My family DR is a rare one, and I do like him. He is more willing to think outside the box than most I have had. He also treats my mom, and just as you said, knowing everything about diabetes is impossible...my mom feels that he is not up to speed in this area. So I will have to be as you, and bring him all kinds of cool stuff to read. LOL. Add your reply Flag as Inappropriate
Leigh Marsden	Leigh Marsden replied July 29, 2008 4:19 AM WOW! That's crazy! I am so sorry that this is going on. I have no knowledge of this type of thing, but, I am rooting for you! Leigh Add your reply Flag as Inappropriate
JoJoCooks	JoJoCooks replied July 29, 2008 6:13 AM This is a bunch of BS if you ask me. I would call the medical board...how can they refuse you just because you want to pay with cash and not insurance..WOW..this is the first time I have EVER heard of this. Maybe go to a hospital instead..they can't refuse patients because of no insurance. But I am in shock really...WOW Add your reply Flag as Inappropriate
kdroberts	kdroberts replied July 29, 2008 7:36 AM It's one of those minority spoils it for the majority things. The minority of cash patients will show up and not have money so the doctors office either cancels the appointments and looses money that way, or they keep the appointment and never hear from the patient again. It's actually kind of a dumb practice because the doctor can actually make more money from a self pay patient than an insured one. Ask to speak to the office manager and ask why they have the policy. If you really want to see that doctor, offer to pay when you make the appointment so they know they are guaranteed to get paid. Add your reply Flag as Inappropriate John Crowley replied July 29, 2008 7:54 AM Most doctor's offices I've visited in the last 10 years have a sign right on the front desk that says "Payment must be made at time of services if arrangements for payment have not been made." In other words, cash patients pay up front. Which I think is probably a fair way to handle it. You wouldn't expect to get your car fixed and not pay for it when you picked up the car. So this is the same thing. You see the doctor, you pay the doctor. Seems like a simple solution. Add your reply Flag as Inappropriate kdroberts replied July 29, 2008 8:18 AM It is a simple way, but reality isn't as cut and dry as that. What do you do when a patient turns up with an appointment but no money or insurance? Do you cancel the appointment and lose the money you would have got for the patient or do you have the doctor see them knowing the chances of you actually getting paid are slim? It's not an accident that they don't have cash in hand to pay, they may have no other option or they may just want to pull a fast one. It's this type of person who spoil it for people. If you have the choice of a guaranteed payment of $50 or a chance of a $75 payment but an equal chance of $0 and an empty appointment slot or $0 and services rendered, which are you going to go for? From a business sense you can't really argue with it and since healthcare in the US is primarily a business it shouldn't come as much surprise. Doesn't make it right though. Add your reply Flag as Inappropriate Jonathan replied July 29, 2008 8:27 AM While I sympathize with doctors who have patients who show up without the ability to pay, I think it is deplorable for a doctor to refuse a patient because the patient does not have insurance. My own experience with most of my doctors in NYC has been that they do not even take insurance to begin with. While a doctor has a right not to get screwed out of payment, when a patient is willing to pay, the doctor should accept the appointment. I wonder if business is that good for the endos that they can afford to turn patients down? Add your reply Flag as Inappropriate kdroberts replied July 29, 2008 9:02 AM "I wonder if business is that good for the endos that they can afford to turn patients down?" Actually it is. There are no where near enough endos to cope with the patient load and it's getting worse as fewer new doctors are specializing in it. I read one statistic a while ago that in order for every diabetic who wanted to see an endo, every endo in the country would need a patient load of more than 15,000. Add your reply Flag as Inappropriate DiabetesDiva replied July 29, 2008 10:15 AM I'm so sorry, Gabby. What an injustice. I just see my primary doc and she is fabulous. My father lives in a small town and there aren't even enough primary docs for him to see. The 1st one moved away, the 2nd retired and the 3rd one moved away, all in one year. May I ask what state you live in? My husband works for the county Health dept here. He may be a resource for us. Take care. Love, Kate Add your reply Flag as Inappropriate Gabby replied July 29, 2008 5:20 PM I live in marion county in Florida. Add your reply Flag as Inappropriate John Crowley replied July 29, 2008 10:41 AM Sorry, kdroberts, I didn't mean to suggest that I was disagreeing with you. You are absolutely correct that a few have spoiled it for the many. I was just trying to point out that at least around where I live, there seems to be a standing policy. And if the patient pulled out their checkbook or cash and paid on the spot, it seems to be very little risk for the doctor. In fact, from a business cashflow perspective, it would be much better to get paid at the time the services are rendered than to bill insurance companies and wait and wait. Add your reply Flag as Inappropriate kdroberts replied July 29, 2008 10:57 AM Last edited about 1 year ago No worries. I agree with you and every doctor I've been to has the same sign. They also make more of self pay patients because they get paid less with negotiated insurance. The problem comes in when you are selecting the patient, not when the patient comes in for the appointment. For an insured one it's almost guaranteed that if they make an appointment you will get paid. With a self pay you don't know what will happen until the patient shows up to the appointment. All the signs in the world are not going to help if the patient turns up and can't/won't pay. You either lose an appointment slot that could have been used for a paying customer or provide a service and run the risk of not getting paid. That's why I suggested offering to pay at the time you set up the appointment. It maybe slightly inconvenient to you but the doctors office knows they have a guaranteed payment so may be more willing to help. It's one of the major downsides to privatization of services (not just healthcare but anything). Once something goes private it becomes a business and is no longer a service. The primary goal switches from serving people to making money and policies are geared towards protecting the businesses interests rather than protecting the customers interests. Add your reply Flag as Inappropriate Gabby replied July 29, 2008 5:23 PM The crummy part is that I told them up front that I wanted to know how much the vistis would be so I could come prepared...actually save some more. LOL. That is what burned me so much. I am not a big fan of the "system" and I could go down a really dark path in voicing some opinions. This just made me cry. I couldn't believe it at all. Add your reply Flag as Inappropriate
Frustrated mom	Frustrated mom replied July 29, 2008 1:39 PM That is crazy..But maybe they think CASH only is a risk, because having Diabetes of any kind is so expensive. Have you tried for any kind of assistance? Good luck! Frustrated Mom Add your reply Flag as Inappropriate Gabby replied July 29, 2008 5:31 PM Here is my beef. They are DOCTORS! They are supposed to CARE about people and do what they can to make sure that we are well cared for. They take an oath to not harm people. Denying a patient is bad enough, and I know they cannot live on air, BUT if I have money, and I need their help, WHY CAN'T THEY SEE ME? I am so angry that they don't care about anything but the pocket book. I don't do my work for free either, but I do offer those who NEED my services breaks when the cause is good. And my business is a "luxury" business. Being a doctor is filling a NEED not a want. I was not asking for any special consideration, I am just uninsured and can only pay with cash for any of my life needs. I am sorry, I am babbleling...I am so beside myself. Add your reply Flag as Inappropriate seawolf1944 replied July 29, 2008 7:05 PM Hello everyone, So glad to join the discussion. Simple solution: when a doctor finishes med school, He or she takes a medical oath to treat the sick.rich or poor. Theres nothing in the oath about monetary payment,insurance or other wise. If,You make a medical appointment,ask what the monetary charges are for seeing the doctor. Be sure,You make the appointment in person at the office. if,They quote the amount,show them the cash up front,offer them the cash right the and there and ask for a receipt. If,They refuse cash, Contact the American Medical Association,ask for a reprsentative,Who can take your complaint. After a few complaints,Im pretty sure the practice can be eliminated. Also don't be afraid to contact your local newspaper editor,tv station,even Email CNN or Fox news. It time to stop the stupidity. This practice of refuseing cash is nothing short of disgusting treatment toward people seeking medical help. That putting it mildly. John Add your reply Flag as Inappropriate butterfly_8 replied July 29, 2008 8:45 PM I have listened to all of this and I cannot under any circumstances understand a no cash policy. It seems you should be able to pay for services with any legal tender,and if this is not true then it should be considered illegal and against the law to turn anyone away.I would be interested in what the media would have to say about that. Add your reply Flag as Inappropriate tmana replied August 1, 2008 2:04 PM Here are the issues against self-pay as I understand them: Before consultation, the doctor cannot tell you what tests he will require, and how much they will cost. On my previous insurance, I'd get a complete breakdown from the doctor's office about which tests were performed, what the standard rate was for each, what the negotiated rate was for each, and what was paid by the insurance company. My standard three-month visit ran me a $20 office-visit co-pay plus about $10-15 in test co-pays at 90% coverage (no deductable for standard office visits). If I had paid out-of-pocket, it would have run me about $450 per visit. As far as "not turning anyone away", the way negotiated payments work is, that if you charge a lower rate for ANYONE at ANY TIME, the insurance companies will lower your standard-and-customary for ALL patients to that level, and pay you even LESS for the work you're doing. Already, the insurance companies are mandating that doctors spend less than 10-15 minutes per patient a day, and most doctors are NOT living high off the hog given the office expenses, business insurance expenses (including, but not limited to, malpractice insurance), test equipment expenses, AND the bargaining-down by health insurance companies... Add your reply Flag as Inappropriate morris.js replied July 29, 2008 8:14 PM Gabby, Girl you know there will be a way to fix this, so just settle down, maybe try that new bottle of red wine, and relax....LOL You will get to see your specialist, just take a breath and follow some of the advice you have been given here. All your friends are here to keep your sanity level down so your sugar level stays down. You know your in my thoughts and prayers. John Add your reply Flag as Inappropriate Gabby replied July 30, 2008 4:35 AM I like the relaxing with a glass....LOL Thanks John :) Add your reply Flag as Inappropriate
Gabby	Gabby replied July 30, 2008 4:33 AM Thanks everyone for your advice and encouragement. My weekend project will be getting some letters out, and confronting my nemisis'. You have a lot of great ideas, and I will take it to the papers too. I've been front page before and know a few people on staff. I will let you know what happens. Add your reply Flag as Inappropriate
Gabby	Gabby replied July 30, 2008 12:27 PM I did call the offices back and asked again about cash payments. They told me that I would have to have a referral anyway from my primary so I would have to pay twice. (that is if they would take me, which they won't) One was very helpful and gave me the number to my county health department. So one day next week, I will go jump thru the hoops and hope that I don't make too much money to qualify. I also don't know what kind of care to exepct from them so it should be interesting. Do any of you use your local health department for your medical needs? Add your reply Flag as Inappropriate John Crowley replied August 1, 2008 12:44 PM OK, as if this whole situation wasn't crazy enough, you were seriously told (as a patient without insurance) that your primary doctor had to refer you? That is a practice implemented by the HMOs to try to avoid having to pay a specialist whenever they can. There is just no reason to force you to see your primary doctor, unless they think you're not really a diabetic! If you know you have diabetes, why on earth would you need a referral to see an endo? I'm not writing this to get you more upset, I actually find it laughable that an HMO policy would somehow become a doctor's policy. Especially, when it was a money-driven policy in the first place. Add your reply Flag as Inappropriate
Kristine	Kristine replied July 30, 2008 1:21 PM I know what you mean about medical places that wish you to pay with only insurance. But I've been on the end where you are employed, diabetic and in battling with the insurance people that are involved with the company you're employed by. My problem was with policies involving pre-egsisting conditions because you have diabetes. I was caught in the middle. Waiting to be accepted and was hospitalized while waiting to be accepted. Now I'm in between and caught in the mist of paying hospital bills and unemployment at the moment. These days companies are not wanting to take on people that are such health risks to their companies. Neverending circle of being screwed by companies who don't want to insure you. Decided pretty much to insure myself. Seeing that I'm so discusted by what I've already gone through. Plus, I'm unemployed right now which makes getting my insulin all that more difficult to get. Add your reply Flag as Inappropriate Gabby replied July 30, 2008 1:40 PM Kristine, You know what. Working for yourself is the best thing in many ways. I know I complain because I don't have insurance. No one will touch me now, but I am kind of over it. I work for myself and if I am having an off day or I need to do something for myself, I don't have to worry about a boss not understanding why I am late or out. I don't know what you do for a living, but if there is any way you can make it into your own business, I would try. In my book, insurance is a lot of money that I pay for years and I have never used it except for maintenance visits when I had it. It never covers what I need. Dental, Vision, and even my Podiatrits and my toe surgery was not covered...so what is the point of it. To help me if I am in an emergency?? Sigh I guess I am just jaded. Save the money you would normally pay the insurance and use it. Until we are on Medicare, it just doesn't seem to work very well. At least that is my experience. Add your reply Flag as Inappropriate DiabetesDiva replied August 1, 2008 1:31 PM Last edited about 1 year ago Hi Gabby- Please explore the insurance option a bit more, maybe things have changed a bit. More & more of us are self employed. Kate Add your reply Flag as Inappropriate kdroberts replied August 1, 2008 2:07 PM "For others, if you work for larger companies, there are no pre-exisiting denials." Yes the is and it happens frequently. HIPAA has helped but you still need to prove creditable coverage with no significant gaps in order to count against any waiting period for pre existing conditions. Group health plans count as creditable coverage and a significant break is 63 days or more. It works by giving you a day in credit for each day you have been insured to offset the pre-existing condition period. Say that pre-existing condition period is 18 months and you only have 12 months of creditable coverage, you will have 6 months where your pre existing condition will not be covered. If you have 18 months or more than you will be covered from the start. If you have 6 months, a gap of 64 days and then 10 years before that, only 6 months counts towards your creditable coverage. That's why COBRA is such a good idea to have if you are between jobs so you can keep creditable coverage. People moving to the US from another country should be able to use coverage in the foreign country as well, although sometimes it's a hassle. I know if you move to the US from the UK you can get a letter from the NHS saying you've been insured by the government for x number of years and that should negate any pre-existing condition blackout period. Add your reply Flag as Inappropriate DiabetesDiva replied August 1, 2008 2:46 PM KD: You're right for some companies the continuous coverage does apply. Cobra can be so expensive, it may not be an option for some that are unemployed. My sister's Cobra was twice as expensive as a policy from Blue Cross. She was 60 at the time and did have some pre-existing conditions. Add your reply Flag as Inappropriate kdroberts replied August 1, 2008 4:26 PM Technically COBRA isn't more expensive than the policy you were on. It's just that it isn't subsidized by a company so you have to pay the whole premium. It does make you appreciate how much your employers actually pay towards your policy. Even with the expense it's still worth trying as hard as you can to pay it since the policy cost will pale in comparison to medical costs that possibly won't be covered. Add your reply Flag as Inappropriate DiabetesDiva replied August 3, 2008 11:18 AM KD: Are you a Benefits Broker? Add your reply Flag as Inappropriate kdroberts replied August 3, 2008 1:40 PM No. I just used to work for a company that handled electronic medical claims submission and electronic patient records so I have HIPAA training and insurance issues out the wazoo on a daily basis. Add your reply Flag as Inappropriate Gabby replied August 3, 2008 5:34 PM I have, and I can get discount programs, but not insurance. I have searched and searched. I can't see spending $120 plus a month to still have to pay out of pocket for most of my stuff. It is disheartening, and I have pretty much decided that I will just do my own thing for now. Add your reply Flag as Inappropriate
Barb Silcott	Barb Silcott replied August 3, 2008 2:07 PM That's one of the most insane things I've ever heard! Won't take cash? What about a check or money order. No? Why all of a sudden is good old American currency a bad thing? My family doc doesn't know a whole heck of a lot about diabetes, but he hooked me up with another internist who is well versed. Then I found out there's another one about 15 miles closer. Sigh We can't win for losin'. Add your reply Flag as Inappropriate
Dancehawk	Dancehawk replied August 3, 2008 3:13 PM yeah either its insurance or medicade they do not take cash cause there afraid you ll want to make payments. Our dentest has a program it is a prepay card ask if they have that. next time I go i ll grab the pamplet and read it to you, I just remember its like a debt card for them you put the money in they draw it out on payment due date. Our there any clinics close by your town? I hope things work out . me very very sads. Catherine Add your reply Flag as Inappropriate
DonnaAnn	DonnaAnn replied August 3, 2008 3:52 PM Do you have a Access AGENCY near you? it is a agency that helps people that does not have insurnace to get insurance. In CT we also have something called Charter Oak, which also helps people with out insurance. there are many agencies out there, you just have to look and ask around. Call your local welfare office to inquire. Add your reply Flag as Inappropriate Gabby replied August 3, 2008 5:37 PM I contacted my local health department to see if I can get in there. I am not sure about the quality of care, but you never know. I probably make $5 too much a year and won't qualify...I'm usually in the limbo land stuff. I am going next week to see. Add your reply Flag as Inappropriate Gabby replied September 20, 2008 12:59 PM I didn't qualify for the county health department. I can go if I get some kind of communal disease like rabies. Gee thanks...Oh well, I will just keep doing the best I can where I'm at. I am so frustrated with it all, I am just going to hope that if I get in a really bad place, it is the end. So until then, I am going to keep my life going in the right direction. Just pray for me a lot. LOL Add your reply Flag as Inappropriate
DonnaAnn	DonnaAnn replied August 3, 2008 3:56 PM Its a shame that the ADA can not help us out. Arent they the ones who help us every other way? Add your reply Flag as Inappropriate
wetinkwisdom	wetinkwisdom replied September 20, 2008 11:12 AM I was told you have to be referred by your main doctor to see an Endo. Doctor. Add your reply Flag as Inappropriate Gabby replied September 20, 2008 12:56 PM Yes, they do want a referral, but the fact that I pay cash because I don't have insurance, is why they won't even accept me as a patient. My doctor would have no problem referring me...but you know what, If I don't have insurance and I WANT to see any doctor, I SHOULD be able to see whom ever I want. Our system is just so messed up. Add your reply Flag as Inappropriate caspersmama replied October 18, 2008 7:42 AM I asked my Doctor about this and he said this. When you go to a specialist like an Endo, there are so many tests that they want to run but those are contracted out so the only thing you are paying for is the office visit. Plus if he needs to run more tests he has to wait for you to come back with enough cash to cover the visit. While it really does suck about this for you, you would think they could arrange a payment plan for the other tests or work out one with the contracted services. Good Luck to you. Add your reply Flag as Inappropriate Gabby replied October 18, 2008 5:06 PM It's not even that they won't do a payment plan. They won't accept a patient that pays cash at all. That is what burns me. I could understand not wanting to make payment plans, they are not a bank. But I was calling to see how much I needed to save up to go, and pay all at once...but they said no. Add your reply Flag as Inappropriate
Avera	Avera replied October 21, 2008 2:36 PM These kind of things have also baffled me as well. It seems as if money is more important than health to doctors these days. Have you ever had one want you to pay before they call you back for your appointment? Add your reply Flag as Inappropriate Gabby replied October 21, 2008 3:13 PM NO, I have not had that happen...yet LOL Add your reply Flag as Inappropriate Anonymous replied October 21, 2008 3:21 PM My daughter's doctor does that all the time. She pays for the office visit and she is billed the rest if they have run any more test or etc. And she pays the rest on a payment plan. I never saw anything wrong with that. Add your reply Flag as Inappropriate Gabby replied October 21, 2008 3:39 PM I wish they would do that for me. But I have tried. I have just kind of given up on doing anything about it anymore. When the economy gets turned around and I can actually earn a living again, I guess I will look into it again. By then, I hope I won't need any meds, and that I will be in control and won't need anything from them except a pat on the back and a howdy do. LOL Add your reply Flag as Inappropriate