Author Topic: Doctor Refuses Cash/Must Submit To Insurance  (Read 1528 times)

aksirk

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Doctor Refuses Cash/Must Submit To Insurance
« on: January 23, 2012, 04:53:57 PM »
I just had a procedure done by my dermatologist.  I wanted to pay cash for it, but was told I cannot.  They said they are under contract with the insurance company (Blue Cross) and must submit it. The doctor's billing agent worried that the insurance company would not look kindly on them doing a "side deal" with me. This makes no sense to me. I surely think they are misinterpreting some aspect of their rate reimbursement agreement.  As the patient and consumer, how can I have no say in the matter? Lastly, I would think if every policy holder paid their own bills, the insurance company would be quite happy.

DMK

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Re: Doctor Refuses Cash/Must Submit To Insurance
« Reply #1 on: January 23, 2012, 06:29:54 PM »
Is Blue Cross your insurance carrier?  Is it a covered procedure? Do you have deductible to meet?  Do you have a co-pay?

If you're a Blue Cross member, and he's a Blue Cross provider, it's my understanding that they have to bill it.  If for no other reason than they might not know what the contracted amount is for the procedure you had done, so they wouldn't know what to charge you.  (Even with a high deductible, where you KNOW you will have to pay, they may not know what to charge you.)

Once it goes to Blue Cross, you can always come back and pay cash for the portion you owe.   If they can even accept cash.

Not all offices have the ability to process cash payments.  I'm not pointing fingers or accusing anyone but there have been some offices where the payment gets posted but the cash disappears.

There are many different scenarios that it COULD be.  But I really appreciate your willingness to pay for services at the time they were rendered!  You're right, healthcare might be in an entirely different place if everyone were so conscientious!

aksirk

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Re: Doctor Refuses Cash/Must Submit To Insurance
« Reply #2 on: January 23, 2012, 06:52:36 PM »
Blue Cross is my provider.  The procedure I got was cosmetic and I was warned by the doctor months before getting it done that insurance likely would not cover it.  I was told how much the procedure cost and being that it was only $40 more than my $50 co-pay ($90) I decided to pay for it myself. I have a great distrust of insurance companies so my thinking was to just keep them out of this.  Unfortunately, my wife and I had a lot of medical care the past couple of years and I don't want to get on their radar if not medically necessary. The crux of my question is how can an agreement between two other parties dictate what I can do?  Blue Cross does not dictate that I can't pay for my own services. If insurance companies are setting the rules for doctors, then doctors need to post those rules for all patients to see.

PMRNC

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Re: Doctor Refuses Cash/Must Submit To Insurance
« Reply #3 on: January 24, 2012, 07:59:22 AM »
Quote
Blue Cross is my provider.  The procedure I got was cosmetic and I was warned by the doctor months before getting it done that insurance likely would not cover it.  I was told how much the procedure cost and being that it was only $40 more than my $50 co-pay ($90) I decided to pay for it myself. I have a great distrust of insurance companies so my thinking was to just keep them out of this.  Unfortunately, my wife and I had a lot of medical care the past couple of years and I don't want to get on their radar if not medically necessary. The crux of my question is how can an agreement between two other parties dictate what I can do?  Blue Cross does not dictate that I can't pay for my own services. If insurance companies are setting the rules for doctors, then doctors need to post those rules for all patients to see.

If only things were so simple right? I can understand the situation but your provider is under contract with BCBS, so "keeping them out of it" would not be ethical and it would indeed violate their contract.  They could have taken your deductible amount from you but they also may have waited because sometimes by the time a claim is submitted the deductible has been met. I'm pretty sure that when you went in they had an office and financial policy that was given to you, maybe you just don't remember, Physicians are the most highly regulated in the country.   Insurance companies really are not the bad guy, but unfortunately when dealing with providers they can't just arbitrarily decide to keep your insurance out of it.
Linda Walker
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