My husband and I are moving, and being old and on all sorts of meds, need to find doctors immediately.
Our doctors down here don’t know anyone near our new location, but a frien had a recommendation or two. I looked at their board certifications and chose one, who is able to get us in sometime in February.
However, the receptionist wanted to make it clear that the doctor does not accept assignment from Medicare or any insurance companies. All charges are due in total at the time of service, and although he will file the insurance, that’s all he will do. I will have to accept whatever the insurance company decides his service is worth.
I understand that he is not running a charity, and that insurance payments can lag months behind, so I don’t fault him. My dentist does the same thing, but I don’t see her as often as I do the doctor, and I can always put off a root canal for a while.
I have just never run into this before, and am wondering if it is more common than I’d thought. Has anyone else ever had this happen? I kept the appointments because something is better than nothing, but am investigating other options.
I don’t know about medical and dental, but when I was an optician in the 90s we would have made next to nothing, and even lost money on some jobs if we’d accepted assignment for Medicare patients.
There are some doctors around here (DC metro area) who are like that - they are not in-network for anyone. I went to one such for a while around the time the kids were born; her office was in a very affluent area in the District. A friend goes to one now, but is looking for someone new for a number of reasons (not related to the reimbursement scenario)
Cons are obvious:
you have to front the cash, then get reimbursed by your insurance - usually at a lower rate for out-of-network
Out of pocket limits are often quite a bit higher for out of network care: our OOP is 7400 for in-network, but the therapist my daughter sees is out of network and we won’t hit her out of pocket; we’d have to have literally about 50,000 dollars in expenses (reimbursed at 90%) before we did so.
Deductibles might be higher for out-of-network; on my husband’s insurance it was 200 dollars where regular visits had no deductible; on mine it would have been something like 2 grand.
Their rates might be higher than the insurer’s allowed rate, and you’re out the difference; for example if a regular office visit is 100 dollars and the insurer’s allowed rate is 80 and they pay 80%, they’ll pay 80% of 80 dollars, or 64 dollars. So you’re out of pocket 36 dollars.
Depending on your plan, you may not even have ANY coverage for out-of-network care
Pros:
It’s quite possible their rates may be lower than in-network rates (though personally I’d doubt that, in-network rates can be pretty brutally low).
The practice might have a lower patient load, therefore making it easier to get in to see the doctor, better face time, etc.
On rereading, I saw you mentioning Medicare: I have no idea how (or if!) Medicare works with doctors who don’t participate. I’d suggest checking into that.
Also: February? and it’s early November? That’s 3 months away. While a non-urgent visit might not be “today”, 3 months seems a bit long and I’d worry about the patient load or their hours or something. Does this doctor have some magic cure-it-all elixir that makes him/her so in demand?
When I was doctor-shopping a couple years back, I met with two. I wound up going with the one whose initial visit was only a week or two away as opposed to a month away.
In your situation I’d keep the appointment for now but keep looking. You may find someone you like in the interim, you may also meet with him/her in February and decide it IS worth it; perhaps a new-patient wait time is not reflective of general wait time, etc.
My daughter works for a “concierge doctor.” Not only does he not accept assignment, patients have to pay an annual retainer to see him.
On the other hand, he gives his patients plenty of time during an office visit, they can get an appointment at the last minute (even on his day off) and he acts more like a case manager than a typical doctor.
Thanks. I am thinking that the reason it will take so long to see him is that he takes sixty to ninety minutes for his initial visit, and he probably only sets a couple of those blocks aside each week, but what do I know.
My husband needs a cardiologist pretty quickly; he had his third heart attack two months ago and is still doing the rehab. I would like to have the name of a cardiologist just in case something happens right after we move. I need an oncologist, but it’s not urgent. Just follow up stuff.
I was also given the name of a cardiologist who does seem to take insurance and Medicare. Although my husband’s current cardiologist doesn’t know anyone where we are moving, I bet he would call in a referral if one was needed. I’ve been thinking of starting with the cardiologist and asking him to recommend an internist at my husband’s visit. I will call him tomorrow and try and set up an initial appointment.
Never move, and never get sick if you can help it!
Doesn’t your health insurance company have a website at which you can search for in-network physicians? Usually you can specify doctors within a given distance of your zip code, physicians accepting new patients, ones with relevant specialties, etc.
Yes, it does, and I have looked at that. We are moving from a rural area to a larger city, and it shows 30 or so internists, all of whom seem to be wonderful and gifted physicians, which is why I was hoping for a recommendation.
I’m probably making finding a doctor much harder than I need to.
I have seen a few more popular doctors do this. It works. For one thing, since they (almost) always get paid, their rates aren’t inflated. The doctors I dealt with did accept Medicare, that was their choice. Elderly folks need care and often can’t afford to pay for it out of pocket. So the Medicare patients got to see some of the best doctors in town, and those of us who chose to got reasonable rates for high quality care. Plenty of other doctors went the usual ‘accepts all major insurance plans’ route so there was care available.
I moved from Florida to Boston bout years ago. Getting a new set of docs was a PITA.
You are. It’s luck of the draw sometimes.
If you have ongoing medical conditions, you may well find that a physician who does not accept assignment is crazy expensive. There are no caps on what that physician can charge.
You will also take a hit from Medicare or your insurance company for using an out-of-network provider, and you may only be reimbursed “80% of the allowed amount”, which is certainly going to be far less than the doctor charges.
Call your insurance company. Tell them you need a doctor who can see your husband immediately for a heart condition (mention that your husband is in cardiac rehab and you’re moving). They can help you find someone who is in-network and accepts their insurance.
I did this when I moved to Boston and was able to get an appointment for the same day.
It may take a few tries to find a doctor with whom you click. Don’t stress about that either. It happens.
I know that it’s weird to use Yelp to help you find a doctor. Also, some folks don’t trust their reviews.
But I found my GP through Yelp. Everything that the posting patients had to say about him was true; he does a good job and I like him a lot. Try looking up one of your current or past physicians who you liked and see how they score, and that’ll give you a better idea of how much faith to put in using Yelp as a filter.
You may not wish to rely on it 100%, but it can be a helpful tool to give you some additional input when you make up your mind.
I found my dentist through yelp and have recommended him to a number of people. My first doctor in this location has great reviews on yelp, but I wasn’t comfortable with his staff, so I changed doctors.
Meaning: look at yelp, give one a try if they’re on your insurance and sound good. But be willing to change doctors if you decide that’s the right thing for you.
I am so happy I am with Kaiser. As long as I am within their service area, all their doctors ‘accept assignment’. If I am sent to an outside doctor for some reason, I still pay my regular co-pay and they pay the rest.
Use your insurance company’s list of in-network physicians and cross-reference each doctor by name on HealthGrades.com. You’ll find real patient reviews and get some idea of which doctor(s) are better than others.
It’s luck of the draw sometimes.