is it illegal for MDs to reject insurance?

[chef]

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i've heard of some plastics and derms flat out reject insurance and only see pts who pay out of pocket. is this legal only b/c they are doing cosmetic procedures? if IM or a FP did this would they be get prosecuted? is there a law for this?

 

[Sanman]

I'm no expert, but as far as I know any doctor can reject anyone for any reason s/he sees fit. The only time thats not true is when an emergency comes into the ER, and then they only have to stabilize the patient.

 

[ckent]

MD's in all specialties can and do routinely reject to see pt's based on their insurance co, many refuse to see all medicare/medicaid pt's, many refuse certain HMO's as well. Some won't even accept any insurance and only want cash. The only exception to this is that you can't refuse to see a pt if he or she shows up at your office and it's a medical emergency. The opposite is also true, that is insurance co's can also refuse you to see certain docs that they don't have contracts with.

 

[ERMudPhud]

Originally posted by ckent
The only exception to this is that you can't refuse to see a pt if he or she shows up at your office and it's a medical emergency.

Actually, this only applies to emergency departments or medical facillities that have ER's. So if I show up to your office in the hospital with SOB or anything that might be an emergency you are required by law to run me down to the ER or otherwise make sure that I am taken care of. On the other hand if I show up to your clinic in some free standing office building somewhere with a steak knife sticking out of my forehead legally you don't have to see me. Ethically, you should probably at least call an ambulance. The law covering this is called EMTALA and the regulations arising from it are complicated and seem to be continuosly changing

 

[ckent]

Originally posted by ERMudPhud
Actually, this only applies to emergency departments or medical facillities that have ER's. So if I show up to your office in the hospital with SOB or anything that might be an emergency you are required by law to run me down to the ER or otherwise make sure that I am taken care of. On the other hand if I show up to your clinic in some free standing office building somewhere with a steak knife sticking out of my forehead legally you don't have to see me. Ethically, you should probably at least call an ambulance. The law covering this is called EMTALA and the regulations arising from it are complicated and seem to be continuosly changing

I know that the laws regarding this matter are extremely complicated, but I do recall reading about a recent successful (or unsuccessful from the physician's standpoint) malpractice case involving a pt who showed up at a physician's office with some emergency that the physician could have handled, but the physician refusing to see the pt. Some states even have good samartin laws that require you, as a physician, to intervene to the best of your ability even when you are not in your office. I suspect that this issue varies largely from state to state.

 

[md03]

Hmmm, I've always heard of good samaratin laws as begin there to protect the bystanders who help from lawsuits by the party the helped. (As long as they act reasonably) This is to prevent a situation where no one helps out of fear of being sued.

I've never head of a good samaratin law that requires MD to help a pt... the only laws I have heard of in that regard are the EMTALA laws which apply to the ED.

 

[Ligament]

illegal not to take insurance?! jesus, they got you by the balls chef!

It is financially STUPID to take insurance if you can get patients to pay cash.

This is still, only by a hair, a capatalist profession.

 

[doc05]

Originally posted by chef
i've heard of some plastics and derms flat out reject insurance and only see pts who pay out of pocket. is this legal only b/c they are doing cosmetic procedures? if IM or a FP did this would they be get prosecuted? is there a law for this?

are you serious? of course you can reject insurance; more importantly you can reject patients.

some physicians (and patients) prefer this because paying out-of-pocket means more ca$h per patient. thus the physician can spend more time with each patient.

this is a great option if your patient base has good insurance. that way they pay cash, you don't have to deal with insurance crap, and at the same time they can file for partial reimbursement with their insurer.

 

[Sessamoid]

Originally posted by chef
if IM or a FP did this would they be get prosecuted? is there a law for this?

Speak not of which you have no knowledge. Internists and FPs do this ALL THE TIME. Of course there's no law for this, except for emergency cases.