Follow
Share

When I first arrived in our new town, I set out to find Mom a doctor. I got good referrals. Every office I called said that they were not taking new patients. This week I needed to go to the doc and called one of those offices. Suddenly, they are taking new patients.
Can a doctor legally refuse to take Medicare patients? No one has come out and said this, so I'm not sure now.

This question has been closed for answers. Ask a New Question.
Find Care & Housing

68 Answers

Most
Helpful Newest
First Oldest
First
1 2 3
If you're trying to find a new doc and u have Medicare u need to make sure they ACCEPT ASSIGNMENT ON MEDICARE..which means they bill med and take what they allow as payment..unless u have a secondary ins u will b responsible for balance that Medicare doesn't pay..some doc tell u they TAKE MEDICARE...meaning they r not a participating member of med..if they ACCEPT ASSIGNMENT they accept what med pays...u may have a small balance left to pay but nowhere what it would b if they didn't ACCEPT ASSIGNMENT...doc can choose to participate with med or not some will bill medbfor u and they money med pays comes to u which u use toward paying doc...docs r like people who own property to rent...they can choose to rent to a person who has HUD government assistance for paying rent or not..
Helpful Answer (1)
Report
(First, there is one answer - "5 years ago" - that the problem is massive cuts mandated by Obamacare - sorry, that isn't accurate at all, and has nothing to do with the ongoing and historical situations per Medicare). Currently, yes - doctors can (and do) refuse to accept any Medicare patients because of the low reimbursement rate. I personally really resent this whole system, because Medicare is "the health insurance of the retired" ?!!! I am now on Medicare, with a Medicare Advantage plan through AARP. Medicare isn't free - admittedly, it's much less expensive than "real" health insurance - but there is an automatic deduction from Social Security as well as another premium if you choose to have extra/enhanced coverage through an Advantage (or "gap") plan (you can't have both at the same time). I needed a counselor after a severe and ongoing trauma but couldn't find one for months who would accept Medicare. The first one I finally found that would was a complete idiot (sorry, but he was!), and after I poured my heart out for an hour (and recounted the horror I'd been going through for a year), he looked at me and said "So, do you think this has caused you stress in your life?" - Really? I just told him "you're fired!". I now have a nice counselor who just feels everyone should have access... Interesting fact, though - my "United Health AARP" Medicare Advantage coverage requires a co-pay of $40 for "mental health" visits - twice what they charge for medical Specialists - and in fact, more than the amount they actually pay. Since I'm currently going to my counselor once a week, $160.00 for co-pays is a pretty hefty bill out of my pocket? Mental health care shouldn't cost more than any other care!

I think the denial of Medicare acceptance is discriminatory against an entire segment of the population - the retired/elderly - and there should be some system to ensure coverage is available. Maybe there should be a requirement that doctors or clinics/medical groups, whatever, accept a minimum percent of Medicare patients... If this was spread uniformly across the board, everyone would have to "share the pain"? Non-compliance could carry a penalty at tax time (any incentives or deductions currently available - I don't know? - denied?) Something! I've gotten to the point that if someone does accept Medicare I'm somewhat skeptical why - can't they attract enough "paying" patients and have to take the dregs? This is an issue I'm not seeing debated, or even acknowledged, by the current controversies...
Helpful Answer (2)
Report
I am guessing that if doctors refuse patients with Medicare, it is because they do not have a contract with Medicare. Therefore, Medicare is most likely going to have to reimburse the patient for what Medicare would have paid the doctor. In other words, you can see the doctor, pay his price, get a bill and submit it to Medicare. Medicare would then reimburse YOU what they would have given to the doctor.
Helpful Answer (2)
Report
Not right but yes if they don't take Medicare. There are also some doctors who don't even take Medicaid, so yes. What you can do is either call Medicare and see if they have a booklet on doctors who take Medicare, or you can ask your local hospital. Ask for the hospital admin, start there. Someone will be able to help you get a list of local Medicare doctors. Of course another one might also be social services, you can try that
Helpful Answer (0)
Report
Yes, legally a doctor can refuse to accept Medicare as payment in full. Now for that doctor to refuse to accept this new patient because he/she doesn't accept Medicare, they do have the option of charging you and making you pay for their full normal fee. Medicare pays a much lower portion of the fees they charge and Medicare and its supplement must be accepted as payment in full. So if you want to pay full costs, they cannot refuse you - they can only refuse to be contracted to Medicare payments.
Helpful Answer (1)
Report
Isn't an apartment owner more like a Doctor than a Hospital? Hospitals receive federal funding and required by law to offer services. Apartment owners are just people trying to make a living off of their personal investments. How could anyone expect an apartment owner to rent for less than it costs for upkeep? I have some experience here. An example was a family that had a son who sit their apartment on fire. While the owner was rebuilding the state sent the family to a hotel. The tenant was suing the apartment owner because he was refusing to let them back in the apartment. The tenants won the lawsuit and moved back in.
Helpful Answer (0)
Report
A person can always go to the ER and get care no matter what is their insurance carrier or if they have no insurance.

A hospital won't turn away someone if they can't afford treatment [per a law put into place by President Reagan], but a landlord can turn down a person if that person doesn't meet the income requirements to pay for said apartment and/or has terrible credit.
Helpful Answer (2)
Report
As a apartment owner I am required to rent to anyone without regard to their physical ability or whatever, how is that a doctor can put a persons life in jeopardy by refusing treatment because it is their business and they can accept who they please? An apartment owner rents apartments as his business and also needs to make enough to make ends meet. DOUBLE STANDARD!!!!!
Helpful Answer (0)
Report
Yes, my FIL limits the number of medicare/Medicaid patients he takes in his office - but doesn't eliminate entirely. The reimbursement rate is lower than his costs & also the reimbursement takes forever.
Helpful Answer (1)
Report
Some doctors bill by the medical group, and some of these groups have opted in to medicare. Some doctors bill independently and some independent doctors have opeted out. if a doctor, or group, has opted out, they cannot even take your cash. If they accept assignment, they take medicare, but may not take your HMO plan. If you have a PPO supplement, it will pay if medicare accepts assignment. Generally. If you need help sorting it out, you can get help from SHIP, your state health insurance agency or call medicare directly, which has been, in my experience, the least amount of run around.
Helpful Answer (0)
Report
Kaiser Permanente offers Medicare Advantage, which so far has been good for me.
You have to sign up during the fall Open Enrollment period. The premium this year is 0, the basic copay for an office visit is $15, labs are reasonable. Within the system you can always get in to see somebody, but you do need to get to know which doctors work the system best. I had a really good primary care dr, who after 20 years knew about my bad experience with med side effects and knew I preferred not to take prescription meds if possible. When he retired, they put me on with a doctor who is a pill-pusher and when I told him I have already been there, done that with the meds he wanted me on, he called the front office and told them I needed a different doctor and put me down on my record as "non-compliant." My current doctor is willing to let me work with diet and supplements to keep my lab results within reasonable limits, and the other day the nurse for a specialist I was seeing high-fived me when she found out I was on NO prescriptions. She said she hadn't seen anybody over 50 who wasn't on at least three regular meds. There have been times I've had to go through several referrals to find the right doctor for something, but once you get to know their system you can make it work.
There was some talk about Obamacare killing off Medicare Advantage, but so far its still going, and seems to be working for me.
Helpful Answer (1)
Report
Pat, I have heard of that happening when one moves to a new area. If one had been a patient with a variety of doctors prior to Medicare, then those same doctors will still keep you as a patient after going on Medicare.

I wouldn't quit Medicare, the program is too good to give up. Just keep dialing around until you find a doctor that has an opening for a Medicare patient. It's my understanding that many doctors will take Medicare but they have a quota for new Medicare patients, and if that quota is met, then they won't take any new patients. You would have to wait for an opening.

Some urgent care facilities have primary doctors that you can use as your regular doctor. I just switched over my parents [mid-90's] to the urgent care physicians mainly due to the fact the office is just down the street, minutes from my parents house, young fellows who are up to date and no nonsense.... no more long drives on the major high speed highways to their prior physician.
Helpful Answer (1)
Report
I got on Medicare when I turned 67 and, coincidentally, moved to a different region in the US. Suddenly, it became very hard to find primary care physicians. I also have a secondary insurance, a very good one, that would pay all but co-pays under almost all circumstances. If I quit Medicare would I be able to find a physician more easily?
Helpful Answer (0)
Report
Because the reimbursements from Medicare are so low, doctors are now refusing to either see Medicare patients or they are limiting the number of Medicare patients they take, opting to take those with higher reimbursements.

I worked for doctors for years in the insurance department so I have heard all of this. At first I thought it could not be true, if they were a participating Medicare doctor then they HAD to take you. I have seen this happen in the past and it is getting worse. Medicare reimbursements actually set the playing field itself as all other insurances look to them and then base their reimbursements off what Medicare is paying. We use to have secondary insurance carriers that paid the remaining 20% in full but now we are coming across those that only pay a portion of what is owed or they are now charging copays. Our insurance system is crazy making, which is why I quit my job. It literally changes every single day and it is so difficult to remain on top of all of it....my brain after 10+ years felt like it was full and could contain no more!

Ask the doctor you want to see if they have dis enrolled from Medicare period or are they only taking a certain number of new patients at different times throughout the year. If it's the latter then you may be able to call back and get in later on.
Helpful Answer (1)
Report
There are massive lists of doctors and clinics who accept Medicare in each state. But that doesn't mean all doctors accept it, or that the doctor you'd prefer to use or who is conveniently located will accept it.
Helpful Answer (1)
Report
Duncan, I don't understand. If Medicare is your primary insurer, and you have supplemental insurance, almost any physician should see you and administer to you.
Do you have the booklet, " Medicare and You"? There is a massive list of participating physicians in every state.
Helpful Answer (1)
Report
I have long dreaded the day that I had to become medicare eligible because of stories I had heard about doctors who choose not to see medicare patients. Well the day came 2 weeks ago and I have already had my first refusal. I am a retired teacher and have supplemental insurance with them with medicare my primary. It is a shame that our medicare system makes it so difficult and pays so poorly that you are denied having medical attention that you desire. It seems something is terribly wrong here!! Do I have any options?
Helpful Answer (0)
Report
http://www.medicare.gov/physiciancompare/results.html#expanded=dvcon0&viewmap=0&keyword=geriatrics&loc=EVERETT%2C%20WA%2C%20USA&lat=47.9789848&lng=-122.2020794&type=All&xpnd=1&vflg=1

I went to Medicare.gov and under Searching for Doctor/Hospital I typed in Evertt Washington as the location. the names of 18 geriatrics doctors came up. That's whats in the link above. Most of them appeared to be affiliated with the Everett Clinic. I don't know if you're looking for a Geriatrics doc, but you can type in another specialty if you need to. Good Luck!!!
Helpful Answer (0)
Report
Medicare resources at the Evertt Clinic. There is a patient advocate number on the page, I believe. You could probably get information about whether they have a Medicare contract from Medicare.gov.
Helpful Answer (0)
Report
Many years ago I learned that many doctor offices do accept Medicare patients but once that office reaches their quota they can start to refuse new Medicare patients.... but later accept new patients when their regular Medicare patients moved away.

One advantage of living in a large metro area, I never had a problem finding a new doctor for my parents who have been on Medicare for over 25 years. Nor for myself as I am also on Medicare.

There are a lot of myths floating around about Affordable Care Act [ObamaCare]. One myth I wish to break is the rumor about the Federal government cutting funds to Medicare. What is being cut is Medicare fraud, which is a good thing.

The ACA closes the “donut hole” that was causing Seniors not to be able to afford their prescriptions, another good thing.

ACA expands existing coverage for seniors, including preventive care and wellness visits without charging you for the Part B co-insurance or deductible. Seniors will no longer need to put off preventive care and check-ups due to costs. This reform has been active since 2011 and gives seniors better access to cancer screenings, wellness visits, personalized prevention plans, vaccines, flue shots and more.
Helpful Answer (3)
Report
The largest primary care system in my town(Everett Washington) refuses to see new Medicare patients. How can I find out if they have a Medicare Contract? Name of the system is Everett Clinic. They refuse to answer any questions..
Helpful Answer (0)
Report
Can a medical equipment company, that accepts Medicare, refuse to repair a device owned by a Medicare patient.
Helpful Answer (0)
Report
Physicians Refuse Take Patients based on age alone.
Helpful Answer (0)
Report
I suppose that the billing manager works for the doctor and is following instructions. You might try to talk to the doctor directly and find out.
Helpful Answer (0)
Report
I was seeing a foot dr. I owed him money from when I was on private insurance. I am currently on medical. I have been making monthly payments to the Dr. However, I get a call from the office the day before my appointment and I am told that, "you cannot see the Dr. unless you pay half of your bill." Mind you 50.00 monthly arrangements had been made. Can the billing manager refuse me service because I am paying on my past account and under different insurance?
Helpful Answer (0)
Report
With ObamaNoCare you will see more and more doctor's offices refusing many insurances.
Helpful Answer (1)
Report
Physicians in private practice (or small group) are NOT obligated to accept either Medicare or Medicaid patients, just as they are not obligated to accept any other type of health insurance. They can also drop a patient's insurance as long as they give 30 days notice in writing.

As others have pointed out, it is the very low reimbursement rates and delayed payments that deter some physicians from accepting Medicare/Medicaid patients at all. Often the reimbursement amount is not even enough to cover the office's expenses of that visit. (staff wages, utilities, insurance, syringes, etc.)

I know of one state in which a physician may NOT allow any patient who is on Medicare to pay cash for the visit....but the physician does not have to accept Medicare patients. So, it's a catch-22 situation where a moderately affluent senior who has the resources to pay the $150 office visit is not permitted to do so. Weird.
Helpful Answer (0)
Report
brandywine1949: In California Kaiser Permanente is an HMO plan for its members only. My father was rushed their via an ambulance then transferred to a non HMO hospital.
Helpful Answer (0)
Report
Try a large practice such as "Billings Clinic." Or a large practice such as Kaiser Perm. They most likely will take medicare patients.
Helpful Answer (0)
Report
Not all doctors PARTICIPATE with all insurance plans including Medicare or Medicaid/Medi-Cal, just like they do not all PARTICIPATE with HMO plans or numerous private plans. Before taking your loved one or yourself to a new doctor ALWAYS ask if they PARTICIPATE with your plan. Most every doctor around has always participated with Medicare, it was pretty much a standard, but with current reductions in fee schedules many doctors are now refusing to take it. Many years ago when I worked in this area the Medicare reimbursement rate is what every other insurance based their reimbursement rates off of. It use to change every year but I understand there are changes happening several times throughout the year. It can be a traumatic event for doctors who see their reimbursement rate continue to fall to the point that they can no longer stay in business, You may be billed $2500 for a service but the doctor may receive $125 from Medicare. Patients with no insurance at all would have to pay the $2500 in full.

Yes doctors who DO NOT PARTICIPATE WITH MEDICARE do not have to see you unless you are willing to pay in cash. IF THEY DO PARTICIPATE WITH MEDICARE, I DO NOT THINK THEY CAN REFUSE TO SEE YOU AS IT WOULD BE A VIOLATION OF THEIR CONTRACT.
Helpful Answer (0)
Report
1 2 3
This question has been closed for answers. Ask a New Question.

Recent Questions


Popular Questions


Related Questions

Ask a Question
Subscribe to
Our Newsletter