My mom is on Medicare, can a doctor's office refuse to see a Medicare patient?

Any physician, be he/she a specialist or a PCP, may refuse to treat a patient on Medicare. That is their choice. I have found a wonderful doctor inthe little city whee I live, who charges anywhere from $15.00 to $35.00 for an office visit. This man is an MD and a Ph.d. His wife is a Nurse Practioner and his son is a Pediatrician. He'll spend as much time as you wish with you to discuss any problem. Lab Tests and Hospital Tests are extra, of course.

N1K2R3,,, Are you sure the charge from your doctor ("$15 to $35) is the entire office visit charge ? That sounds more like the 20% Medicare doesn't cover (which would mean the actual visit charges would be $75 to $175).

You're right, one1joe, ..the fifteen dollars or now ten dollars ( as of 01/01/13) , is the co-pay for an office visit to the PCP. ER co-pay is $65.00 and for specialists, the co-pay is $35.00 I think these are Medicare Advantage co-pays.

can a goctor refuse to see a cash client

can a doctor refuse to see a cash client

I was told when you turn 65 your health benefits are lowered to the level of Medicare by law. If you want to move to another area, the chances of getting a doctor to take you on as a new patient are slim to none. We now have a new type of ghetto, the medical ghetto. You can have health insurance as long as you use your current doctor. I may be wrong, but I heard that doctors cannot charge much more than Medicare cost even if the patient is not using Medicare. It seems that there are laws that only allow a low payment to the doctor for those who are 65 and older. I was fortunate in that I did not have to use my health insurance when I was young; that was 35 to 40 yrs of paying health insurance. Now that I am older and with issues, I cannot move to another area and have guaranteed access to a doctor. It seems that the only guaranteed medical care is the ER. Those WITH health insurance will find that they may not have access to the medical care that they are paying for.

I am sorry that your experience has been so bleak, HaroldSaxon. I have no trouble at all finding doctors who accept Medicare. The one exception has been geriatric psychiatrists in private practice. My husband was on Medicare twenty years; I've been on it three. We have had access to absolutely excellent doctors, including those at Mayo Clinic.As our health conditions have changed we've changed doctors. No problem.

Maybe in some areas there are many more doctors who do not accept Medicare patients. But here it is the rare exception, not the rule.

Oh, absolutely, doctors can (and many do) legally refuse to accept/treat Medicare patients. They can also refuse to accept/treat Medicaid patients. They can also refuse to accept/treat patients with any or all forms of “insurance” coverage, including any of the coverage now “universally available” under Obamacare.

I think a lot of people are about to learn the hard way, as I have over the last four years, that “health coverage” does NOT equal “health access.”

This extremely unwelcome reality doesn’t ping on the radar for most of us until we are either trying to find a doctor for a loved one on Medicare or until we are forced onto Medicare ourselves and are told by the doctors with whom we’ve had a relationship for years that we need to find a new care provider (which I HAVE heard of happening even in some big-city practices, though not as often in those as in smaller towns).

The “reimbursement rates” set by the government for Medicare services are shockingly low. The bureaucratic reporting requirements are shockingly high. The net result is that in order to have any hope of being profitable, doctors would have to shuffle an enormous number of Medicare patients in and out of their practices very quickly ... and this is particularly ridiculous when you consider that the Medicare patient population is not one that can or should be “shuffled quickly.” Many practices have had to cope with the fiscal realities by other closing their practices entirely to Medicare patients or by capping the number they will carry.

This has been a well-known problem for years. There is constant pressure to raise the reimbursement rates, and Congress constantly drags its feet. (It’s hard to imagine how this won’t get worse with the $750 billion cut from Medicare to help fund Obamacare ... I do realize that a lot of THAT pain is being borne by seniors whose premiums are doubling or tripling and whose out-of-pocket maximums are doubling, but I assume it will also be spread to the provider end of the spectrum?)

Anyway, if you search the Web to try to find out what the current trend is ... are more doctors opting out of Medicare (i.e., refusing to take new Medicare patients, or "firing" their existing Medicare patients, or simply capping the number of Medicare patients they will agree to see), you will find a wealth of conflicting articles. "Yes!" screams The Wall Street Journal. "No!" insists the department of Health and Human Services.

The REAL answer is somewhere in between ... except that it isn't. In my experience, the real answer is pretty much all "yes" or all "no" ... for the individual who is affected.

For Medicare-age people living in or near fairly large metropolitan areas, finding doctors in almost any specialty who will accept new Medicare patients ... and who will see them within a reasonable time frame ... may not be horrifically difficult.

For retirees in rural communities, the picture can be VERY different, and much bleaker. This has been my father’s experience, in rural southern Oregon, and I have read countless similar accounts from people with parents in Colorado, Virginia, and other states.

For people who are retiring now or getting close to retirement, it is ESSENTIAL to be aware of this fact. Often, people dream of retiring to small towns where the pace of life is slower, more relaxed, and pretty. Maybe with wooded areas nearby where there can be fishing, and so on. In the early years of retirement, medical/health issues may be few and far between. As time goes on, the needs increase. If the nearest “big town” is half an hour or 45 minutes away, that may not seem too far to drive when you’re 65 and in good health. But when you’re 67 and fighting breast cancer, the distance quickly becomes an insurmountable obstacle.

As for people aging “in place” in rural communities, it is especially important that when they turn 65 and are forced to go onto Medicare, they – or the adult children or friend or guardian who is caring for and making decisions for them – REALLY understand the difference between traditional Medicare (with or without Medi-gap insurance) and Medicare Advantage (a quasi-governmental government-funded Medicare insurance policy, typically referred to as a “MedAdvantage” policy).

It can be hard enough for a Medicare patient in a rural or underserved area to find a doctor who will accept a new Medicare patient at all (i.e., traditional Medicare). But if the person has selected a MedAdvantage policy, then he or she must find not only a doctor who will accept new Medicare patients, but one who will accept new Medicare patients AND who is ALSO a member of that particular MedAdvantage network. This can narrow an already extremely narrow stream of provider choices down to the barest drip ... or to nothing.

Worse, when a person first turns 65 and is first forced by our system to go onto Medicare, he or she has “guaranteed acceptance” by whatever Medi-gap or MedAdvantage policy he or she selects. BUT he or she may not realize this will never the case again, except under very specific circumstances (for example, unless he or she moves out of the service area of the current policy) . If a person lives in a rural (or otherwise medically underserved) area and chooses a MedAdvantage policy right at the outset, he or she MAY be inadvertently dooming him or herself to many YEARS of access problems ... regardless of the annual Medicare “open enrollment” period in which people are supposed to be allowed to switch policies.

Imagine, for example, that after a year of living with a MedAdvantage policy, a person living in a rural or underserved community discovers (to his or her surprise, because he or she has never had trouble getting in to see a doctor before!) that it is now EXTREMELY difficult for him or her to get access to health care ... and that the reason he or she is given for this is that doctors in that particular MedAdvantage network simply aren’t taking new Medicare patients, or won’t schedule an appointment for four or five months. During Medicare’s annual Open Enrollment Period the following year, the person might think, “Okay, that MedAdvantage policy was clearly a mistake! I’m going to switch back to traditional Medicare and get a Medi-gap policy instead. At least that way, I’ll be able to see ANY doctor who will take new Medicare patients.”

Except that NOW, that person no longer HAS “guaranteed acceptance” into any Medi-gap policy. Now, he or she can be denied for reason of any pre-existing condition the Medi-gap insurance policy may set ... even if they’re limited to the very same conditions he or she had back when he or she first became “eligible” for Medicare and would have had guaranteed acceptance into the same policy.

My father, who lives in southern rural Oregon, was, like many retirees have been, dumped from the employer-sponsored retiree health insurance benefit program he had been promised over 40 years of service and forced instead onto the Medicare rolls. He’d been assured, back when the law changed to make it legal for employers to shuffle retiree health benefits off their own books in this way, that this would never happen ... but it did, just a few years ago. By then, the dementia was already a problem, and he was having a terrible time even reading the newspaper anymore, much less understanding complicated documents.

I knew he was upset, but didn’t understand why. He told me that his company was cancelling his insurance and wanted him to select some new health insurance through Medicare, but that he had decided to decline this “generous offer,” since he didn’t want to see doctors anyway. I panicked and said, “No, you have to have health insurance,” and threw myself into learning as much as I could about Medicare in the few days remaining in that year’s open enrollment period. In the end, I selected a MedAdvantage policy for him, because the directory for the policy made it look as if there were plenty of doctors taking new Medicare patients in his town, and the premiums seemed reasonable.

For a year, nothing happened. We paid premiums. He didn’t a doctor. His memory got worse. I got more worried. By the following year, I knew I needed to get him in to see a doctor about the dementia ... probably a neuropsychologist, but I quickly learned I couldn’t do that without a referral from a GP. So I started looking for a GP in Dad’s town. I pulled out the current physician directory for his MedAdvantage policy and started calling around.

And I rapidly discovered that of the some 24 doctors listed in the directory as accepting new Medicare patients, over half worked for a clinic in town that not only was NOT accepting new Medicare patients, but HAD NOT DONE SO for FOUR YEARS. I asked why they were still listed in the network directory as accepting new patients, and they explained to me – get this – that the fact that they were still seeing Medicare patients they had already had before they decided not to take any new ones allowed the program to list them as “accepting new patients.” ?!?!?

I called the rapidly dwindling list of other doctors in the directory, and in the end found that only TWO were actually taking new Medicare patients. Both had very poor reviews from patients on the Web (e.g., for not listening, for being rude, for being impatient, and for keeping patients waiting very long times). Both had graduated from very low-ranked medical schools. Both were quite elderly themselves; one had retired and returned to work. Both worked for the same clinic in town. (Are you used to researching doctors, or getting recommendations, and making a considered choice? Welcome to Medicare in rural America! Whenever I see the commercials about how “You’re 65! Welcome to Medicare! You’ve EARNED it!” I remember having to choose between these two doctors for my Dad, and I want to cry.)

I called to make an appointment. The earliest appointment the clinic would make “for a new Medicare patient” was nearly FIVE MONTHS out. And they told me they would not even put THAT appointment on the books until my father – who could at that point barely find his way around town to places he already knew how to get to -- had come personally into their office to fill out all of their paperwork (a HUGE amount) and deliver all of his medical records from his previous physician in another town.

I was shocked. I explained that I was concerned that my father was showing increasing signs of dementia, and that I had read that such a condition COULD be due to a treatable vascular or heart condition, but that if that were the case and the condition were not treated promptly, the damage caused in the meantime would be irreversible. Could they not make an exception and get him in earlier?

Did I want the appointment or not?

When we day finally came, we waited an hour and a half to see the doctor, and got literally 7 minutes of his time. He was unfriendly and had a hearing problem. He asked questions and repeated the answers incorrectly. But he gave my Dad a “mini-cog” exam that consisted of about 5 questions and gave us the referral to the neuropsychologist in a larger town, 45 minutes away. (None of the neuropsychologists in town in the directory were taking new Medicare patients.)

And THAT, in a nutshell, describes, REPEATEDLY, my experience with Medicare (at least, from the point of view of a person with MedAdvantage) in rural southern Oregon. At this point, my Dad’s primary care provider is a nurse practitioner, which is not uncommon in rural and underserved areas.

During the very next Medicare Open Enrollment period, I resolved to switch him to traditional Medicare and a Medi-gap policy, which is when I learned that his ability to make such a switch was no longer "guaranteed," and that I would have to find an insurer who was willing to accept him with any pre-existing conditions (which, of course, now included an FTD diagnosis). Fortunately for Dad, he did NOT have any of the other conditions that would have made it impossible for him to be accepted by a Medi-gap insurer (i.e., joint replacement recommendations, kidney issues, and I can’t remember what all else ... there was a list of 8 or 10 coverage-killing conditions). So now he’s on traditional Medicare with a separate Medi-Gap and Part D policy, and his monthly premiums are about triple what they were with the MedAdvantage policy ... but my hope is that if something happens and I need to find him a doctor in some specialty, I will have a better shot at finding one who will take a new Medicare patient without the additional bottleneck of the network filter.

I’ll be keeping an eye on how things develop with Medicare and Obamacare over the coming years. I don’t think things are sustainable as they are, so I don’t really feel as if I can plan for my own retirement assuming that the current rules/situation will still be in place. It’s frightening ... it took me a long time to learn and understand enough to navigate these waters on my father’s behalf. He could have done this easily at my age, and there’s no way he could do it now. What shape will my brain be in by the time I have to do it for myself?

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.

Try a large practice such as "Billings Clinic." Or a large practice such as Kaiser Perm. They most likely will take medicare patients.

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.

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.

With ObamaNoCare you will see more and more doctor's offices refusing many insurances.

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?

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.

Physicians Refuse Take Patients based on age alone.

Can a medical equipment company, that accepts Medicare, refuse to repair a device owned by a Medicare patient.

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..

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.

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.

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!!!

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?

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.

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.

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.

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?

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.

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.

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.

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.