Is This Allowed!?

K.:

Welcome to mamapedia!!!

Yes, it's allowed. Doctors offices DO NOT have to accept new patients. It's that simple.

Just because they are registered does NOT mean they HAVE to accept the insurance. Nor does it mean that the insurance records are up-to-date.

They told you upfront they are NOT accepting new patients! You should be thankful they told you that. Do you want to go in and sit for hours waiting? That's what happens in doctor's offices when they are over-burdened with patients.

If they took you in as a patient? then yes, they have to honor the contract, to the best of my knowledge. But I would assume since they told you they were not accepting new patients....you didn't go in to the office????

Find another doctor.

Yes, a doc has the power to stop accepting patients. His work load probably dictates who he sees and the fact that he says he won't accept any more from your insurance probably means it doesn't pay him in a timely mannor or is shorting him.

I'm sure the insurance site lists more than one Ent Dr.
Find another one that takes your insurance.

Totally allowed. They have a contract with the insurance company, not you. What they have is a contract that says when the doctor accepts your insurance they will write down their billed amount to a specific amount. They are not required to take everyone that walks in with that insurance though. NO insurance company writes into their contracts they must take everyone with their insurance. What the insurance company figures is that if each provider takes ten people with their stripped down payouts then good they save enough money to offer you insurance at the price you pay. Your insurance company could care less if you have to call everyone on their list of providers to find one that is accepting new patients, they only care about their bottom line.

They already told you they will not take you as an insured patient. If you chose to use them anyway they will not bill to your insurance and they are not legally obligated to do so. They will make you sign an agreement to that effect.

Just because a physician has agreed on a certain rate structure with your insurance company does not mean that they are required to treat you. Put yourself in the shoes of the physician and try to understand what might lead a physician to no longer accept patients from a certain insurance carrier. Top reasons: the insurance company does not pay the doctor the full amount they have agreed to pay; the insurance company does not pay the doctor in a timely manner. Your beef should really be with your insurance company, since if a doctor's office is refusing to see their patients, it is because your insurance company is not being a good business partner.

The ER doc was totally capable of treating this infection/virus in the ER. All he had to do was prescribe an antibiotic. My granddaughter was in the hospital for nearly a week with the most severe strep the doc had ever seen. He tested her for Mono 3 times but each time it came back negative. It was just strep. Her throat was nearly closed from the swelling.

I don't know why the ER doc didn't treat your hubby while he was there. That's what the ER docs always do.

Yes, you are correct. They can't charge you as a self pay as long as their contract is still effective. I would suggest you call your insurance and request they have a chat with dr office.

They don't have to take your insurance, or even take you as a patient. Now if they saw you first and said they took it and then decided not to take it and make you pay, that would be wrong, but to tell you up front that they will not take it is their right. It sucks, and you may have to travel, but if they will not take your insurance you may have to call around to find someone else.

Call the insurance company to clarify what you should do. If they are listed as a preferred provider, I believe they have to accept your insurance. But - if they're in the process of becoming a non-preferred provider, maybe that changes things. If there's no other ENT in the area, your insurance will have to give you some other alternative.

Anytime I call our insurance, BCBS PPO, they tell me that although the Dr is on their approved list, I must still verify with the Dr office when I make an appointment with them. They say, not only should I verify it when I make the appointment, I should verify the day I get to the Dr office.

So to answer your question, I guess the contract between Dr & insurance company could change at any time.

This is between them and the insurance company. Rules are very specific, and if they are not going to contract with this insurer anymore, I'm sure they cannot accept new patients with that insurance. Nobody can make them do this. There is no "insurance police."

Yes they should have to honor the contract until it's voided however since you don't have a relationship established with this ent why start now? Since he isn't going to be in the network shortly that means any additional care your husband may need would have to be done either out of network or with a new ent. You might as well select an ent that isn't cancelling and be done with it.

Of course it's "allowed." Doctors aren't obligated to take appointments with people. What your husband has isn't life-threatening at this point, but I would say that the emergency room doctor should have prescribed an antibiotic if he didn't.

The reason the ER doc would have suggested an ENT is if he suspects that the strept throat is part of a pattern of throat infections that needs to be treated. I needed an ENT for my strept because it would cycle every 6 weeks or so for over a year. The ENT figured out that the strept was lodged in my tonsils and ended up removing my tonsils. I haven't had strept since (and this was in my early 20's maybe? 19 yrs old?)

If throat infections and other infections regarding ears, nose, and throat are chronic for your husband then an ENT (Ear Nose Throat Specialist) is the way to go but you may have to call around your area to find one that accepts your insurance. Don't just take the word of the ER doctor or who is "on the list" with the insurance since contracts change constantly.

And no, don't tattle on the doctor. The insurance can't force the doctor to treat you, they can only suggest another doctor in your area or state who "might" be accepting new patients and who "might" still be on contract with them.

Call your insurance company and tell on him. I hope you found another doctor.

Is it ethical? No. But can they do it? Yes. They can turn away a patient.