Prefered Provider Question

Discussion in 'General Parenting' started by SRL, May 25, 2007.

  1. SRL

    SRL Active Member

    I am looking for a PCP and called the office of a doctor who I had heard at one time had a practice that was quite full. I asked if he was taking new patients and instead of yes or no the receptionist asked what insurance I had. I told her BCBS and then she said no, he wasn't taking on more patients.

    I know doctors in my area are frustrated with the level of payments from BCBS but if they are under contract as a preferred provider can they turn away patients for that reason?
  2. slsh

    slsh member since 1999

    SRL - I'd call BCBS and ask them if docs are obligated to accept BCBS patients per the contract. Because I can be kinda slippery, I'd probably call doctor back first and say you have a different ins. co and see if that gets you in the door... but it sure does sound fishy that they ask what ins *first* and then say no.

    While I understand that PPO/HMO reimbursements can be really atrocious compared to actual fees, on the other hand the docs knew what they were getting into when they signed the contract in the first place. I know that right before husband switched jobs and got better insurance, a major healthcare organization in our area (several hospitals, a gazillion docs, most of our providers in fact) cancelled the PPO contract with- our ins co, which is a major insurer in the area. We were sweating bullets big time. The reason was because of the lousy reimbursement rates.

    It's been a couple of decades since I worked on the contract side of PPO/HMOs and medical providers, but back in the dark ages it was part of the contract that docs would see pts covered by the ins that they were signing the contract with.
  3. Kathy813

    Kathy813 Well-Known Member Staff Member

    The rules may be different depending on the state you live in but I am covered through a BCBS HMO and the book that lists doctors specifically denotes which ones are not accepting new patients.

    So, here in GA anyway, a doctor can be part of BCBS but still refuse to accept new patients. I had left BCBS for a little while when we switched to husband's company's insurance. When he was laid off, we switched back to my insurance (BCBS). Our doctor had stopped accepting new BCBS patients in the meantime. Luckily for us, he did agree to accept us under BCBS since we already were existing patients although covered by different insurance.

    Trying to understand insurance policies makes my head spin! :slap:

  4. dreamer

    dreamer New Member

    I think some docs offices denote a certain percentage of their patients to different insurances- and if they are at their limit for a particular type of insurance, then maybe they can turn new patients away?
  5. flutterbee

    flutterbee Guest

    A lot of doctors and mental health professionals are no longer accepting new patients with BCBS, but they will continue to see patients established at their practice that have BCBS. BCBS cut the rates they are paying doctors. According to difficult child's therapist, BCBS hasn't increased what they are paying since 1995 and this year they cut what they are paying. So, I can't say I blame them.

    To answer your question, yes I believe they can do that. If you contact your insurance company you can find out if that is true for you or not.