I’m facing a bit of an issue with my upcoming appointment and could use some advice. I have a regular annual visit scheduled with my PCP later today. I called ahead to update my insurance information, and the receptionist told me that my insurance plan is not accepted by their office. They then informed me that they would cancel my appointment as a result.
I asked if I could still keep the appointment and simply pay in full at the time of the visit, but the receptionist said this isn’t possible because I have insurance, and she mentioned she would get in trouble.
I understand there’s no law in Colorado (or federally) that mandates I must use my insurance if I choose not to. So, my question is: Can a medical facility refuse to see me if they don’t accept my insurance and I offer to pay out-of-pocket?
Has anyone experienced something similar or know the legalities involved? I’d really appreciate any insights or advice on how to handle this situation.
It’s possible for a doctor to refuse an appointment even if you offer to pay out-of-pocket, especially if they have policies against seeing patients with certain insurances. You might want to ask for a written explanation or find another provider who can work with you directly.
This is something I’ve experienced with the California Providence Health System. I was attempting to schedule a visit with a physician for a second opinion in order to talk about a clinical trial because I have Kaiser.
When I asked what the cash pay price was, they told me that since I had insurance, they could not accept my payment in cash. They indicated they only give discounts for cash pay to those without insurance. I clarified that I just wanted to pay with cash and didn’t want a discount. They said that since I had insurance, I couldn’t pay cash. but then stated that they wouldn’t accept Kaiser (which, since I knew they wouldn’t accept Kaiser, I never inquired about in the first place). A complete catch-22. I ultimately went to a different location where, without my asking, they accepted cash payments and offered me a cash pay discount. It was really annoying.
Although it’s not required by law, the provider’s office’s contract with the insurance company may require them to bill your insurer for services rendered, even if they are rendered outside of your network and prevent you from paying for them yourself.
