Why Some Doctors Don't Accept Medicare or Insurance

A reader wrote to me recently, to complain about the policy of one of the doctors I've interviewed here who treats thyroid and hormonal imbalances. The reader had contacted the doctor, and was furious after learning that the doctor does not accept Medicare patients.

That doctor is not alone, however. An increasing number of doctors are opting out of the Medicare system, including many of the specialists, internists, and integrative physicians who handle thyroid, hormonal, fatigue, and immune system problems. In fact, many of these doctors don't accept Medicare, and also do not participate in any private insurance programs at all. Their patients need to pay out of pocket, up front, and file themselves to get whatever reimbursement is available under their coverage.

Why are more doctors opting out of Medicare and insurance programs? There are a number of reasons.

  • Medicare regularly cuts the rates of reimbursement, which means doctors earn less for office visits and various procedures
  • There is a longer delay than ever before for doctors to get reimbursements from Medicare
  • Medicare has a very convoluted, bureaucratic process that allows some tests and treatments, refuses to pay for others, and limits how a doctor can practice medicine
  • Private insurers set low reimbursement rates for various services and treatments, rates that may not even cover a doctor's overhead.
  • Insurers often systematically make reimbursement deliberately difficult, complicated and time-consuming.
  • When reimbursement is approved, payments from insurers can be extremely slow to reach the physician.
  • Doctors may need additional staff to handle the extra paperwork, phone calls, resubmissions, and negotiation with insurance companies.

How do you find a doctor who accepts Medicare? The Medicare Web site provides a list of enrolled doctors. You would need to contact a doctor to determine if he/she is accepting new Medicare patients, however, as many don't. Some patients choose to use an urgent care center, which is also known as a "walk-in clinic", "stand-alone clinic" -- or, derogatorily, sometimes called a "doc-in-a-box." There are more than 18,000 of these clinics in the U.S., and the majority of these centers do take Medicare patients. The American Academy of Urgent Care Medicine has a directory of urgent care centers online, by the state.

As for doctors who will accept your insurance, most insurers will provide you with a directory of participating physicians, and may even assist you in getting an appointment or signing up as a new patient.

Learn More About Medicare and Insurance Issues, and Why Doctors Are Opting Out