Question:
Dr. doesn't accept any insurance?

Hi I'm sorry if this is a stupid question but I have been told by Dr. Gagner's nurse that he dosn't accept any insurance. I have never run into that before. Why wouldn't a doctor accept any insurance. I do have a PPO with out of network privleges but I'm not sure how that's going to help me. Mount Sinai Hospital is within the network, does that mean I only have to pay for his fee out of my pocket? I'm so confused....help!    — [Anonymous] (posted on January 28, 2002)

January 28, 2002
If you have a PPO, they will probably pay some of the doctor's fees. You'll need to look at your policy, or the explanation you got from your employer. There is usually a deductible you have to pay. Then your insurance will pay a portion of their maximum allowance for the surgery. You will then have to pay the difference between that and what your surgeon charges. For example, if your surgeon charges, $5,000 and your insurance's maximum allowance is $3,000 and they pay 80% of their maximum allowance, the insurance would pay $2,400 and you would pay $2,600. Remember, this is just an example. You really need to see what your policy says to know how big your deductible is and how much of a percentage your insurance pays for out of network services. If the hospital is in network, then you would only have to pay your portion of what the insurance company allows as its maximum. There are a lot of reasons doctors don't accept insurance. It may be that they believe the payment from insurance is too low. They may not want to have to pay an extra person (and sometimes more) to do all the paperwork that insurance billing requires. If you'd like to email me for more info, please feel free to do so.
   — garw

January 28, 2002
Hi there. I think I would check it out a little more. I would be very wary of any doctor that did not accept any insurance. Sounds fishy to me. JMHO
   — Cindy K.

January 28, 2002
Your doctor may not like to deal with insurance company crap and may be getting enough business from self-pays. If you don't wish to self-pay, I would suggest you find another doctor within your network (or even outside of it, since your PPO will pay regardless).
   — Terissa R.

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