Is it legal for a doctor to refuse doing a procedure because insurance doesnt pay them enough to do it?

Question

let me add some..I am on medicaid, i want to have a procedure called essure done...medicaid covers it and there are a list of docors who perform the procedure that accept medicaid. I have called several doctors, when finally the last one told me that he wouldn't do it because medicaid doesn't pay him enough to...and thats probably why the others refuse to do it as well.

This just doesn't sound right to me...is that legal??

Answer 1

I don't know aboput legal, but no one should be required to sell anything for lesss than its worth.  If Wal-Mart has a TV priced at $2000 and I only offer $1000 they aren going to sell it to me.  

I don't accept work that costs me money.

Answer 2

If they are a contracting doctor with your insurance and you have the benefit for the procedure, no, they may not refuse. This is part of the agreement they have with the insurance company.

Answer 3

Its not illegal, but it is in violation of the doctor's contract with medicaid... Unless...

If the practice is too full to accommodate any new patients, he's within his rights to refuse all services.

Answer 4

Lori S is correct, you need to call your insurance carrier and report to them what the doctor is telling you.

If he is out of network the he can refuse to do the surgery. If the surgery is not medically necessary he may not feel it is appropriate for you.

Answer 5

Yes, it is legal.  Doctors are not required to accept the payment structure offered by Medicaid.  The only requirement is that the physician cannot pick and choose which procedures to do.  If he refuses Medicaid, he must refuse all Medicaid patients.  He is also able to continue working with existing Medicaid patients, while choosing to accept no new ones effective with a certain date.

Answer 6

You are not already a patient of this doctor, correct?

In my state, it would not be illegal for this doctor to refuse to take you on as a new patient.  Many doctors in my area reserve a only limited number of spots on the schedule for Medicaid patients, so that the Medicaid patients don't make up too high of a percentage of their overall number of patients.

(Doctors and hospitals lose money every time a Medicaid patient walks in the door - they don't get reimbursed enough to even cover the cost of treating a Medicaid patient.  We get patients who end up having to receive lots of expensive medications while in the hospital - the Medicaid reimbursement for the entire hospitalization doesn't even cover the cost of the drugs alone, not even counting the expense for the nurses, room and board, etc.)

If you were already a patient of the doctor and that doctor refused you a medically necessary procedure, that would be illegal in almost every state I'm aware of.  But, its less likely that it would be illegal for a doctor to take you on as a new patient for an elective procedure like Essure.  Sorry.  :(

Just in case your state has different laws/regulations, you should call Medicaid to confirm whether that provider is violating any laws in your state.

Answer 7

it might be! i think it is

Answer 8

Very legal. Doctors do not have to accept Medicaid benefits. The plan pays little and pays late. Assume you were a baby sitter and you wanted to charge $8.00 an hour but one of your customers had a plan which pays baby sitters $6.00 an hour. Would you work for that person or look for a better customer?

Answer 9

absolutely legal.  You need to offer to pay for the procedure yourself.

Answer 10

What makes you think it is illegal??  The doctor is not doing anything illegal at all.