Jump to content

Must a physician refuse cash payment from a patient who is insured?


Recommended Posts

A friend visiting his physician was told (by the receptionist) that the physician does not participate in the insurance plan that covers the patient. The patient is ready to pay the physician's full fees (and to do so without seeking a reimbursement from the insurer), but the receptionist said that the Affordable Care Act prohibits the physician from accepting any cash payment from someone who is insured. Is that right? If there is a restriction, does it apply differently between those who are Medicare-covered and those who are younger?

Peter Gulia PC

Fiduciary Guidance Counsel

Philadelphia, Pennsylvania

215-732-1552

Peter@FiduciaryGuidanceCounsel.com

Link to comment
Share on other sites

I have not seen or heard of this. I would have asked the receptionist to give me the exact cite.

George D. Burns

Cost Reduction Strategies

Burns and Associates, Inc

www.costreductionstrategies.com(under construction)

www.employeebenefitsstrategies.com(under construction)

Link to comment
Share on other sites

GBurns is correct, ACA does not restrict the use of cash. My best guess is; 1) it was an excuse to not accept the patient or 2) confusion on the part of the receptionist. With many providers going to cash only (concierge) it is possible that this was such a provider, who knows.

Link to comment
Share on other sites

GBurns and Ivena, thank you for your good help.

Today, I learned some new facts. It seems that the receptionist might have been blaming all the ills of the world on the Affordable Care Act; rather, the described belief is that New Jersey insurance law restrains the patient's proposed arrangement.

To me, it seems odd that an insurance contract regarding which the physician is NOT a recognized provider could restrain the conduct of the physician merely because the patient could choose to get his insurer to pay for the service if the patient were to choose a different physician.

Even if everything described is dead wrong, isn't this more complexity than our society should ask a patient to face?

Peter Gulia PC

Fiduciary Guidance Counsel

Philadelphia, Pennsylvania

215-732-1552

Peter@FiduciaryGuidanceCounsel.com

Link to comment
Share on other sites

masteff, thank you for the nice help.

Concerning non-Medicare patients, one suspects that many of us will learn much more about how physicians arrange themselves from 100% third-person payment to 100% patient payment, and the complexity of configurations between those absolutes.

Peter Gulia PC

Fiduciary Guidance Counsel

Philadelphia, Pennsylvania

215-732-1552

Peter@FiduciaryGuidanceCounsel.com

Link to comment
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
×
×
  • Create New...