Choosing Your Health Insurance: Will Your Doctor Accept It?

In previous columns, as a doctor I have tried to emphasize the critical importance of having health insurance of any kind. Even if you cannot afford the best health insurance which allows you complete choice of physician and complete access to second opinions, such as PPO insurance or Medicare insurance, you should always attempt to have some type of insurance to reduce the risk of serious or catastrophic illness.

But as a doctor, I can honestly tell you that many doctors won't see patients with certain types of insurance! And many insurance companies won't contract with certain doctors they consider too expensive. Confirming this, a recent study indicates that the type of insurance that you choose will determine which physicians you might be able to see. This has always been obvious in cases of HMO insurance, or insurance that depends upon your staying within a certain IPA (Independent Practice Association, a closed panel of physicians in a community). This new data indicates that many other physicians are also refusing to accept certain types of insurance!

In a study published in Morbidity and Mortality Weekly Report (MMWR, which is a publication of the Center for Disease Control (the CDC) in 2007, office-based physicians across the United States were evaluated to determine if they were accepting new patients, and which type of insurance was accepted into their practice. Over 94% of these physicians said that they were accepting new patients into their medical practice. This is good news and indicates that you are very likely to be able to find a physician in your community who will see new patients for medical care.

However, when these same physicians were asked which patients they were willing to see based on the patient's type of health insurance, the results were astonishing. Only 57% of physicians were willing to see patients who were likely to be uninsured patients. Only 57% of physicians were willing to see patients whose medical care was to be covered by Workers' Compensation insurance. Remarkably, only 68% of physicians were willing to see patients who had a capitated type of insurance. This insurance is typical of many HMO type plans, and indicates that physicians are increasingly concerned about poor payment for their services by HMO insurance companies.

The best acceptance of new patients was associated with having non-capitated insurance, with 89% of physicians accepting new patients with these types of health policies (capitated insurance pays doctors a standard low fee every month for each patient with the insurance regardless of whether the doctor ever sees the patient or not, and often encourages under-treatment in my experience). Non-capitated policies include non-capitated HMO insurance, and all PPO policies and standard commercial health policies (non-PPO). This means that if you are considering purchasing health insurance that is HMO, or even a PPO, you should be absolutely certain whether or not the insurance is a capitated program or non-capitated, since your ability to see physicians whom you trust may be dependent upon the type of plan which you agree to purchase.

In the situation of having Medicare insurance, 80% of doctors were willing to see new individuals who were covered by Medicare plans. However, since some Medicare Programs are now HMO based programs and are capitated (the so-called Medicare Advantage Programs), be very careful with your Medicare card and benefits, and especially consider the consequences if you agree to sign over your Medicare card to a Medicare Advantage Program which may have been advertised to you by direct mail or on television. These programs may dramatically reduce the likelihood that you can receive care from a physician of your choice, or a specialist whom you need to control an illness.

If you are having questions about what type of health insurance to purchase, or which type of health insurance is being offered by your employer, be certain to ask a health insurance agent about your options. The advice of a health insurance agent is free, and can help you to compare the benefits and risks of different types of health policies. Your ability to live a long and healthy life, and to prevent or control chronic illnesses most effectively, will directly result from your choice of health policy.

Therefore, as a physician my recommendations from this week's column are, be certain that you have health insurance, and be cautious that you have picked the health insurance program that gives you what you feel you most need in living a happy, healthy, and long life.