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Your Options When a Provider Won’t Accept Your Insurer ~VeryWell

Which Doctors or Healthcare Facilities Accept Insurance Varies

Your Options When a Provider Won’t Accept Your Insurer

Each year, doctors and healthcare facilities like testing labs, hospitals, and pharmacies negotiate pricing with health insurers and payers. In its simplest form, it goes like this:

Doctor: When a patient with diabetes visits my office, I charge $100 for the visit, and $75 for the blood work.

Payer: That’s too much money. We’ll pay you $55 for the visit and $35 for the blood work.

Doctor: I can’t pay my staff or keep my lights turned on for that paltry amount. How about $65 for the visit and $45 for the blood work?

Payer: Deal.

That negotiation takes place for every possible service your doctor performs, with every insurance company, each year. Some insurance companies refuse to pay some doctors the amount those doctors believe they are entitled to be paid. When that happens, the doctor will stop accepting that form of insurance as reimbursement. Then, of course, once the doctor no longer accepts that insurance company’s reimbursement schedule, then she no longer accepts patients who use that payer’s insurance.

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