I called a Dr to see about making an appt, he checked through my ins and called back and said I have to pay $5000 before I can see him. Now, this is just a regular Dr, no surgery, nothing but an appointment. I have never been told this ever... is he lying or misinformed? I have used my current ins to go to several Dr appts and nothing has ever been said about paying the deductable. Anyone know anything about this?

Just to add, he acepts my insurance and I've had the same ins for a long time... I've only been asked to pay a co-pay by any other Dr. This seems strange.

I would call the office manager to find out what was going on and then make an appointment with a new doc

I think what he means is you have a $5000 deductible with your insurance plan, and since you have not met that deductible yet, you would have to pay cash for his services, then apply that to your deductible on you own.

In short, he does not want to process your insurance claim, only to be told that there is no coverage, because the deductible has not been met yet, and then have to turn around and bill you for the visit.

This policy cuts down on the amount of time it takes him to be paid for his services.

He runs his own practice and there is a serious lack of this type of Dr in this area.

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Originally Posted by passmeby

He runs his own practice and there is a serious lack of this type of Dr in this area.

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All you need to do, is tell him that you will be paying for the visit and services.

I'm sure they will make an appointment for you if you do.

You will have to have the funds available to do so, if this is what you want to do.

What I'm not getting about this , is of all the Dr's Ive seen with my current ins, not a single one has ever said anything about me having to satisfy my deductible. I was always seen, paid my co-pay and any other uncovered expenses, and that was it. It just seems strange. I've never got any kind of bill from my ins saying I need to pay any money into my deductible just to be seen or for any other reason...

To add, these Dr's that I have seen with no problems regarding ins, they have always been paid promptly, I have never received any kind of bill for the services besides uncovered expenses.

I would call your insurance carrier and ask them. You should know if you have a $5K deductibel or not. Basically with that high a deductible you only have catastrophic coverage. And it doesn't sound like that's what you have.

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Originally Posted by passmeby

What I'm not getting about this , is of all the Dr's Ive seen with my current ins, not a single one has ever said anything about me having to satisfy my deductible. I was always seen, paid my co-pay and any other uncovered expenses, and that was it. It just seems strange. I've never got any kind of bill from my ins saying I need to pay any money into my deductible just to be seen or for any other reason.....

To add, these Dr's that I have seen with no problems regarding ins, they have always been paid promptly, I have never recieved any kind of bill for the services besides uncovered expenses.

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Seriously, you don't understand the Doctor not wanting to wait a month or more for the bill to go to your insurance, for your insurance to deny the claim based upon your deductible not being satisfied yet, for the bill to then be sent to you, and for you to send in the payment?

I think it makes perfect sense for the Doctor to require that he be paid without going through all this waiting and wasting of his time and effort.

I'm sorry you are in this position, but the insurance coverage you have is the cause, not the Doctor.

I think he does not accept your insurance plan and the Dr's that just charged a co-pay did accept your plan. You may be able to determine if that Dr. is a participating physician by going to the website for your plan. You may be able to file your own claim if you use that Dr (assuming he is not participating) but many insurance plans pay only 50-80% of the reasonable cost (determined by them) for out-of-network Dr.'s.

I stated in the OP that he accepts my ins plan, in fact it's the only plan he accepts.

progunr, as for other Dr's I have seen with this ins, I get statements or whatever they're called very promptly (within days to a week) after the appt showing what was covered, what was paid and what I would owe in addition to my co pay.

I think I will just contact my ins company. I think he might just be mad at me because I saw him a couple yrs ago and wrote him a bad check (which was promptly paid)... I'll just call the ins co. Thanks.

To add a relative question to this thread, is it even common practice to require that the full deductible be paid before a patient can be seen? That doesn't sound right to me, and I have never heard of this. I have never encountered this situation ever, with any Dr or hospital. I thought the deductible amount was reduced every time you payu for un-covered expenses and co-pays... I really don't know. But I have never heard of a Dr saying I can't be seen using my ins until my deductible was met.

No, I believe what they are saying is that before your insurance will pay, the entire deductable has to be meet. They should still set an appointment, but will want to know how you are paying.

Insurance has various clauses, for example one policy may be limited to 4 or 6 doctor visits in a year, after that they will fall under the deductable.
Or it is possible the clerk was wrog when they verified insurance also