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  1. #1
    Join Date
    Aug 2016
    Posts
    1

    Default Doctor Won't See a Patient Despite Coverage Through Secondary Insurance

    My question involves insurance law for the state of: Florida.
    I have had insurance through my husbands employer for many years.
    I recently started a job with the county school system and am now receiving insurance through them.
    I made a doctors appointment today and the doctor refused to see me because my new insurance is not accepted at his office and they will not bill my secondary insurance.
    The have seen me before at this office and accept my husbands insurance. Both plans are through Cigna. Both plans are OPen access plus.
    Is this actually legal?

  2. #2
    Join Date
    Jan 2006
    Posts
    38,867

    Default Re: Doctor Won't See a Patient Despite Coverage Through Secondary Insurance

    will they accept a cash payment?

    Have you offered to pay cash?


    unless the contract between the provider and insurance company (the secondary insurer) requires them to file with a secondary insurer, they don't have to file with the secondary insurance.

    Either way it's an issue between the medical provider, the insurance provider, and you.

  3. #3
    Join Date
    Oct 2014
    Posts
    8,238

    Default Re: Doctor Won't See a Patient Despite Coverage Through Secondary Insurance

    Quote Quoting frogfur
    View Post
    Is this actually legal?
    It is legal, meaning that there is no law that says the doctor must take you. The law for most businesses and professions, including doctors, is that they are free to refuse service to anyone for most any reason except for reasons that amount to illegal discrimination, i.e. because of your race, color, religion, national origin, or disability under federal law and because of your race, color, national origin, sex, pregnancy, disability, familial status, or religion under Florida law. In short, the doctor is not violating any law by refusing to see you because the insurance you have is not accepted by his practice and he/she doesn’t want to bother with billing the secondary insurance.

    You may offer to pay cash and do the paperwork yourself for reimbursement from your insurer — I’ve not yet met a doctor that wouldn’t take cash for his/her services. But that can cost you; the doctor is under no obligation to accept what an insurance company has set as the reasonable fee for the service as they often are when the doctor is a participating physician with your health plan. So your insurance reimbursement likely won’t cover nearly as much of the cost as it would if the doctor were participating in the plan you have.

    Your other option, of course, is to change doctors to one who does accept your insurance plan.

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