Are doctors declining care due to my insurance plan?

Question

I buy my own individual (non employer based) plan. It's expensive ($20k/year), but the best you can buy in California (major carrier PPO, great coverage). But, although I take no assistance, I use the California state exchange because I was told it can offer group-like benefits not available with individual plans purchased directly.

Active and hard working all my life (58 yo) but recently hurt my back and afraid I'll have to stop work. Multiple surgeons agree MRI looks bad (lumbar herniations, stenosis) but not that bad and refuse to treat.

I've always stayed very fit and participated regularly in extreme activities (boxing, MMA, rock climbing) for 40 years, so no stranger to injury and have worked through them conservatively more than once. There is no way this is ok.

This is the first time I've used individual health insurance, so wondering if there's some unspoken discrimination among medical providers (even though they accept the plan) and wonder if they would be treating if I had an employer based plan?

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Anonymous · Answer

Surgery doesn't always help; they may be worried that if it makes things worse (which could happen), you'll sue them.

car253 · Answer

You think you have the best plan then you should post the company.    You take no assistance?   Why?   Are you wealthy?   Why is your insurance so expensive?   I have never seen $20,000 a year in premiums.   Are you really old?

You should have a real life insurance agent shop around for you for the same coverage at a lower cost.   And, it does not cost anything to do with an insurance agent that does all the work for you.     And, deadline for Covered California is Jan. 15.

StephenWeinstein · Answer

Surgery doesn't always help; they may be worried that if it makes things worse (which could happen), you'll sue them.

Amy · Answer

The doctor examining you usually has no idea what your insurance plan is. That's handled by their office staff.

If multiple surgeons think your injury is "not that bad", then maybe it really is not that bad. Surgery is dangerous (especially in a hospital full of covid) and can't fix everything anyway .

babyboomer1001 · Answer

The doctors do not decide based on your plan.  They could be denying treatment because of the particular injury - too delicate to treat - could cause a worse problem, or maybe it is something that cannot be done safely.  Ask your doctor why.  Btw, back surgery is successful only 50 percent of the time and the risks are far too great.  It is not something any doctor would recommend for a family member.

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Are doctors declining care due to my insurance plan?

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