A doctor who won't take any insurance or Medicare? Yank their license, plus imprisonment.

[Ms. Toad]

112. That is not entirely correct.

It may be the case with some insurance companies, but for most group policies it is the obligation of the doctor. The claims need to be submitted with coding and information which is not accessible to individuals. Every time I have had to become involved in clearing up insurance payments because they were submitted incorrectly by the provider I have been very clearly informed that it is something the doctor (or the doctor's billing service) must handle - the insurance companies have also refused to permit me to speak with the individuals who could tell me what should have been billed so I can relay the information to the provider so the provider could rebill it.

I have had individual insurance where the claims were my responsibility, but by and large that is not the case.

The other reason it is not the patient's responsibility is that most providers have contractual relationships with insurance companies through which they have agreed to accept as little as $.05 on the dollar as payment in full. If the claim is submitted directly by me, the doctor's office may not credit me with the discount (up to 95% on the bills I have been tracking recently), so even though the insurance company believes the doctor has been paid in full, and the doctor agreed to accept it as payment in full for any patient using that particular carrier, if the step in and file the claim directly the doctor does not necessarily know to apply the discount.