Why Certain Doctors Are Excluded From Health Insurance Policies
Friday, October 15th, 2010 by adminHealth insurance quotes rarely include coverage for visits to any and all physicians. Insurance companies have a preferred physician list, involving only those physicians who have agreed to lower rates for all services. Excluded doctors are those with whom the insurance company has no agreement. Treatment from excluded doctors can require a patient to pay a higher co-payment, or even the entire cost of the visit or treatment.
Physicians are not excluded because of their background or education. If a physician has completed the national licensing requirements, he or she can be a provider of treatment on a policy. However, if a physician has significant malpractice claims or has lost his license, even if that loss occurred in the past and the license has subsequently been reinstated, he or she may be excluded from a health insurance company's policies. This situation is not universal, though, and so potential customers should inquire into the health insurance company's standards for physicians on their lists of providers.
Insurance companies have often excluded doctors from their health insurance policies because they provide specialized care. Visits and treatments by specialists, such as pain management and obstetrical doctors, are often paid for by a higher co-payment. While this co-payment goes towards the patient's yearly deductible, they are often not included in health insurance quotes because they are expected to be visited less frequently than family care physicians.
Doctors may also be excluded because they are employed by a hospital or other, large healthcare provider. These physicians would not be individually approved by insurance companies because their employer would have been approved. This means that the insurance company accepts treatment by any one of the physicians in the company's employment, but not if treatment by that physician is sought independently. Essentially, the coverage extends to the hospital or company and not the physician. Therefore, a physician that you visit at the hospital on Mondays and Thursdays may not be an insurance-approved provider on Tuesday or Wednesday.
Some insurance companies exclude doctors because they order costly medications or perform expensive tests more frequently than an insurance company would like. Because insurance companies are a business, they do not like to have to spend money on their customers. As such, if they believe that a doctor will perform treatments that are more expensive than they would like the company may decide to exclude that physician from their plans.
Health insurance quotes are extremely tricky and, unfortunately, do not always cover medical treatment from any and all physicians. For this reason, individuals should ask for a preferred provider list prior to signing a contract, particularly when the individual is currently under treatment by a particular physician.

