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Ed H's avatar

Hi Marshall - I came across this post while looking to a solution I am currently facing.

I have been experiencing a severe vestibular issue for almost 6 months now, and have been to multiple doctors (11 and counting) with no relief, nor even a solid diagnosis.

A large local university health system has a specialized vestibular clinic, and my GP referred me there to see if we could find a solution. It took several weeks for them to accept the referral, and I spoke to them yesterday about an appointment. The scheduling person said I wound need to speak with finance first, and transferred me.

Finance told me since my insurance is out of network (and aligned with another local university health system), they would not schedule me. I told them I'd like to cash pay, would be happy to put a card on file, and sign any required payment responsibility paperwork. She refused all of this, and said that if I had out of network insurance there was no way I could be seen in their system, and since I had insurance cash pay was not an option.

My GP practice called on my behalf - explained the ongoing problems I'm facing, and the fact that my network does not have a specialty practice in the area I need. They asked what else was needed to get the referral through as an exception, and was told the same thing I was and that this was a new policy they created in 2021. My doctors office questioned the legality of this and mentioned HIPAA, and they were told it was just the new policy.

This sounds similar, but not exactly the same as this post. Do you have any thoughts or suggestions on this? Thank you for helping us navigate this broken system!

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Urb's avatar

Interesting - I always thought self-pay charges were higher, not lower, than negotiated insurance rates! But... you do note that when you self-pay, that doesn't get you closer to your insurance deductible (e.g., a HDHP, which I have). So if this is the only health care you need this year, great, you save money. But if someone goes into the hospital next month, you get whacked for the whole deductible. So if your health-care costs are very low in a given year, sure, this will save you some money. But I'm not about to call HR and cancel my insurance!

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