Obamacare: can specialists refuse to treat me?

Do uniquely qualified specialists have the right to refuse to treat a patient who has name brand private sector insurance, just because the policy was purchased on the health insurance exchange?

Special Case

Dear Special Case,

If the specialist accepts patients with insurance from that insurer, he or she would not be able to reject a particular patient covered by that insurer.   The specialist has a contract with the insurer which obligates him to take all patients who have that insurer’s plans.  

That is not to say that a specialist cannot refuse a patient.  Just that the reason for the rejection could not be based upon the insurance.  The specialist may be able to refuse the patient on other grounds, such as the patient does not follow treatment plans or misses too many appointments.  He or she would have to apply the same rules to all patients; that is, the policy about refusing or firing patients would apply to everyone who misses appointments, etc.  

If your specialist is refusing to take you and is on your plan’s network (or your plan pays for out-of-network doctors), then you should call your plan’s member services and ask for their help.

Recommend this article
Linda Riddell

About Linda Riddell

A published author and health policy analyst with 25 years’ experience, Linda Riddell's goal is to alleviate the widespread ailment of not knowing what your health plan can do for you.