19 answers

Why Would a Doctor Deny Me Care?

I am 24 weeks pregnant and just recently got approved for Medicaid since I had to relocate in the middle of my pregnancy (couldn't get private healthcare). Well, it's been the biggest headache of all time! Once I got coverage, I am now trying to find a doctor that will accept me. I had to send my records/paperwork from my past Obgyn to the doctors I am looking at. Then they have to "approve" me for care. So far, I've been denied by one doctor. (this doctor accepts medicaid).

Does anyone have experience with this or understand the reasons why I would be denied? Is it because I am so far along in my pregnancy? I just hate that it's so hard for someone like me to find a doctor! It shouldn't be like this.-

The only "medical issue" I have is thyroid disease. But, other than that, nothing strange with my pregnancy.

Suggestions please!

What can I do next?

Featured Answers

Have you considered working with a midwife? I had a homebirth, and my midwife was very professional, personal, and great to work with. It was a great experience, and a LOT cheaper than OBGYN and hospitals.

1 mom found this helpful

You don't need a referal to get seen by an OB. I just had my baby a few weeks ago and never did I have to do that. With tyroid issues, theyw ould probably consider that as a high risk pregnancy and some doctors aren't willing to treat those because they are afraid (I had a doctor admit that once...) I don't think it's because you're 6 months ...I switched to the dr who delivered my baby at 6 months pregnant and had no issues....
Best bet is to call Medicaid and ask them for high risk OBs or call around (did they send you a booklet of doctors?)

More Answers

Many doctors will only take a certain number of Medicaid patients because they receive much less money for them. If they take X number of Medicaid patients, it still looks good to the government and insurance companies, but leaves enough time for patients with regular insurance who will bring in more money. The doctor who denied you has probably already hit their limit.

3 moms found this helpful

I do not know what goes on in your state, but I do know in ours not all doctors accept Medicaid. They are like the insurance companies, they do not accept all of those either. I suggest that you call Medicaid and inquire the names of those who will see you. I also know some doctors are around for years and just don't accept new patients. Get a list of who will take you pronto. It doesn't have to do with how far along you are. You just need to get someone that is available. Also, you did not mention any other issues, those are the only ones that I can think of why you would be denied.

2 moms found this helpful

It's probably because you have medicaid. not all doctors take medicaid. In many cases it can take YEARS to get payment from the govt, so most doctors will only accept a certain % of their patients as medicaid so that they can still pay their bills.
You should be able to get a list from the your medicaid office of ob/gyn's who are accepting new medicaid patients.

It may also be because you are so far along. I switched Dr's midway through my pregnancy and I had a lot of Drs say they wouldn't take me.

Good Luck!

2 moms found this helpful

You have to have a referal from your primary care physician first for medicaid to cover obgyn. Then just because the obgyn accepts medicaid does not mean they accept your type. In indiana there are 3 coverage providers and some doctors do not accept all of them...here it is anthem, medwise and something else. They also have to have an opening for newe patients. I would call your medicaid customer service number and they will be able to tell you who is available and sign you up for them. You also should do this with your primary care first if you dont have one yet.
Unfortunatly there are typically very few drs that accept medicaid anymore especially pediatricians so good luck it is a frustrating process.

2 moms found this helpful

The answer is simple, sorry to say.
Doctors are not obligated to take Medicaid patients. Fewer and fewer of them will because they get paid such a low percentage of the actual costs and expenses. This isn't just pregnant women, it's elderly and people on disability.
It won't make you feel better to know that you aren't alone, but what you need to concentrate on is finding a doctor who WILL accept medicaid. You likely won't be able to pick and choose. Many doctors don't accept new patients at all, even if you have good insurance.
Get out the phone book, start calling around and find the ones that take new patients and accept medicaid. If they say they won't take you, ask them if they know of other places and just keep trying.
I broke my leg, in California, and had to go on disability and medi-Cal, and you would be surprised how many doctors and physical therapists would not even take me. It took 8 weeks just to get an authorization for an MRI and then another 6 weeks for autho to get physical therapy that was over an hour away and I couldn't even drive with a broken right leg.
Call your county Department of Public Health and explain your situation. Ask them for a list of doctors who can take you and deal with your pregnancy. It will be a lot quicker, I would imagine. At least you'd have a list of docs who will take medicaid patients.

I wish you the best and I'm sure you'll find someone.
Take care!

2 moms found this helpful

Well, I'm sorry to say you've received a lot of bad information.

Each state administers Medicaid slightly differently. Elizabeth from Kokomo, IN is correct that we have 3 managed arms of Medicaid in addition to traditional Medicaid (that covers ~10% of lives). However, Indiana is one of the few states that administers with the managed arm in addition to traditional Medicaid services.

Your OB likely accepts Medicaid but isn't accepting new patients. The level of payment they receive for Medicaid is a small fraction for a patient with private insurance. Most offices simply can't take all the patients who need care despite being a provider because they can't afford to. Typically, a physician has 10-20% of their practice in Medicaid, ~70% in traditional insurance and ~10% cash paying patients.

It sounds like your OB/GYN is a Medicaid provider but isn't taking new patients from how you've described in your statement. You really should call your state's Medicaid program and ask the questions. You should be able to access a list of offices that accept Medicaid, and you'll likely have to call around until you find one accepting new patients.

You may also be able to find a family practitioner who still has OB privileges and covers new Medicaid patients.

I used to cover the Kokomo, IN area (which is why I'm so familiar with Indiana's Medicaid system) as a pharmaceutical rep. I had one office with over 90% Medicaid patients. Some had to travel over 2 hours to the office because they were the only one accepting new patients.

Good luck.

2 moms found this helpful

I am a military dependant and we must first go through a Primary Care Physician and get a referral to an OB/GYN. Do you have a general practicioner you are currently under care of? Or are you seeing a specialist regarding your Thyriud Disease? I would speak with one of them to obtain guidance as to how to find a doctor to treat your pregnancy.

Otherwise, I would contact Medicaid directly and get them to find you a doctor.

Best wishes!

1 mom found this helpful

Have you considered working with a midwife? I had a homebirth, and my midwife was very professional, personal, and great to work with. It was a great experience, and a LOT cheaper than OBGYN and hospitals.

1 mom found this helpful

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