Why Doesn’t My Doctor Take My Insurance?

If you’ve ever wondered why your doctor doesn’t accept your insurance, the answer likely lies in the increasingly difficult relationship between medical practices and insurance companies. While patients see their premiums rising year after year, doctors are facing the opposite trend—declining reimbursements, increased administrative burdens, and payment delays that make it nearly impossible to keep their practices afloat.

One of the biggest challenges doctor’s offices face is delayed payments. Insurance companies often take months to reimburse physicians for services provided, creating cash flow problems for practices that still have to pay staff, rent, and other overhead expenses. Even when payments do come through, they are often down-coded, meaning insurers pay for a lower level of service than was actually provided. This tactic allows insurance companies to save money at the expense of the doctor’s work.

Another growing issue is post-payment audits, where insurance companies recoup money from doctors years after services were rendered. In many cases, these audits claim that payments were made in error, forcing physicians to repay large sums without much recourse. The burden of proof falls on the doctor, who may not have the resources to fight back against large insurance corporations.

To put this into perspective, imagine you’re an hourly worker at a job where your employer:

• Takes months to pay you for the hours you worked.
• Decides after the fact that your work was worth less than agreed, so they pay you at a lower rate.
• Asks for money back years later, claiming they overpaid you, even if you have no way to dispute it.

No one would tolerate this treatment in any other profession, yet this is exactly what doctors experience under the insurance system.

What makes matters worse is that while reimbursements continue to shrink, inflation drives up the cost of running a medical practice. Rent, staff wages, medical supplies, and technology upgrades all increase in price, yet insurers keep slashing how much they pay doctors. Despite this, insurance premiums continue to rise for patients, leading to a stark imbalance where patients pay more, doctors receive less, and insurance companies pocket the difference.

Insurance companies also engage in shady practices when selling plans to customers. One common strategy is panel padding—listing doctors as “in-network” even when they no longer accept that insurance or were never a “in-network” to begin with. Patients sign up for a plan believing they have access to a robust network of providers, only to find out that many of those doctors have already dropped the insurance due to low reimbursements and administrative headaches. This deception leaves patients scrambling to find care, while insurance companies continue profiting.

As these issues worsen, more doctors are choosing to opt out of insurance altogether. Many are switching to direct-pay or concierge models, where patients pay out-of-pocket rather than dealing with unreliable insurers. If these trends continue, patients may find that fewer and fewer doctors accept insurance, making it even harder to access affordable care.

Ultimately, the insurance system is squeezing doctors to the point where many may choose to leave medicine or radically change how they practice. Without reform, the healthcare landscape will only become more challenging for both physicians and patients.