And why are some site specific?
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Every doctor has a negotiated arrangement with each insurance company for how much the insurance will pay them for their services. Sometimes a doctor will decide that a particular insurance company will not pay them enough to be worthwhile and stop taking patients with that insurance company. Another doctor may have negotiated a better rate or simply decided that they will accept the amount offered.
Because insurance companies negotiate with every individual doctors offices on prices, and the procedures between different insurance companies are different
Some doctors offices might decide one insurance company is too much of a hassle to work with or is giving them a shitty deal, so it just isn’t worth it.
So to be able to become eligible to take an insurance, providers have to go through a lengthy process known as “credentialing”. If the insurance doesnt have you credentialed, then you cannot turn in claims for reimbursement for the provider. Even the facility as a whole has to go through this approval process. I have seen this process take up to 4 months or more for a provider.
For a while in Texas, certain Medicaid providers weren’t reimbursing doctors for services provided to Medicaid enrolled patients. As a result, a lot of hospitals and physicians were forced to stop accepting those specific providers. They would still accept Medicaid, but only from some of the providers.
Also, some insurance providers in this state are regional. I have Medicare. When I moved from East Texas to West Texas, I had to change my provider and policy because it wasn’t accepted in my new area (different networks). It’s one of the few exceptions to changing your provider outside of open enrollment.
True answer: some doctors who are well liked and have been around a while, can afford to take less insurance or at least only the better paying ones. The young docs take everything in order to fill their schedule.
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