In Massachusetts, USA, can a physician refuse to see patients that are not referred by their primary care physician? (Even patients whose health insurance does not require a referral for the appointment to be covered?)
asked Sep 11, 2015 at 19:49
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Is the physician under a contract with the insurance company? If so, what does it say?– cpastSep 11, 2015 at 19:58
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@cpast the physician is regarded as in-network from the health insurance standpoint, so there is some contract between the physician and the health insurance. But I don't believe I have legal access it.– Franck DernoncourtSep 11, 2015 at 20:01
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What kind of physician, and in what situation? In a medical emergency the physician might have a duty to treat the patient, but otherwise I would suspect not - I believe doctors, like other service providers, generally have the right to decline to treat any patient they want, for any reason not otherwise forbidden.– Nate EldredgeSep 12, 2015 at 3:12
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1I found this article which says that "The historical rule is that a physician has no duty to accept a patient, regardless of the severity of the illness." It's not clear if this is current or whether it applies in all states.– Nate EldredgeSep 12, 2015 at 3:18
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@NateEldredge No emergency, just consulting a specialist for some pain. I agree a broader question is in what situations a physician can / cannot decline a client. Interesting link, thanks!– Franck DernoncourtSep 12, 2015 at 3:39
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1 Answer
Is there some reason you think they can't?
In general, anyone is free to do business, or refuse to do business, with anyone else.
There are a few restrictions on this. For example, certain businesses can't refuse to serve clients based on their membership in a protected class such as race or sex. I don't know how either federal or Massachusetts law treats medical practices with respect to anti-discrimination statutes, but it's fair to assume a "whites only" medical practice could find itself in hot water under certain circumstances.
Apart from the protected reasons, people are generally free to refuse to do business with anyone, for any reason. Someone couldn't come to your web design business and demand that you design their web page, and if you had a policy that you only accepted business on a referral basis, they couldn't sue you. And if you had a restaurant with a "customers must wear pants" policy, you could refuse to serve a pantsless patron. For the most part, a medical practice is no different.
It's possible a doctor might have signed a contract with a third-party payor (for example, your insurance company) saying that he or she has to accept that payor's policyholders without referrals. But absent any such consideration, a doctor is as free as anyone else to do business, or refuse to do business, with anyone he or she sees fit.
This only applies to nonemergency care, of course, which your question specified you were asking about. The question gets more complex in urgent/emergency situations, where there are specific laws about who is entitled to what treatment.
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To elaborate on your third paragraph: This hinges on a medical practice not being classified as a "public accommodation" (in which case my understanding is that state and federal anti-discrimination laws apply). If a custom bakery is a "public accommodation," is it clear that a medical practice is not?– feetwet ♦Sep 30, 2015 at 1:41
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"Is there some reason you think they can't?". yes e.g. if you read French, allodocteurs.fr/… "ces refus de soins sont illégaux. L'article L. 1110-3 du code de la santé publique qualifie le caractère illégal de tels refus : "aucune personne ne peut faire l'objet de discriminations dans l'accès à la prévention aux soins".". In short in some case physician cannot legally refuse a patient in France. Sep 30, 2015 at 3:43